Just recently, I performed a vitrectomy, or FOV, to remove floaters in the right eye of a 40 year old male. He has had longstanding floaters in both eyes, but had healthy eyes.
This case is different for two reasons; there is a huge “floater” and I am closing the sclerotomies and conjunctiva with 7-0 Vicryl sutures (stitches).
Sutures Require Extra Step
The sclera is the actual “white” of the eye. It is covered by a very thin and very translucent tissue called the conjunctiva.
In most cases of 25 gauge vitrectomy, I simply insert the trocars straight into the eye without the need for cutting away the conjunctiva.
This extra step is necessary when I choose to close the sclerotomies (the entry holes in the sclera) with sutures.
Once the conjunctiva has been opened, the vitrectomy system is installed in the usual fashion.
In other words, I have to get the conjunctiva out of the way to allow me to use stitches on the sclera.
PVD and Large Floater
This patient had already had a PVD in the right eye. There was no need to induce a PVD. Regardless, having a posterior vitreous detachment allows me to more efficiently remove more vitreous than without a PVD.
Having a PVD allows the vitreous to move toward my operating instrument versus my having to move my instrument toward the vitreous.
The floater is very large and actually never cleared his central vision. It was very easy to demonstrate on video. Most cases are more challenging to visualize the floaters.
Closing the Conjunctiva
After the vitrectomy is completed, I close the sclerotomies with sutures. The last step is to cover the sclerotomies with the conjunctiva, requiring two additional sutures.
In the video, you can see how one conjunctival flap is large enough to cover two sclerotomies, hence, only two conjunctival sutures are placed.