Most Cases are Now Sutureless, Making Healing Faster and More
Over the past several years, retina surgery has followed the
lead of cataract surgery. Advances in technology and better
instrumentation allowed shorter operating times which then
permitted surgery on an outpatient basis and without general
anesthesia. In general, more and more retinal specialists
operate in this fashion compared to 10 years ago.
A standard vitrectomy system requires the sclerotomies, or
holes in the wall of the eye, to be large enough to allow 20
gauge (width) instruments to pass in and out of the eye. These
holes must then be sutured closed in addition to the overlying
conjunctiva at the close of surgery.
The concept of a 25 gauge vitrectomy system was introduced
several years ago (the higher the number, the smaller the
diameter). This sutureless system employs thinner instruments
than the older system. As a consequence the holes are small
enough that suture closure is not necessary as the sclerotomies
self-seal. The result, decreased surgical time, improved
patient comfort and faster healing times as there is much less
tissue dissection with the thinner, self-sealling system.
At present, not all vitreous surgery can employ the 25 gauge
system due lack of instrumentation. As the arsenal of thinner
instruments increases, more and more vitreous surgery can
utilize the 25 gauge system. The thinner and smaller
instruments pose some technological challenges that limit the
variety of instruments that are available. That is, there are
still more instruments available in the larger 20 gauge system.
At present, most cases of vitreous hemorrhage, macular pucker,
macular holes and others may take advantage of this patient
friendly system. I have also found this system useful for most
cases of retinal detachment, including giant retinal tears.
More recently, the two major ophthalmic surgical manufacturers
have developed a 23 gauge vitrectomy system. The hope is to
achieve all the advantages of both the 20 gauge and 25 gauge
systems. Basically, there is more instrumentation than the 25
gauge systems and the system remains sutureless.
Written by Randall V. Wong,
M.D., retinal specialist, ophthalmologist, Fairfax, Virginia.
All rights reserved.
- Summer 2007