Modified sutureless sclerotomies in pars plana vitrectomy

PURPOSE: To study the effectiveness and safety of a modified sutureless sclerotomy technique in pars plana vitrectomy. METHODS: We rotated the scleral tunnels of the original sutureless sclerotomy technique through 90 degrees, thus rendering them parallel to the corneoscleral limbus. This modified technique was applied to 25 consecutive eyes (25 patients) that had pars plana vitrectomy during a 2-month period. RESULTS: Twenty (80%) of 25 eyes (25 patients) did not require suturing of the sclerotomy sites associated with pars plana vitrectomy. Eight (11%) of 75 sclerotomy sites required suturing to ensure watertight closure. No clinically significant complications were encountered. CONCLUSION: The modified sutureless sclerotomy technique was found to be safe, more convenient, and easier to perform, especially in eyes with small interpalpebral space.     

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.     

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。     

Ultrasound biomicroscopy findings of 25 G Transconjuctival sutureless (TSV) and conventional (20G) pars plana sclerotomy in the same patient

Background  

Transconjunctival Sutureless Vitrectomy (TSV) is a recent advancement in vitreo-retinal surgical techniques involving the use of 25 G instruments through self-sealing sclerotomies. It has been hypothesized that there may be less chance of vitreous and retinal herniation in the scleral wound as compared to conventional sclerotomy incision. However there are no reports on differences in 20 gauge and 25 gauge sclerotomies using ultrasound biomicroscopy (UBM). We report herein the differences in sclerotomies undertaken with 20 gauge (G) and 25 gauge instruments in the same patient.     

玻璃体切割术后早期高眼压的UBM临床观察

目的 通过超声生物显微镜（UBM）对玻璃体切割手术前后患眼进行检测比较,探讨玻璃体切割术后早期高眼压的发病机制。方法 应用UBM观察玻璃体切割手术前后患者眼前节结构的变化,分别比较有晶状体组、人工晶状体组术前术后各测量参数的变化。结果 高眼压组术后瞳孔阻滞,睫状体全周脱离、水肿、前旋。参数测量：有晶状体组的高眼压组与正常眼压组前房深度相比差异有统计学意义（t=2.000,P=0.049）,房角开放距离500高眼压组与正常眼压组相比差异有统计学意义（t=2.069,P=0.050）。人工晶状体组的高眼压组与正常眼压组前房深度相比有统计学意义（t=2.066,P=0.050）,高眼压组与正常眼压组睫状体厚度比较差异有统计学意义（t=1.926,P=0.037）。结论 术后睫状体水肿前旋致前房变浅、房角变窄,导致眼压升高,参数测量提示有晶状体高眼压组术后较术前有前房变浅、房角开放程度减小的趋势。     

Ultrasound biomicroscopy study of direct and oblique 25-gauge vitrectomy sclerotomies

PURPOSE: To study 25-gauge sclerotomy healing process in vivo with ultrasound biomicroscopy (UBM) in direct and oblique incisions. DESIGN: Prospective interventional case series report. METHODS: At our institution, we performed UBM studies on 53 sclerotomies during the first 30 days after 25-gauge vitrectomy, looking for conjunctival bleb development, sclerotomy healing signs, and vitreous incarceration in the wound. RESULTS: Echographical healing signs were completed in 77% of patients by day 15 with no differences between direct and oblique sclerotomies. By day 30, all but one sclerotomy were closed. Conjunctival blebs developed over 64% of direct sclerotomies, and 25% of oblique (P = .0059), but all resolved spontaneously by day 15. Vitreous incarceration appeared in 72% of sclerotomies. CONCLUSIONS: Twenty-five gauge sclerotomies heal by day 15 in most cases with no difference between direct and oblique sclerotomy construction. Conjunctival blebs developed more frequently over direct than oblique sclerotomies.     

玻璃体切除联合超声乳化术巩膜穿刺口UBM临床分析

目的 通过UBM对比观察单纯玻璃体切除和玻切联合超声乳化术后巩膜穿刺口的愈合情况,分析联合手术是否可以减少巩膜穿刺口玻璃体增殖条索的形成.方法 UBM 检查巩膜穿刺口的愈合情况共分为4级,0级,无玻璃体嵌顿;1级,穿刺口内可见玻璃体嵌顿;2级,玻璃体嵌顿并形成同穿刺口相连的增殖条索;3级,出现牵拉性视网膜脱离或存在视网膜组织嵌顿.对30例单纯玻璃体切除手术和20例联合超声乳化手术后行UBM检查巩膜穿刺口的愈合情况,对检查结果进行x2检验,分析两组之间巩膜切口愈合情况的差异.结果 在单纯玻切手术组:0级、1级切口愈合17例,占56.7%;2级、3级切口愈合13例,占43.3%.联合超声乳化组:0级、1级切口愈合17例,占85.0%;2级愈合3例,占15.0%,无3级愈合病例.单纯玻切手术组术后巩膜切口发生玻璃体嵌顿并产生增殖牵拉的病例数明显高于联合手术组,差异有统计学意义(P<0.05).结论 玻璃体切除联合超声乳化手术可以减轻术后巩膜穿刺口的玻璃体嵌顿.     

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     

Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy for diabetic vitreous hemorrhage

OBJECTIVE: This study was aimed at assessing changes at the sclerotomy site using the ultrasound biomicroscope (UBM) in eyes that underwent primary pars plana vitrectomy for complications of proliferative diabetic retinopathy. DESIGN: Prospective, observational case series. PARTICIPANTS: Eighty-six eyes of 84 patients with vitreous hemorrhage caused by proliferative diabetic retinopathy. INTERVENTION: Three-port pars plana vitrectomy followed by UBM evaluation of all sclerotomy sites between 6 and 8 weeks after surgery. Correlation with intraoperative findings done in case of reoperations. Forty-one eyes had repeat UBM at 6 months. MAIN OUTCOME MEASURES: The changes at the sclerotomy site were classified into six groups: well healed, gape, plaque, vitreous incarceration, fibrovascular proliferation, and anterior hyaloidal fibrovascular proliferation (AHFVP). The UBM characteristics of each of the groups were defined. The findings at 6 months were compared with those at 6 to 8 weeks. RESULTS: At 6 to 8 weeks after surgery, most sclerotomies were well healed or had either moderate to high reflective plaques bridging the site. Wound gape was seen in 22.1% of active ports, 32.6% of light ports, and 25.6% of infusion ports. Vitreous incarceration was seen most often at the infusion port (18. 6% of eyes). Fibrovascular proliferation was seen in 9.3% of active ports, 12.8% of light ports, and 15.1% of infusion ports. Thirteen eyes had recurrent vitreous hemorrhage 6 to 8 weeks after surgery. Cases with rebleeding and no fibrovascular proliferation at the sclerotomy on UBM did well with outpatient fluid-air exchange (two eyes) or observation only (three eyes). Those with fibrovascular proliferation on UBM (eight eyes) required more extensive surgery. CONCLUSIONS: UBM is helpful in detecting complications at the sclerotomy sites after pars plana vitrectomy and is an invaluable tool in the assessment of the patient before reoperation.     

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.     

Ultrasound biomicroscopy of sclerotomy sites: the effect of vitreous shaving around sclerotomy sites during pars plana vitrectomy

PURPOSE: To study the difference in the amount of vitreous incarceration between conventional pars plana vitrectomy (PPV) and PPV with vitreous shaving around sclerotomy sites. METHODS: A dynamic in vivo examination using ultrasound biomicroscopy (UBM) was performed on the sclerotomy sites of 22 eyes after PPV. Patients were divided into two groups. In the study group (n = 11), the vitreous was completely shaved from the internal initial sclerotomy by cotton-tip depressed vitrectomy under coaxial illumination. In the control group (n = 11), no vitreous shaving was performed. RESULTS: Vitreous incarceration into sclerotomy sites was significantly less in the study group compared with the control group (P <0.001). No difference was seen among the three sclerotomy sites regarding vitreous incarceration within individual eyes. No difference was seen between eyes operated by right- and left-handed surgeons. CONCLUSIONS: Vitreous shaving of sclerotomy sites using depressed vitrectomy significantly reduces vitreous incarceration. This may reduce the rate of sclerotomy-related complications following PPV in selected cases.     

Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts

AIM: To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM). METHODS: 18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM. RESULTS: Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated ("isolated," "confluent," and "clustered" cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes. CONCLUSIONS: The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.     

Retinal detachment after small-incision, sutureless pars plana vitrectomy: possible causative agents

Background and purpose  

To identify possible agents causing retinal detachment following small-incision, sutureless vitrectomy.