Effect of vicryl 7 - 0 suturing versus diathermy closure on the ocular surface after small-gauge vitrectomy: a prospective randomized study

To compare the impact of routine 7 - 0 Vicryl suturing versus external bipolar diathermy for 23-gauge sclerotomy closure on postoperative ocular-surface integrity and patient discomfort.

This prospective, multicenter randomized study included adults undergoing primary 23-gauge transconjunctival pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment repair or macular surgery, without combined phacoemulsification. Patients were randomized to sclerotomy closure with a single 7 - 0 polyglactin (Vicryl) suture at each port or to external bipolar diathermy sealing. Ocular-surface assessment was performed with Keratograph^® 5 M and included non-invasive tear break-up time (NIBUT), corneal fluorescein staining (Oxford scale), and bulbar redness (automated quantification). Outcomes were measured preoperatively and at 1 week, 1 month, and 3 months. Secondary outcomes included ocular discomfort (10-point VAS) and intraocular pressure (IOP).

Fifty-four patients were analyzed (Vicryl n = 26; diathermy n = 28). Both groups showed an early postoperative reduction in NIBUT and increased redness, but diathermy demonstrated faster recovery. At 3 months, NIBUT was higher with diathermy (7.5 ± 1.4 s) than Vicryl (5.0 ± 1.3 s; p < 0.001), with lower bulbar redness (1.0 ± 0.3 vs. 1.9 ± 0.4; p < 0.001) and lower VAS discomfort (3.0 ± 1.0 vs. 5.0 ± 1.1; p < 0.001). No persistent postoperative hypotony occurred.

In primary 23-gauge PPV with routine port closure, external bipolar diathermy was associated with superior ocular-surface recovery and lower discomfort compared with 7 - 0 Vicryl suturing through 3 months, with reassuring short-term IOP outcomes.