Gauge Sutureless Vitrectomy

Objective: To review available peer-reviewed publications to evaluate the efficacy of 20 gauge sutureless pars plana vitrectomy. Methods: Literature searches of the PubMed and the Cochrane Library databases were conducted with no date restrictions; the searches were limited to articles published in English only. All publications with level II and III evidence were studied extensively. A comparison of this technique was also performed with available results from other small gauge sutureless vitrectomy techniques. Results: The overall safety profile of 20 gauge sutureless pars plana vitrectomy is similar to that established for conventional 20 gauge pars plana vitrectomy and provides comparable visual acuity results. Compared with conventional vitrectomy, this technique is associated with significantly lower levels of patient discomfort and ocular inflammation, and the time required for improvement in visual acuity is shorter. Recent modifications in techniques of making biplanar sclerotomies along with application of fibrin tissue adhesives to the sclerotomy and conjunctival openings make this procedure comparable to smaller guage transconjunctival sutureless vitrectomies, but with the advantage of retaining advanced fluidics. Conclusions: In this review, the authors enlist various surgical techniques and their modifications in 20 gauge sutureless pars plana vitrectomy and summarize the emerging results from early studies conducted in this novel approach. Current evidence warrants conducting prospective, randomized and controlled clinical trials to compare this technique with conventional 20G vitrectomy as well as the newer smaller gauge vitrectomy techniques. As surgical techniques evolve and clinical experience grows, continued close surveillance is necessary for an accurate assessment of complications.