Modified sutureless sclerotomies in pars plana vitrectomy

PURPOSE: To report late suture migration as a complication of blepharoptosis surgery. METHOD: Case reports. RESULTS: After upper eyelid blepharoptosis repair, two eyes of two patients developed unusual foreign body reactions and ulceration in the conjunctiva caused by migration of nonabsorbable suture from the levator aponeurosis to the upper conjunctival fornix. The foreign body caused eyelid edema, papillary changes in the upper tarsal conjunctiva, recurrent blepharoptosis, and a foreign body sensation that started more than 3 months after the surgery and persisted until the suture was removed. The sutures, hidden in edematous conjunctiva of the superior fornix, eluded detection. CONCLUSIONS: Foreign body reaction secondary to suture migration is an uncommon complication of blepharoptosis repair.     

Modified sutureless sclerotomies for pars plana vitrectomy

PURPOSE: To describe a modified technique for performing sutureless sclerotomies for pars plana vitrectomy and to examine its efficacy and safety. DESIGN: Retrospective, interventional case series. METHODS: Self-sealing sclerotomies were created in 35 consecutive cases by oblique penetration of the sclera with a 19G MVR blade. RESULTS: All but two (2.9%) of the sclerotomies were watertight without suturing at the end of surgery. A conjunctival bleb was observed during the first postoperative week in one case, but it resolved without intervention. CONCLUSIONS: Construction of sutureless sclerotomies by this technique is simpler and more rapid compared with previously described techniques. The resulting sclerotomies are more resistant to stretching and tearing of the tunnel's roof, they rarely need suturing, and insertion of instruments is facilitated.     

自闭式巩膜隧道切口用于玻璃体切除术的研究

目的　探讨自闭式巩膜隧道切口用于经睫状体平坦部玻璃体切除术的有效性和安全性。方法　经睫状体平坦部玻璃体切除术 3 9例 ,行自闭式巩膜隧道切口 78个。结果　玻璃体切除完毕 ,巩膜切口能自闭不需要缝合的有 61个(78 .2 1%) ,需要缝合的 17个 (2 1 .79%)。巩膜隧道式切口在器械进出切口时能防止眼内灌注液外流 ,避免眼球塌陷 ,不必反复插入和拔出巩膜塞。结论　自闭式的巩膜切口简单易行 ,能缩短手术时间 ,避免术中退出器械和拔除灌注头时的低眼压。减少和切口有关的并发症。     

Self-sealing sclerotomies for sutureless pars plana vitrectomy

OBJECTIVE: To determine the efficacy of self-sealing pars plana sclerotomies for vitrectomy and to identify complications associated with this new technique. METHOD: There were 150 self-sealing sclerotomies performed in 50 patients undergoing pars plana vitrectomy between October 1996 and March 1998. RESULTS: Of the 150 sclerotomies, 115 (76.6%) did not require suturing while 35 (23.3%) were closed with one radial 7.0 vicryl suture. The scleral tunnel incisions ensured minimal loss of intraocular fluids during instrument exchange and scleral plugs were not required to avoid ocular hypotony during scleral indentation. Distortion of scleral flap incisions requiring a suture were commonly seen in procedures using multiple instrumentations and extensive explants. CONCLUSIONS: Sutureless sclerotomies are simple to perform, save operative time, and reduce the risk of peroperative hypotony following removal of instruments or the infusion cannula. The technique reduces postoperative inflammation, suture-related problems including astigmatism, and allows more rapid rehabilitation.     

Keratometric alterations following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy

Purpose: To assess the alterations in keratometric astigmatism following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Methods: Sixteen consecutive patients were enrolled into the study. Conventional vitrectomy was applied to eight of the cases and 25‐gauge transconjunctival sutureless vitrectomy was performed in eight patients. Keratometry was performed before and after the surgery. Results: In the 25‐gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were not observed in the corneal curvature in any post‐operative follow‐up measurement (p > 0.05); whereas in the conventional pars plana vitrectomy group, statistically significant changes were observed in the first postoperative day (p = 0.01) and first postoperative month (p = 0.03). We noted that these changes returned to baseline in three months (p = 0.26). Conclusion: Both 25‐gauge transconjunctival sutureless and conventional pars plana vitrectomy are effective surgical modalities for selected diseases of the posterior segment. Surgical procedures are critical for the visual rehabilitation of the patients. The post‐operative corneal astigmatism of the vitrectomised eyes can be accurately determined at least two months post‐operatively     

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM: To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. METHODS: Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. RESULTS: A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. CONCLUSION: In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.     

Office-based sutureless transconjunctival pars plana vitrectomy

PURPOSE: This is a preliminary report to describe our technique of office-based vitrectomy (OVIT) and to report the incidence of complications over a 6-year period. METHODS: In a retrospective, noncomparative case series, OVIT was performed on 225 patients in four participating offices. Each patient was operated on with a 23-gauge vitreous cutter that the authors have developed. They have also developed a 23-gauge transconjunctival infusion needle device. Diagnoses included endophthalmitis, uveitis, intravitreal lens fragments, ghost cell glaucoma, and rhegmatogenous retinal detachment. RESULTS: The surgical goal was accomplished in all cases, but supplemental office procedures were required for two eyes, and a scleral buckle was necessary in one eye. There were 15 complications in 14 eyes: "fish-egg" gas bubbles (one eye), intraocular hemorrhage (nine eyes), choroidal detachment (two eyes), new retinal breaks (one eye), retinal detachment (one eye), and temporary elevation of intraocular pressure (one eye). The hemorrhages, choroidal detachments, and fish-egg bubbles all resolved spontaneously. CONCLUSION: Office-based sutureless transconjunctival pars plana vitrectomy, with infusion when needed, is an effective operation for selected diseases of the posterior segment. In a multicenter series of 225 eyes, there were 15 complications in 14 (6%) eyes. Two of the complications were successfully managed with additional office procedures; one was managed in the operating room; and 12 resolved spontaneously.     

One-port pars plana vitrectomy (by 25-G micro-incision)

Purpose  A pilot study to test a novel, minimal invasive vitrectomy, through one-port pars plana sclerotomy, by 25-G instruments, for selected vitreous, macular and vitreomacular interface disorders. Methods  Setting: institutional. Design: interventional, prospective case series of 14 eyes of 14 patients. The “one-port pars plana vitrectomy” (OPPPV) by 25-G micro-instruments was performed on seven pseudophakic eyes, and the “phacoemulsification OPPPV” (phaco OPPPV) by 25-G on seven presbyopic/cataract phakics. Minimal vitrectomy on eight eyes. Subtotal vitrectomy on six eyes. Follow-up: 12 months. Main outcome endpoints: surgical feasibility/suitability, patient tolerability, post-operative recovery time. Intra- and post-operative complications were recorded. Results  All OPPPVs by 25 G were completed as planned. Anatomical surgical objectives were fulfilled on all eyes; functional ones on 13 out of 14 eyes. The whole OPPPV group and four of the phaco OPPPV subset of patients tolerated comfortably less than 30′ surgical time, and three phaco OPPPV ones less than 45′. Full regimen anti-inflammatory therapy for 2 weeks kept ten eyes out of 14 stable. Post-operatively, two eyes developed a transient alteration of the intraocular pressure. At the end of the follow-up, neither retinal detachment nor endophthalmitis occurred. Conclusions  OPPPV by 25 G techniques promise to be an effective,comfortable, possible office-based alternative “micro-incisional, minimal invasive vitreous surgery” for selected vitreous, macula and vitreomacular interface disorders. Future research on the safety of the OPPPV by 25 G techniques compared to conventional ones is encouraged. Dr. William Gualtieri (video) presented the ”one-port pars plana vitrectomy” technique at the British and Eire Vitreoretinal Society (BEAVRS) Annual Meeting 23 November 2006, London, England, UK The Author has no proprietary interest. Neither grants nor funds supported this work.     

玻璃体切割术后视网膜脱离分析

目的 探讨玻璃体切割术后视网膜脱离的原因、特点、治疗方法。方法 回顾分析我科近年发生的１６例玻璃体切割术后视网膜脱离的特征及治疗过程。结果 发生率为６％,其中增生性糖尿病视网膜病变４例,非糖尿病性玻璃体混浊１２例,７５％于术后１周内出现视网膜脱离,６９％由医源性裂孔引起。二次手术治疗包括玻璃体切割、经巩膜视网膜冷冻、巩膜扣带、长效气体及硅油充填术。最终８１％视网膜复位、视力提高。结论 玻璃体切割术中应从各个环节防止视网膜的损伤,术后视网膜脱离经二次手术多数可以复位。     

25-Gauge transconjunctival sutureless pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, feasibility, and safety of the transconjunctival sutureless vitrectomy (TSV) system for a vriety of vitreoretinal diseases. METHODS: In this retrospective study, the authors evaluated 71 eyes of 63 patients who underwent pars plana vitrectomy (PPV) with the 25-gauge TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (29 eyes), diabetic macular edema (14 eyes), macular epiretinal membrane (13 eyes), endophthalmitis (5 eyes), vitreous opacities secondary to Behcet's disease (4 eyes), vitreous hemorrhage secondary to branch retinal vein occlusion (4 eyes), and vitreous hemorrhage secondary to age-related macular degeneration (2 eyes). Epiretinal membrane and internal limiting membrane removal, endolaser photocoagulation, and air-fluid exchange were performed when required. RESULTS: Mean follow-up was 3.6 months (range 1-8 months). Mean overall visual acuity (VA) was counting fingers (range light perception to 0.4) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p=0.000). Statistically significant VA improvement was observed in eyes with vitreous hemorrhage, diabetic macular edema, and macular epiretinal membrane. VA improved postoperatively in all eyes with endophthalmitis and vitreous opacities secondary to Behcet's disease. The surgery was completed without conjunctival and scleral suturing in all eyes. Mean intraocular pressure (IOP) was 17.2 mmHg (range 10-26 mmHg) preoperatively, 12.4 mmHg (range 6-24 mmHg) on the first postoperative day, 16.6 mmHg (range 10-33 mmHg) at 1 week, and 15.4 mmHg (range 10-20 mmHg) at 1 month postoperatively. On the first postoperative day, IOP was below 10 mmHg (between 6 and 9 mmHg) in 12 eyes (16.9%). In these eyes, IOP was normalized within 1 week without affecting the visual outcome. Five eyes (7%) had transient increase of IOP controlled by topical antiglaucomatous medications. Vitreous washout using 25-gauge TSV system was performed in two eyes, in which vitreous hemorrhage recurred. CONCLUSIONS: The TSV system was observed to be feasible, effective, and safe for a variety of vitre o retinal diseases. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time, and postoperative inflammatory response, and improve patient comfort.     

Self-sealing, sutureless sclerotomy in pars plana vitrectomy

BACKGROUND: If sutures are used in the regular closure of sclerotomies a trauma to the bulbus can be inflicted and intraocular bleeding might result. Phases of intraocular hypotony accompany the intraoperative exchange of instruments. Like in no-stitch cataract surgery we employed this type of self-sealing wound closure in pars-plana vitrectomies. A less traumatizing technique yielding a tight and effective closure is an alternative to the conventional approach and results of our experiences are presented. MATERIALS AND METHODS: A modified approach for sutureless sclerotomy closure was applied in 50 eyes (150 sclerotomies). A sclera-covered sclerotomy is performed after preparation of adequate scleral pouches in conventional positions. A minimal conjunctival peritomy allows at the end of surgery an electric cauterization, thus using no suture material in the whole course of vitrectomy. RESULTS: Sutureless vitrectomies can only be installed in the primary operation. However, re-operations on 3 eyes were possible in the same manner using the old sclerotomy sites up to 6 weeks after initial surgery. In 12 eyes the sclerotomy had to be covered with a single suture to obtain adequate wound closure. A repetitive change of instruments during the surgical procedure is possible with this technique and all types of intraocular instruments can be employed. CONCLUSIONS: Self-sealing sclerotomies are a simple and atraumatic approach for wound closure in pars-plana vitrectomies and allow a control of intraocular pressure during surgery.     

玻璃体手术治疗自发性玻璃体积血

目的观察玻璃体手术治疗非糖尿病性自发玻璃体积血的疗效及其与手术时机的关系。方法45例(46眼)非糖尿病性自发玻璃体积血行标准三通道闭合式玻璃体切除并联合眼内激光光凝等手术,并对不同时机手术的患者术后视力及并发症进行分析。结果1月以内手术者术后视力均提高。1月以上手术者14眼中术后视力提高者2眼,不变8眼,下降3眼。手术并发症主要为术中出血和医源孔及术后高眼压。术中医源孔和术后视网膜脱离均为1月以上手术者。结论玻璃体手术治疗非糖尿病性自发玻璃体浓密积血者疗效佳,并发症少。考虑玻璃体积血为视网膜裂孔所致者应及时手术。     

25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study

Background The aim of the study was to evaluate the safety and functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20-gauge vitrectomy system.Methods Forty-six consecutive patients with idiopathic ERM were recruited for this study and prospectively evaluated. In group 1 (n=26) we used a transconjunctival sutureless 25-gauge vitrectomy system (TSV), patients in group 2 (n=20) were operated on using a standard 20-gauge vitrectomy system. The ERM was removed and the internal limiting membrane (ILM) was peeled in all eyes. Surgery-related complications, operating time, intraoperative balanced salt solution (BSS) consumption, postoperative discomfort, postoperative intraocular inflammation, lens opacification, and long-term visual outcome are reported and compared.Results No surgery-related complications were observed in either group. Operating time was shorter in group 1 compared with group 2 (mean 15.6 and 29.6 min respectively). Intraoperative amount of BSS consumption was less in group 1 (mean 28 ml in group 1 and 42 ml in group 2). Postoperative discomfort and intraocular inflammation were significantly reduced in the 25-gauge group. In the 20-gauge group cataract formation requiring surgery was observed in two eyes. Visual acuity improved significantly in both groups. The 25-gauge group improved on average by more lines of vision and the improvement in vision was more rapid.Conclusion The TSV system is a safe and efficient surgical technique for ERM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing postoperative intraocular inflammation and the patients’ discomfort. The incidence of cataract formation may be less using TSV. Postoperative recovery is accelerated.The authors have no financial interests related to this publication.     

玻璃体切除术后的白内障超声乳化术

目的 描述在曾做玻璃体切除眼再施行超声乳化白内障摘出术中的特征及其并发症和视力结果。方法 回顾研究了作者3年内30眼曾做玻璃体切除术后再施行白内障手术。资料包括术前特征，术中发现。术后并发症及视力。结果 在所有做过玻璃体切除的术眼，均可发现术中有晶状体悬韧带松弛、前房异常加深和散瞳。有些术眼在初期前房加深后，还相反可见前房变浅和缩瞳(灌注偏差综合征)，未见有何严重威胁视力的并发症发生，最后视力较术前多有明显增进。结论 在已施行玻璃体切除眼上再做白内障手术存在有特殊的问题，包括丧失玻璃体支持，后囊膜不稳定及悬韧带脆弱等。为减少前房深度的突然改变，应将灌流液瓶的高度降低，在前房深度异常波动时，超声乳化头应放置在虹膜平面之前，且避免在囊袋内作超声乳化术。     

BSS PLUS眼内灌注在玻璃体手术中的应用评价

目的：评价BSS PLUS眼内灌注在玻璃体手术中的临床应用价值。方法：在138例(144眼)玻璃体手术中，分别采用BSS PLUS和国产BSS灌注液眼内灌注，对比术后第一天角膜内皮和眼内反应性炎症的变化：随访3月，比较晶状体透明度的差异。结果：术后第一天BSS PLUS组角膜内皮丢失少于BSS组，差异有显著性(t＝5．183，P＜0．05)；两组间所有病例术后第一天眼内反应性炎症未显示明显差异(x^2＝1．677，P＞0．05)；而将两组内各病例分类比较后，显示出糖尿病组的玻璃体手术中，使用BSS PLUS者术后眼内炎症反应明显轻于使用国产BSS者，差异有显著性(x^2=4.711，P＜0．05)。结论：BSS PLUS眼内灌注液有较好的组织相容性，可保护角膜内皮，减少眼内炎症反应。     

玻璃体切割手术相关医源性视网膜裂孔的临床观察

目的分析玻璃体切割手术过程中医源性视网膜裂孔(iatrogenic retinal breaks,氉IRB)的发生率、危险因素及预防措施。方法回顾分析129例133眼玻璃体手术病例,记录眼别、术前诊断、玻璃体后脱离状态、晶状体状态,分析术中IRB的数目、分布及预防措施。结果 133眼中12眼术中出现13个IRB,总体发生率为9.0%。其中,黄斑裂孔或黄斑前膜33眼中3眼(9.1%)出现IRB,增生性糖尿病视网膜病变52眼中6眼(11.5%)出现IRB,玻璃体积血40眼中3眼(7.5%)出现IRB。8眼(6.0%)出现巩膜切口相关IRB,5眼(3.8%)出现其他区域IRB,其中1眼同时存在巩膜切口相关IRB及其他区域IRB。术中制作玻璃体后脱离组的IRB发生率(12.3%)高于术前存在玻璃体后脱离组(6.6%),但差异无统计学意义(P=0.256);有晶状体组的IRB发生率(10.5%)高于术中联合超声乳化组(4.5%)及人工晶状体或无晶状体组(8.0%),但差异均无统计学意义(均为P>0.05)。术后发生视网膜脱离4眼(3.0%),所有视网膜脱离眼经二次手术后视网膜均达到解剖复位。结论各种疾病行玻璃体切割手术均有发生IRB的可能,没有证据表明术中制作玻璃体后脱离及晶状体状态与IRB的发生具有明显相关性。为避免IRB可能引起的玻璃体术后视网膜脱离,术中仔细排查与处理是非常重要的。