VITREOUS INCARCERATION IN SCLEROTOMIES AFTER VALVED 23-, 25-, OR 27-GAUGE AND NONVALVED 23- OR 25-GAUGE MACULAR SURGERY

Overview

Journal Retina

Date 2017 Jan 14

PMID 28085776

Citations 5

Authors

Gian Marco Tosi

Alex Malandrini

Gabriele Cevenini

Giovanni Neri

Davide Marigliani

Arianna Cerruto

Gianni Virgili

Affiliations

Soon will be listed here.

Abstract

Purpose: To study the patterns of vitreous incarceration at sclerotomy sites by ultrasound biomicroscopy in patients subjected to valved or nonvalved small-gauge pars plana vitrectomy.

Methods: A prospective comparative study of 88 eyes affected by epiretinal membrane and macular hole. Patients were divided into four groups: valved or nonvalved 23-gauge (16 eyes each) and valved or nonvalved 25-gauge (20 eyes each); their vitreal disposition was compared by ultrasound biomicroscopy. Vitreal disposition was also assessed in 16 eyes of 16 patients subjected to valved 27-gauge pars plana vitrectomy.

Results: Three vitreal patterns were identified: P0 (vitreous not visible or vitreous strand distant from the sclerotomy site), P1 (vitreous strand parallel to and in contact with the sclerotomy site), and P2 (vitreous strand entrapped in the sclerotomy site). The effect of valved trocar use on vitreous incarceration seemed to be somewhat beneficial, but no statistically significant effect could be shown (odds ratio: 0.85, 95% confidence interval: 0.42-1.74, P = 0.657). Similarly, no differences in vitreous incarceration were shown among vitrectomy gauges (23, 25, or 27) both in a model including valved trocars only (P = 0.858) and in a model with all available data (P = 0.935).

Conclusion: In 23- and 25-gauge macular surgeries, postoperative vitreous incarceration does not seem to be reduced using valved cannulas and was similar to that observed in 27-gauge surgery.

Citing Articles

Comparison of Chandelier-Assisted versus Standard Scleral Buckling for the Treatment of Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis.

Kao Y, Chen C, Huang Y, Chen S Ophthalmologica. 2024; 247(5-6):345-354.

PMID: 39159609 PMC: 11614423. DOI: 10.1159/000540820.

Small-Gauge Vitrectomy for Macular Surgery Using a Systematic Approach to Wound Closure: 27-Gauge vs 25-Gauge.

Christensen C, Thompson I, Nielsen J J Vitreoretin Dis. 2024; 8(1):45-50.

PMID: 38223781 PMC: 10786086. DOI: 10.1177/24741264231209587.

Preoperative estimation of retinal hole location using ultra-wide-field imaging.

Li D, Zhou N, Gao R, Duan J, Shang Q Ann Med. 2023; 55(2):2258790.

PMID: 37725940 PMC: 10512843. DOI: 10.1080/07853890.2023.2258790.

Prophylactic Laser Treatment Posterior to Pars Plana Vitrectomy Sclerotomy Wounds During Macular Surgery.

Ajlan R, Pfannenstiel M, Luvisi J Kans J Med. 2022; 15:198-201.

PMID: 35762004 PMC: 9224892. DOI: 10.17161/kjm.vol15.16376.

Hybrid 23/27 Gauge Vitrectomy - Combining the Charm of 27G with the Efficacy of 23G.

Garweg J, Ouassi D, Pfister I Clin Ophthalmol. 2020; 14:299-305.

PMID: 32099314 PMC: 6999778. DOI: 10.2147/OPTH.S233884.

References

Nagpal M, Wartikar S, Nagpal K . Comparison of clinical outcomes and wound dynamics of sclerotomy ports of 20, 25, and 23 gauge vitrectomy. Retina. 2009; 29(2):225-31. DOI: 10.1097/IAE.0b013e3181934908. View

Avitabile T, Castiglione F, Bonfiglio V, Castiglione F . Transconjunctival sutureless 25-gauge versus 20-gauge standard vitrectomy: correlation between corneal topography and ultrasound biomicroscopy measurements of sclerotomy sites. Cornea. 2009; 29(1):19-25. DOI: 10.1097/ICO.0b013e3181ab98ae. View

Taban M, Sharma S, Ventura A, Kaiser P . Evaluation of wound closure in oblique 23-gauge sutureless sclerotomies with visante optical coherence tomography. Am J Ophthalmol. 2008; 147(1):101-107.e1. DOI: 10.1016/j.ajo.2008.07.046. 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

Benitez-Herreros J, Lopez-Guajardo L, Camara-Gonzalez C, Perez-Crespo A, Silva-Mato A, Alvaro-Meca A . Influence of incisional vitreous incarceration in sclerotomy closure competency after transconjunctival sutureless vitrectomy. Invest Ophthalmol Vis Sci. 2013; 54(6):4366-71. DOI: 10.1167/iovs.13-12008. View

Sabti K, Kapusta M, Mansour M, Overbury O, Chow D . Ultrasound biomicroscopy of sclerotomy sites: the effect of vitreous shaving around sclerotomy sites during pars plana vitrectomy. Retina. 2001; 21(5):464-8. DOI: 10.1097/00006982-200110000-00008. View

Lopez-Guajardo L, Benitez-Herreros J, Camara-Gonzalez C, Silva-Mato A . Assessment of vitreous incarceration in sclerotomies with OCT, ultrasound biomicroscopy, and direct visualization. Ophthalmic Surg Lasers Imaging. 2012; 43(6 Suppl):S117-22. DOI: 10.3928/15428877-20120823-02. View

Gutfleisch M, Dietzel M, Heimes B, Spital G, Pauleikhoff D, Lommatzsch A . Ultrasound biomicroscopic findings of conventional and sutureless sclerotomy sites after 20-, 23-, and 25-G pars plana vitrectomy. Eye (Lond). 2009; 24(7):1268-72. DOI: 10.1038/eye.2009.291. View

Gosse E, Newsom R, Lochhead J . The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy. Eye (Lond). 2011; 26(1):140-3. PMC: 3259601. DOI: 10.1038/eye.2011.289. View

10.

Teixeira A, Allemann N, Yamada A, Uno F, Maia A, Bonomo P . Ultrasound biomicroscopy in recently postoperative 23-gauge transconjunctival vitrectomy sutureless self-sealing sclerotomy. Retina. 2009; 29(9):1305-9. DOI: 10.1097/IAE.0b013e3181b09487. View

11.

Benitez-Herreros J, Lopez-Guajardo L, Camara-Gonzalez C, Perez-Crespo A, Vazquez-Blanco M, Silva-Mato A . Influence of the source of incisional vitreous incarceration on sclerotomy closure competency after transconjunctival sutureless vitrectomy. Curr Eye Res. 2014; 39(12):1194-9. DOI: 10.3109/02713683.2014.905609. View

12.

Singh R, Bando H, Brasil O, Williams D, Kaiser P . Evaluation of wound closure using different incision techniques with 23-gauge and 25-gauge microincision vitrectomy systems. Retina. 2008; 28(2):242-8. DOI: 10.1097/IAE.0b013e318156dea3. View

13.

Rizzo S, Belting C, Genovesi-Ebert F, Di Bartolo E . Incidence of retinal detachment after small-incision, sutureless pars plana vitrectomy compared with conventional 20-gauge vitrectomy in macular hole and epiretinal membrane surgery. Retina. 2010; 30(7):1065-71. DOI: 10.1097/IAE.0b013e3181cd48b0. View

14.

Lopez-Guajardo L, Benitez-Herreros J . Vitreous incarceration in sclerotomies. Ophthalmology. 2012; 119(1):204-5. DOI: 10.1016/j.ophtha.2011.09.007. View

15.

Benitez-Herreros J, Lopez-Guajardo L, Vazquez-Blanco M, Perez-Crespo A, Silva-Mato A . Assessment of Closure Competency of Sutureless Vitrectomy Sclerotomies After Scleral Hydration. Curr Eye Res. 2015; 41(1):129-32. DOI: 10.3109/02713683.2014.1002050. View

16.

Taban M, Ventura A, Sharma S, Kaiser P . Dynamic evaluation of sutureless vitrectomy wounds: an optical coherence tomography and histopathology study. Ophthalmology. 2008; 115(12):2221-8. DOI: 10.1016/j.ophtha.2008.08.027. View

17.

Privat E, Tadayoni R, Gaucher D, Haouchine B, Massin P, Gaudric A . Residual defect in the foveal photoreceptor layer detected by optical coherence tomography in eyes with spontaneously closed macular holes. Am J Ophthalmol. 2007; 143(5):814-9. DOI: 10.1016/j.ajo.2006.12.039. View

18.

Lopez-Guajardo L, Benitez-Herreros J, Teus-Guezala M . Optical coherence tomography as a method for studying sutureless microincisional vitrectomy sclerotomies. Am J Ophthalmol. 2009; 148(2):321-2. DOI: 10.1016/j.ajo.2009.04.013. View

19.

Lopez-Guajardo L, Benitez-Herreros J, Silva-Mato A . Experimental model to evaluate mechanical closure resistance of sutureless vitrectomy sclerotomies using pig eyes. Invest Ophthalmol Vis Sci. 2011; 52(7):4080-4. DOI: 10.1167/iovs.10-6812. View

20.

Lin A, Ghate D, Robertson Z, OSullivan P, May W, Chen C . Factors affecting wound leakage in 23-gauge sutureless pars plana vitrectomy. Retina. 2011; 31(6):1101-8. DOI: 10.1097/IAE.0b013e3181ff0d77. View