Combined 20- and 23-gauge pars plana vitrectomy.

Dear Editor: The 23-gauge (G) transconjunctival sutureless vitrectomy (TSV) technique has advantages of decreased surgical trauma, decreased astigmatism, faster wound healing, and improved postoperative comfort compared with other vitrectomy techniques. Although the efficacy of 23-G is comparable with conventional 20-G vitrectomy, some surgeons still use 20-G vitrectomy in complicated cases, such as complex retinal detachments (RD). Herein, we describe a modified technique combining 20and 23-G sclerotomies and the use of 20-G instruments that provides the advantages of both techniques in a single procedure. Combined surgery was performed in 67 eyes of 65 patients by a single surgeon. During the follow-up period, anatomical and functional outcomes and operative complications were evaluated. Postoperative vitreous hemorrhage (VH) was classified into two groups; early postoperative VH (occurring within 1 month postoperatively) and late postoperative VH (occurring >1 month postoperatively). Transient postoperative hypotony was defined as intraocular pressure (IOP) <6 mmHg lasting <1 week. The degree of intraocular inflammation was clinically defined by the presence of transient fibrin formation in the anterior chamber or vitreous cavity. One inferotemporal 23-G transconjunctival sutureless sclerotomy port for infusion and two superior 20-G sclerotomy ports for instrumentation, including a vitrectomy probe, were created along with two 25-G Torpedo minilight illuminations bimanual vitrectomy. A 23-G single-step TSV trocar-cannula (EyeTech) was transconjunctivally inserted at a 30° angle inferotemporally to the infusion line in all cases. The two superior 20-G sclerotomy ports were created with a 20-G one-step preloaded trocar cannula at a 30° angle tangential to sclera (Synergetic. Inc, Figure 1). The internal valves of the cannula minimize leakage and aid in the maintenance of IOP during the surgical procedure. After completing the vitrectomy, a cotton-tipped applicator was applied to the trocar entry site to prevent leakage from the sclerotomy during the removal of the trocars. The trocar entry site was inspected for wound leakage and then closed with a single 8-0 Vicryl suture. The mean age of study participants was 63.4 ± 14.2 years and 35 (54.6%) were male. The median follow-up period was 3 months (range, 1-6 months). Best corrected visual acuity increased in 39 eyes (58.2%), remained unchanged in 25 eyes (37.3%), and decreased in three eyes (4.4%) because of cataract progression in two eyes and intraoperative choroidal detachment in one eye. Surgical parameters are presented in table 1. Figure 1. One inferotemporal 23-G TSV cannula for infusions and two superior 20-G one-step TSV cannulae with internal valves to minimize leakage.