Comparative Analysis of Sutured and Sutureless 25G Pars Plana Vitrectomy: Impact on Surgically Induced Astigmatism and Hypotony

INTRODUCTION: Vitreoretinal surgery has advanced with transconjunctival sutureless vitrectomy (TSV), using smaller incisions. However, TSV often causes hypotony due to sclerotomy leakage, leading to severe postoperative issues. This study compares outcomes between sutureless and sutured 25G pars plana vitrectomy (PPV) and highlights sutures' significance in TSV.
METHODS: Fifty-four eyes underwent 25G PPV, divided into sutureless and sutured groups based on sclerotomy closure methods. Preoperative and postoperative evaluations at 1 week, 1 month, and 3 months included corrected distance visual acuity (CDVA), intraocular pressure (IOP), auto refractometer readings, and corneal topography. Special attention was given to postoperative hypotony and surgically induced astigmatism (SIA) was assessed
RESULTS: The sutureless (mean age: 67.4±9.1 years, n=31) and sutured (mean age: 59.2±12.7 years, n=23) groups were analyzed. The sutureless group showed stable SIA at 1 and 3 months (1.39±1.1 vs. 1.30±0.9, p=0.695). The sutured group had higher SIA at 1 month (3.16±3.2 vs. 1.39±1.1, p=0.009), decreasing by 3 months (3.16±3.2 vs. 1.95±1.4, p=0.021). No significant intergroup differences were observed at the third month postoperatively. CDVA improved significantly in both groups (p<0.001), highlighting surgical efficacy. IOP was comparable, but transient hypotony occurred in the sutureless group. IOP consistency favored the sutured group.
DISCUSSION AND CONCLUSION: The study findings underscore the impact of suturing the sclerotomy ports on elevating SIA. However, it's crucial to note that SIA usually decreases by the third postoperative month, whereas hypotony-related complications can have enduring effects. Surgeons must carefully assess hypotony risks, particularly in children or high myopia cases, deciding on sutures' necessity in microincisional PPV.