The Effect of Port Geometry on Vitrectomy: A Performance Analysis of Custom Probes Through Water and Tissue Removal Rates, Surgical Evaluation, and High-Speed Video

Purpose: A recent change in pars plan vitrectomy (PPV) has been the advent of smaller gauge “sutureless” instrumentation. Sutureless systems are designed to create selfsealing and leak free sclerotomies. This study’s purpose was to evaluate sutureless 23 gauge (23G) wound integrity via ultrasonographic, photographic, and tonographic techniques using a retrospective case series analysis. Method: Subjects had 23G PPV by one of four surgeons at our institution. Perioperative assessment of wound leaks was judged by the surgeon, and sutures placed where indicated. UBM ultrasonography, slit lamp photography, and tonography was performed at post operative day (POD) one. Results: Well over half of 23G sclerotomies required sutured closure. In non-sutured sclerotomies, POD one slit lamp photographs demonstrate a dark area under the conjunctiva (Figure 1), giving the appearance of an open wound. UBM of the same site shows posterior wound closure (Figure 2). Neither post-operative hypotony nor other peri or post-operative complications were noted. The low complication rate is comparable to our experience with 25G PPV cases over the same time frame. However, no 25G cases required sutured closure. Conclusion: The 23G system combines the benefits of speed and efficiency of a 20G cutter with the sutureless technique of the 25G system. If the 23G wound is selfsealing at the end of surgery, it may still appear open externally on visual inspection. However, UBM data shows wound closure posteriorly. Still, at our institution, the rate of sutured sclerotomies is higher in the 23 vs. the 25G system.