20G Sutureless Vitrectomy

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As an early and enthusiastic proponent of 25-gauge (25G) vitrectomy, it is amazing to me that a short 3 years later I am writing a chapter on 20G sutureless vitrectomy for this textbook! But as I found out on my move to a new hospital and city a few years ago, one of the issues that has become too frequent a problem for many of us surgeons is that our hospitals are no longer willing to buy each and every new technology that is released for our operating rooms. Having done about 90% of all my cases using 25G technologies before moving, I was faced with having to revert to 20G vitrectomy because of the lack of 25G instrumentation at the new hospital. The transition back to 20- technology was made more palatable by the obvious advantages in instrument stiffness and access to the retinal periphery with 20G instruments and my adaptation of a sutureless 20G technique. The notion of 20G sutureless vitrectomy is not a new one, with multiple previous authors having reported on this over the last decade. In fact, as a resident, I was exposed to one of the early surgeons who attempted a 20G sutureless technique, Dr John Chen, who used a crescent blade to create a scleral tunnel after doing a conjunctival peritomy. During my transition back to 20G vitrectomy, I also witnessed another variation on a 20G sutureless technique by Dr Mikael Sebag who presented a variation of a technique described by Dr Theelen, which involved the creation of an "X incision" to aid in sclerotomy closure. Based on these experiences, I converted to a 20G sutureless technique, which I have now had the chance to perfect and enhance over 300+ cases.

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