Changes in Day 1 Post-Operative Intraocular Pressure Following Sutureless 23-Gauge and Conventional 20-Gauge Pars Plana Vitrectomy

Emily Gosse*, 1, Richard Newsom2, Peter Hall3 , Jonathan Lochhead4
1 Department of Ophthalmology, St Mary’s Hospital, Newport, Isle of Wight, UK
2 Department of Ophthalmology, Southampton General Hospital, Southampton, UK
3 University of Leeds, Leeds, UK
4 Department of Ophthalmology, St Mary’s Hospital, Newport, Isle of Wight, UK

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© Gosse et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Ophthalmology, St Mary’s Hospital, Newport, Isle of Wight, PO30 5TG, UK; Tel: 01983 534504; Fax: 01983 534415; E-mail:



The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy.


Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests.


Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50).


Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.

Keywords: : Transconjunctival sutureless vitrectomy, 23-gauge vitrectomy, post-operative hypotony, post-operative IOP.