Modified 20-Gauge Sutureless Single-Step Sclerotomies for Pars Plana Vitrectomy

Modified 20-Gauge Sutureless Single-Step Sclerotomies for Pars Plana Vitrectomy Sutureless sclerotomies provide numerous potential advantages over sutured incisions for pars plana vitrectomy, including decreased postoperative inflammation, faster wound healing, improved patient comfort, reduced postoperative astigmatic changes, and shorter surgical time.1–5 In 1996, Chen3 presented an original self-sealing scleral pocket technique for 20gauge instruments. Several modifications of this technique have ensued,2,4,6–9 with some authors reporting low-complication rates.6,7 In 2004, Yeshurun et al7 described a 19-gauge oblique circumferential singlestep sclerotomy technique for the superior sclerotomies, which seemed promising but the inferior sclerotomy still needed a traditional sutured stab. More recently, a 25-gauge transconjunctival sutureless vitrectomy system was introduced by Fujii in 2002.5 This system seemed more attractive initially, but problems related to the flexibility and fragility of the new set of instruments, the low infusion and aspiration rates, and the increased risk of endophthalmitis have limited its use.1,10,11 The purpose of this study is to report on the results, efficacy, and safety of a modified self-sealing sclerotomy (SSS) technique using a 20-gauge microvitreoretinal (MVR) blade introduced in a stepped fashion to create a self-sealing pars plana scleral wound.