Modified Incision in 25-gauge Vitrectomy in the Creation of a Tunneled Airtight Sclerotomy: an Ultrabiomicroscopic Study

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2007 Feb 24

PMID 17318571

Citations 16

Authors

Stanislao Rizzo

Federica Genovesi-Ebert

Andrea Vento

Sofia Miniaci

Federica Cresti

Michele Palla

Affiliations

Soon will be listed here.

Abstract

Background: The standard straight incision for 25-gauge vitrectomy may not close well at the end of surgery with post-operative hypotony. To overcome incompetent wound closure, oblique insertion of the trocars has been suggested. More recently we have developed an oblique incision. which is parallel to the scleral fibres instead of perpendicular and therefore avoids cutting. The aim of this study was to compare the effectiveness of the different incisions and to investigate their behaviour with the UBM.

Methods: 45 patients affected by macular holes were operated; in 15 eyes using oblique-parallel insertion (OPAI), in 15 oblique-perpendicular (OPEI) and in 15 straight incision (SI). Patients underwent UBM examinations 1 day, 1 week, 1 month p.o.

Results: OPAI was airtight after the removal of 25 g cannulas. UBM examination 1 day post-operatively (p.o) showed the 45 sclerotomies were well healed with perfect apposition of the internal wound lips. 39 sclerotomies were undetectable, 6 slightly evident. With OPEI the incisions were airtight at the end of surgery. At the 1 day p.o. UBM examination the 45 sclerotomies were well-healed but a minimal gape was clearly visible in all of them, 3 eyes showed peripheral cilio-choroidal (CCD) detachment, which was resolved after 7 days although the gape was still evident. At 1 month p.o. examination the gape was not detectable in 20 sites, evident in 25. With SI at the end of the surgery conjunctival bleb formation was detected in 10 cases, air-gas refilling was performed in 7 eyes and 3 sclerotomies were sutured. At 1 day p.o. hypotony was recorded in 5 patients, recovering at the 7 day follow-up. At the 1 day p.o. UBM examination showed a significant gape in all sites, weak vitreous entrapment was shown in 36, subconjunctival fluid in 4, CCD in 7. At the 7 day UBM the CCD had disappeared in 4 and was reduced in 3. At the 1 month p.o. the sclerotomy defect was still detectable but other complications were no longer evident.

Conclusions: OPAI achieved the quickest and most complete sealing since the 1st day p.o without complications, therefore it could be safer when performing 25-g vitrectomy with extensive manipulation.

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References

Pavlin C, Harasiewicz K, Foster F . Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes. Am J Ophthalmol. 1992; 113(4):381-9. DOI: 10.1016/s0002-9394(14)76159-8. View

Chen J . Sutureless pars plana vitrectomy through self-sealing sclerotomies. Arch Ophthalmol. 1996; 114(10):1273-5. DOI: 10.1001/archopht.1996.01100140473024. View

Bhende M, Agraharam S, Gopal L, Sumasri K, Sukumar B, George J . Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy for diabetic vitreous hemorrhage. Ophthalmology. 2000; 107(9):1729-36. DOI: 10.1016/s0161-6420(00)00213-x. View

Okuda T, Nishimura A, Kobayashi A, Sugiyama K . Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases. Graefes Arch Clin Exp Ophthalmol. 2006; 245(1):155-7. DOI: 10.1007/s00417-006-0354-y. View

Meyer C, Rodrigues E, Schmidt J, Horle S, Kroll P . Sutureless vitrectomy surgery. Ophthalmology. 2003; 110(12):2427-8. DOI: 10.1016/j.ophtha.2003.09.004. View

Eckardt C . Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25(2):208-11. DOI: 10.1097/00006982-200502000-00015. View

Taylor S, Aylward G . Endophthalmitis following 25-gauge vitrectomy. Eye (Lond). 2004; 19(11):1228-9. DOI: 10.1038/sj.eye.6701737. View

Ibarra M, Hermel M, Prenner J, Hassan T . Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol. 2005; 139(5):831-6. DOI: 10.1016/j.ajo.2004.12.002. View

Liu D, Chan C, Fan D, Lam S, Lam D, Chan W . Choroidal folds after 25 gauge transconjunctival sutureless vitrectomy. Eye (Lond). 2004; 19(7):825-7. DOI: 10.1038/sj.eye.6701662. View

10.

Lakhanpal R, Humayun M, de Juan Jr E, Lim J, Chong L, Chang T . Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease. Ophthalmology. 2005; 112(5):817-24. DOI: 10.1016/j.ophtha.2004.11.053. View

11.

Theelen T, Verbeek A, Tilanus M, van den Biesen P . A novel technique for self-sealing, wedge-shaped pars plana sclerotomies and its features in ultrasound biomicroscopy and clinical outcome. Am J Ophthalmol. 2003; 136(6):1085-92. DOI: 10.1016/s0002-9394(03)00662-7. View

12.

Byeon S, Chu Y, Lee S, Koh H, Kim S, Kwon O . Problems associated with the 25-gauge transconjunctival sutureless vitrectomy system during and after surgery. Ophthalmologica. 2006; 220(4):259-65. DOI: 10.1159/000093081. View

13.

Fujii G, de Juan Jr E, Humayun M, Chang T, Pieramici D, Barnes A . Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002; 109(10):1814-20. DOI: 10.1016/s0161-6420(02)01119-3. View

14.

Lam D, Yuen C, Tam B, Cheung B, Chan W . Sutureless vitrectomy surgery. Ophthalmology. 2003; 110(12):2428-9. DOI: 10.1016/j.ophtha.2003.09.006. View

15.

Fujii G, de Juan Jr E, Humayun M, Pieramici D, Chang T, Awh C . A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109(10):1807-12; discussion 1813. DOI: 10.1016/s0161-6420(02)01179-x. View

16.

Yanyali A, Celik E, Horozoglu F, Oner S, Nohutcu A . 25-Gauge transconjunctival sutureless pars plana vitrectomy. Eur J Ophthalmol. 2006; 16(1):141-7. DOI: 10.1177/112067210601600123. View

17.

GASS J . Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol. 1995; 119(6):752-9. DOI: 10.1016/s0002-9394(14)72781-3. View

18.

Rizzo S, Genovesi-Ebert F, Murri S, Belting C, Vento A, Cresti F . 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol. 2006; 244(4):472-9. DOI: 10.1007/s00417-005-0173-6. View

19.

Kwok A, Tham C, Lam D, Li M, Chen J . Modified sutureless sclerotomies in pars plana vitrectomy. Am J Ophthalmol. 1999; 127(6):731-3. DOI: 10.1016/s0002-9394(98)00427-9. View

20.

Keshavamurthy R, Venkatesh P, Garg S . Ultrasound biomicroscopy findings of 25 G Transconjuctival Sutureless (TSV) and conventional (20G) pars plana sclerotomy in the same patient. BMC Ophthalmol. 2006; 6:7. PMC: 1403799. DOI: 10.1186/1471-2415-6-7. View