Completely sutureless combined phaco and pars plana vitrectomy

I'm a great fan of sutureless surgery, and have been using sutureless 25g technology for the majority of my vitrectomy procedures since 2003. Of course the later introduction of 23g & then 20g sutureless systems brought in other possibilities...but let's leave that story for another day.....

When doing combined phaco and vitrectomy surgery, even with a 2.85 mm phaco clear corneal incision, I have routinely put a stitch into the corneal incision before going to the post segment procedure, as otherwise, I would sometimes loose the AC during peripheral indentattion whilst completing the peripheral vitrectomy and internal search.

The introduction of sub 2mm phaco technology has solved this problem. Theoretically, the most secure corneal wound is square, and a 1.6-1.8mm wide corneal incision which is of a similar length gets to this theoretical ideal.

So now, the procedure is:
1. Place an inferotemporal 25G cannula in the pars plana and plug it.
2. Do a bimanual microincision phaco using 2x 1.6 mm incisions
3. Implant a microincision lens using wound assisted technique through a sub 2 mm incision
4. Place the infusion line into the preplaced 25g cannula
5. Place two superior 25g ports
6. Complete pars plana vitrectomy (and associated procedures)
7. Remove 25g cannulas
Voila...done

Here is a video of a combined phaco, vity for mac hole case:

Steps 1 to 5 are as above, then you can see the posterior hyaloid being detached and complete vitrectomy with vitreous base shave using indentation being done. After ILM peel a FAX (Fluid air exchange) is done which finishes with direct drainage from the hole - allowing the hole to close on the table- air is left in as tamponade.

Then 25g ports are removed - and in spite of agressive indentation and peripheral vitrectomy during the posterior segment procedure, the AC remains sealed, deep and well formed.