Comparing scleral wound suturing and non-suturing in 23-gauge vitrectomy combined with cataract phacoemulsification for the management of proliferative diabetic retinopathy.

Purpose: To compare the outcomes of scleral wound suturing and non-suturing in 23-gauge vitrectomy combined with cataract phacoemulsification on eyes with severe proliferative diabetic retinopathy.

Methods: This retrospective cohort study enrolled patients with proliferative diabetic retinopathy who underwent a 23-step vitrectomy combined with cataract phacoemulsification. Scleral wounds were either sutured or left unsutured in sutured group and unsutured group, respectively. All patients were monitored for 6 months, undergoing slit-lamp examination, intraocular pressure measurement, fundus examination, and vision assessment.

Results: A total of 79 eyes were enrolled in sutured group and 85 eyes in unsutured group. Both groups were well-matched for factors such as age, sex, intraocular pressure (IOP), hypertension, diabetes duration, HbA1c levels, visual acuity, retinal detachment, neovascular glaucoma, and preoperative pan-retinal photocoagulation. Despite scleral incision sutures in sutured group, there was no significant difference in surgical time between the groups. Silicone oil and gas tamponade were similarly used, and no significant differences in postoperative complications were found, except that scleral suturing potentially exacerbated conjunctival or scleral scarring. Sutured group had a lower incidence of hypotony, though IOP was not significantly different between groups after one week. For silicone oil tamponade, IOP was comparable between groups, while for gas tamponade, early postoperative IOP was significantly lower in unsutured group. The incidence of postoperative hypotension was higher in unsutured group with gas tamponade. Visual acuity recovery showed no disparity between the groups.

Conclusion: For patients with proliferative diabetic retinopathy undergoing vitrectomy combined with cataract surgery, scleral incision suturing appeared to be more effective in maintaining intraocular pressure in the early stage, especially for those who had gas as the vitreous tamponade. However, this might worsened conjunctival or scleral scarring. There were no significant differences observed in postoperative complications and visual acuity recovery between patients with and without scleral wound suturing.