Most Cases are Now Sutureless, Making Healing Faster and More Comfortable
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.