Primary 23-Gauge Transconjunctival Sutureless Vitrectomy for Rhegmatogenous Retinal Detachment

In Brief Purpose: To describe the results of primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment (RRD). Methods: In a prospective case series, 24 eyes of 24 consecutive patients with RRD underwent primary 23-gauge transconjunctival pars plana vitrectomy with intraocular gas tamponade. Postoperative follow-up ranged from 6 months to 16 months. Results: Fifteen eyes (62.5%) had multiple breaks. Seven eyes (29.2%) had inferior breaks. Other complications included giant tear in one eye, peripheral choroidal detachment in one eye, and concomitant macular holes in two eyes. The primary anatomical success rate was 91.7%. The mean postoperative visual acuity at postoperative month 3 improved from 20/41 to 20/25 (P = 0.111) and from 20/735 to 20/56 (P < 0.0001) in macula-on and macula-off cases, respectively. One patient (4.2%) had hypotony on postoperative day 1. No patients developed choroidal detachments. No sutures were used in any of the sclerotomy sites. Of the patients, 87.5% reported no or mild foreign body sensation, whereas 79.1% reported no or mild pain on the first postoperative day. Conclusions: Twenty-three–gauge transconjunctival sutureless vitrectomy appears to be a feasible option in treating RRD in selected cases, with the potential benefit of reducing postoperative ocular irritation. In a prospective consecutive case series, the results of 23-gauge transconjunctival sutureless vitrectomy compared favorably with conventional 20-gauge vitrectomy in treating rhegmatogenous retinal detachment in selected cases, with the potential benefit of reducing postoperative ocular irritation.