Guoling Sun

Comparison of disposable sutureless silicone ring and traditional metal ring in 23-gauge vitrectomy combined with cataract surgery

Background: The purpose of this prospective, interventional, comparative case series was to evaluate the efficiency and feasibility of a disposable sutureless silicone lens ring for corneal contact lens stabilization during combined 23-gauge vitrectomy and cataract surgery. Methods: We developed a ring consisting of a single silicone component with three footplates along the ring margin to fit cannulae for holding conventional contact lenses. Thirty eyes from 30 patients with cataract and vitreoretinal disease were included, and divided into two matched groups according to disease type and ring used. In Group A, we used a 23-gauge transconjunctival vitrectomy system and a disposable sutureless silicone lens ring (n = 15). In Group B, we used a 23-gauge transconjunctival vitrectomy system and a conventional metal lens ring (n = 15). The main outcome measures were: time required for vitrectomy preparation, rate of intraoperative corneal limbus bleeding, and limbus scar rate at the final follow-up visit. Results: Thirty cases were successfully completed. The average vitrectomy preparation time was less in Group A than in Group B (P < 0.01), and the average preparation time saved was 3.94 minutes. None of the Group A patients had intraoperative bleeding or postoperative scarring, whereas all 15 Group B cases had bleeding and five had scarring. There was a statistically significant difference between Group A and Group B for these complications (P ≤ 0.05). Conclusion: This report demonstrates the advantages of using a sutureless silicone ring during combined 23-gauge vitrectomy and cataract surgery. Using this method could allow extra time for the surgeon to pay more attention to complex vitreoretinal procedures.

Disposable sutureless silicone contact lens ring for use with a self-sealing cannula system during vitrectomy.

The use of corneal contact lenses during vitrectomy has become indispensable because they offer an excellent view of the fundus. In traditionally used systems, the lenses were supported by a sutured ring with either two or four sutures.1 However, the placement of these sutures is time-consuming, has the potential to cause bleeding, and increases the possibility of globe perforation. The concept of a suture-free lens ring was first introduced by Ikuno et al.2 They also designed a system, which comprises a stainless steel ring that has 2 upright tabs (180° apart) with a hook on the top and 2 elastic silicone bands (8 mm in diameter) to fix the ring to the eyelid speculum. Although this system was an improvement in comparison to suturing, the silicone bands hindered the rotation of the globe and scleral depression. Chalam et al3–7 designed a series of suture-free lens systems, including three aspheric plastic lenses, a standard wide-angle contact lens, and four footplates. However, these systems were easily displaced from the visual axis when the eyeball was tilted or when they came into contact with the lid margin or lid speculum. On the basis of the self-sealing cannula system, Chong et al8 developed a system consisting of a single plastic ring with multiple concavities at the ring margin to fit 25-gauge cannulas. This ring provided considerable stability to the contact lens system without obstructing the surgeon’s visual field even while using a top-heavy panoramic contact lens or when scleral depression was used for vitreous-based dissection. However, we have noted that the use of 23-gauge cannulas is more popular at present. Therefore, we designed a flexible, disposable suture-free silicone ring to be used in conjunction with the advanced 25-, 23-, and recent 20-gauge self-sealing cannula systems9 and combined surgeries such as vitrectomy and phacoemulsification.