23G玻璃体切割系统硅油取出30例临床观察

目的:评价23-Gauge (23G)玻璃体切割系统应用于硅油取出术的安全性和有效性。方法:回顾分析厦门眼科中心2011-02/06连续收治的硅油填充患者58例58眼。30例30眼应用23G玻璃体切割系统,28例28眼应用20G玻璃体切割系统行硅油取出术的临床资料。对两组平均手术时间、硅油取出时间,术前、术后1d;1wk;3,6mo的眼压、最佳矫正视力应用t检验进行比较分析。并对比两组网膜复位情况、并发症及患者舒适度。结果：23G组与20G组平均手术时间分别为21.81±564min及35.43±6.42min（t=6.382,P<0.01）;平均硅油取出时间分别为6.8±2.76min及6.4±2.41min（t=0.356,P>0.05）。术前、术后1d;1wk;3,6mo平均最佳矫正视力分别为：23G组：0.35±0.21,0.23±0.22,0.26±0.21,0.38±027,0.45±0.26;20G组：0.36±0.28,0.10±0.26,0.24±0.27,0.37±0.25,0.41±0.23。术前、术后1wk;3,6mo两组间平均最佳矫正视力差异无统计学意义（t值分别为0584,0.474,0.583,0.652,P均>0.05）;术后1d 23G组优于20G组（t=1.753,P<0.05）。术前、术后1d;1wk;3,6mo平均眼压分别为：23G组：18.3±2.21,12.2±2.42,15.2±231,16.3±2.97,16.5±2.23;20G组：17.6±2.28,11.1±2.47,16.4±2.37,16.9±2.27,17.4±2.26。术前、术后两组间平均眼压差异无统计学意义（P>0.05）;术后1d两组平均眼压均较术前降低,组内差异有统计学意义（t=1779,1.874,P<0.05）,余时间点组内差异无统计学意义（P>0.05）。20G组所有患者均一次性完整取出硅油,23G组2例残留少量硅油小泡,至末次随访时均自行吸收。术后两组视网膜均在位。并发症：术后1d 20G组出现2例（7%）低眼压患者,23G组出现4例（13%）,均在术后1wk后好转。两组均未出现眼内出血、脉络膜脱离、眼内炎等并发症。23G组与20G组术后眼痛等不适的平均周数分别为0.85±1.23,2.62±1.23wk（t=5.942,P<0.01）;术后眼红外观持续平均周数分别为1.15±1.23,4.13±2.38wk（t=5.753,P<0.01）。结论:23G经结膜无缝线玻璃体切割系统应用于硅油取出术安全有效。     

Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection

Aims

To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases.

Settings and Design

Ege university hospital ophthalmology department. Retrospective case series.

Materials and Methods

Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated.

Statistical analysis used

Paired Student''s t-test.

Results

Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively (P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) (P<0.001).

Conclusions

Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.     

Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal

AIM: To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plana technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety.METHODS: This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group).RESULTS: There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP≤6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group.CONCLUSION: This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.     

Acute endophthalmitis after 25-gauge sutureless vitrectomy

Purpose To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconjunctival sutureless vitrectomy. Methods A 65-year-old gentleman, who underwent 25-gauge sutureless vitrectomy for an idiopathic epiretinal membrane at Beyoğlu Eye Research and Training Hospital, presented with painful loss of vision three days later. For the treatment of acute postoperative endophthalmitis, revitrectomy, phacoemulsification with total capsulectomy and silicone oil injection were performed with intravitreal vancomycin and ceftazidim injections. No predisposing risk factors for endophthalmitis or postoperative hypotony were present. Results Cultures were positive for coagulase negative staphylococcus. He was treated with systemic moxifloxacin and topical ofloxacin, prednisolone acetate postoperatively. Intraocular inflammation resided in 10 days. Silicone oil was removed three months later. At the last visit after 10 months of follow-up, visual acuity increased to 20/63. Conclusions Postoperative endophthalmitis following 25-gauge sutureless vitrectomy occurred after 3 days in the absence of known predisposing factors. Endophthalmitis responded well to antibiotics and vitrectomy with a favorable visual outcome. Unsutured sclerotomies may provide a conduit for bacterial ingress. Preoperative prophylactic antibiotic usage may be considered as a preventive measure in sutureless vitrectomy.     

Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases

Background A 25-gauge transconjunctival sutureless vitrectomy (TSV) has been reported effective. However, complications such as postoperative retinal detachment have been reported. In this study, we report four cases of retinal breaks found after 25-gauge TSV. In this study, we investigated factors contributing to occurrence of postoperative complications.Methods Seventy-five patients (75 eyes) underwent 25-gauge TSV surgery at Kanazawa University hospital between April 2004 and September 2005. Postoperative follow-up monitoring was done for at least 3 months. The surgical charts were reviewed.Results Retinal breaks not accompanied by retinal detachment were noted postoperatively in four patients. All four of these patients had preoperative idiopathic macular holes. In all cases, there was no vitreous traction around the retinal break and photo coagulation was performed. One eye with age-related macular degeneration developed intraoperative rhegmatogenous retinal detachment. No other complications were observed during the intraoperative and postoperative periods.Conclusion Upon performing 25-gauge TSV for macular hole repair, care should be taken to detect retinal breaks and retinal detachment intraoperatively and postoperatively.     

25-gauge transconjunctival sutureless vitrectomy system in the surgical management of children with posterior capsular opacification

PURPOSE: To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children. METHODS: Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded. RESULTS: Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system. CONCLUSIONS: Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.     

25G经结膜穿刺法玻璃体切割术治疗特发性黄斑裂孔

目的:探讨小切口玻璃体切割术治疗特发性黄斑裂孔的手术效果。方法:7例(7眼)经眼底及OCT检查确诊为特发性黄斑裂孔,施行25G经结膜穿刺法玻璃体切割术,剥离视网膜前膜,眼内惰性气体填充,观察术后视力及裂孔封闭情况。结果:7例(7眼)黄斑裂孔均解剖复位,2眼视力无改善,5眼视力提高1～4行,随访1～6mo无裂孔复发者。结论:玻璃体切割术是治疗特发性黄斑裂孔的有效方法,经结膜小切口法较传统玻璃体切割术有明显的优势。     

23G玻璃体切割手术系统治疗婴幼儿先天性白内障

目的探讨23G经结膜无缝合玻璃体切割系统行晶状体切除联合前段玻璃体切割术治疗婴幼儿先天性白内障的疗效。方法对26例（43只眼）先天性白内障施行23GTVS晶状体切除并前段玻璃体切割术,随访观察术后眼部情况。结果采用该手术方式治疗婴儿先天性白内障,术后患儿眼部反应轻微,无纤维素性渗出,并发症少,减轻了术后护理的难度。结论应用23GTVS行晶状体切除联合前段玻璃体切割术治疗婴幼儿先天性白内障,操作简单,术后视觉通路保持良好,具有较好的临床应用效果。     

Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy

Purpose

To compare the intraocular pressure (IOP) after 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various vitreoretinal diseases.

Methods

This was a retrospective interventional case series including 338 cases of 23-gauge TSV and 476 cases of 20-gauge vitrectomy with minimum follow-up period of 1 month. Postoperative 1 day, 1 week and 1 month IOPs were compared. Multiple regression analysis to assess the actual effect of gauge of vitrectomy on postoperative IOP was performed including intraoperative and postoperative factors influencing postoperative IOP as covariates.

Results

The mean IOP of 20-gauge vitrectomy was significantly higher than that of 23-gauge TSV (20.6±8.02 mm Hg vs12.8±4.48 mm Hg, P<0.001) at postoperative day 1, but the differences were not significant at postoperative 1 week and 1 month. The IOP pattern of 23-gauge TSV demonstrated more stable course than that of 20-gauge vitrectomy. At 1 day post vitrectomy, the incidence of hypertony was higher in 20-gauge, whereas that of hypotony was higher in 23-gauge. Among risk factors, the 20-gauge vitrectomy showed the strongest association with postoperative 1 day IOP rise.

Conclusion

Twenty-three-gauge TSV has stable and lower IOP in the early postoperative period than the 20-gauge vitrectomy. In patients whose retina and optic nerves are vulnerable to higher or fluctuating IOP, 23-gauge TSV may be more beneficial.     

A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula

AIM: To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana. METHODS: Forty-eight eyes of 48 patients underwent silicone oil (5700 centistokes) removal (SOR) were enrolled. A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine. Silicone oil was removed with suction of 500-mm Hg vacuum through the cannula. Main outcome measures were SOR duration, number of sutured sites, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications. RESULTS: Silicone oil was successfully removed in all cases. The mean SOR time was 5.70±0.85min. Nine eyes (18.75%) needed suture partial sclerotomies. No intraoperative complications were noted. Transient hypotony (≤8 mm Hg) was seen in 3 eyes (6.25%) on postoperative day 1, but all resolved within 1wk. Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up. BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level. CONCLUSION: Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.     

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.     

Microincision phacoemulsification combined with sutureless transpupillary passive silicone oil removal

Purpose:To evaluate the outcomes of combined microincision phacoemulsification with sutureless transpupillary silicone oil (SO) removal using an irrigation probe of bimanual irrigation/aspiration.Methods:We conducted a single-center retrospective study, including patients who had undergone phacoemulsification with transpupillary removal of SO, which had been used for intraocular tamponade after a previous pars plana vitrectomy. Outcome measures were corrected distance visual acuity (CDVA), refractive error, intraocular pressure (IOP), and endothelial cell count (ECC) evaluated preoperatively and postoperatively at 3-month follow-up. Any intraoperative or postoperative complications, duration of surgery, and final retinal status at 3 months were also noted.Results:Seventy-four eyes (74 patients) were analyzed. The mean interval between SO placement and cataract surgery was 4.73 months (standard deviation [SD]: 1.02). CDVA improved in 66 (89.2%) eyes and remained the same in 8 (10.8%) eyes (P < 0.001). The mean postoperative spherical equivalent was −0.96D (SD: 0.75) at 3 months (P < 0.001). There was a significant drop in IOP from 15.08 mmHg (SD: 2.67) preoperatively to 11.64 mmHg (SD: 2.02) postoperatively (P < 0.001). The average ECC loss was only 5.7% at 3 months postoperatively. The mean surgical duration was 17.20 min (SD: 7.02). One patient had retinal redetachment and required resurgery. At 3 months, the retina was attached in all patients.Conclusion:Combined microincision phacoemulsification with transpupillary passive SO removal using irrigation probe of bimanual irrigation/aspiration is a safe, effective, and less invasive technique that offers the main advantage of reduced surgical trauma, and should be reserved for patients with a stable retina, not requiring additional surgical intervention.     

经结膜无缝合25G玻璃体切割术灌注系统的临床应用探讨

目的:经结膜无缝合玻璃体切割手术灌注系统应用于常规玻璃体切割术,探讨其临床应用价值及手术适应证,并发症.方法:玻璃体切割术患者196眼(190例),其中孔源性视网膜脱离142眼,单纯玻璃体积血患者20眼,糖尿病视网膜病变伴玻璃体积血26眼,特发性黄斑裂孔或黄斑前膜8眼,随机分层分为2组,每组98眼.一组采用经结膜无缝合玻璃体切割手术灌注系统,另一组采用常规玻璃体切割灌注系统.完成三通道经睫状体平坦部玻璃体切割术.包括黄斑部手术操作,使用20G玻切刀、视网膜钩、镊、笛形针、电凝等进行视网膜周边部操作,内界膜及视网膜前增殖膜剥除,视网膜切开,气液交换,视网膜光凝、冷凝等复杂视网膜手术操作.手术结束时仅缝合玻切刀及光纤头巩膜创口,经结膜无缝合玻璃体切割手术灌注系统穿刺口无需缝合.术后随访2～7 mo.结果:随访期间所有患者均未发现感染性眼内炎及切口持续性渗漏等并发症.采用经结膜无缝合玻璃体切割手术灌注系统患者全部手术时间平均78min,采用常规玻切灌注系统,其平均手术时间为95min,两组差别有统计学意义(P＜0.05)手术后并发症包括视网膜再脱离,一过性眼压升高,玻璃体积血等比较无显著性差异.结论:经结膜无缝合玻璃体切除手术灌注系统应用于常规玻璃体切割术,治疗黄斑疾病,玻璃体积血及视网膜脱离等多种较复杂的疾病,扩大了经结膜无缝合玻璃体切除手术灌注系统的临床应用范围,未观察到与改换灌注系统相关的手术并发症.有效缩短手术时间及减少手术创伤.     

Outcomes of 25-gauge pars plana vitrectomy with encircling scleral band for acute retinal necrosis-related rhegmatogenous retinal detachment

Purpose:The aim of this study was to evaluate the anatomic and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) with encircling scleral band (ESB) in patients with acute retinal necrosis (ARN)-related rhegmatogenous retinal detachment (RRD).Methods:Single-center retrospective interventional case series of patients who underwent 25G PPV with ESB for ARN-related RRD. Complete anatomic success was defined as the complete attachment of retina after primary PPV. Functional success was measured by the final best-corrected visual acuity (BCVA) ≥20/400. Intraoperative and postoperative complications were also noted.Results:14 eyes of 13 patients were included in the study. Six patients (46.1%) were immunocompromised. The mean follow-up was 23.64 ± 9.95 (range 6-42) months. Silicone oil was used as tamponade in 13 eyes and C₃F₈ gas in one eye. After the primary PPV, complete anatomical success was seen in all eyes (100%), however, one eye developed phthisis bulbi after silicone oil removal (SOR). Statistically significant improvement of BCVA was seen, from LogMAR 2.03 ± 0.29 preoperatively to LogMAR 1.57 ± 0.63 postoperatively (p-value 0.014). Six eyes (42.9%) had functional success. Nine eyes (64.3%) had improvement in vision while 4 eyes (28.6%) maintained preoperative vision. 10 eyes (71.4%) underwent cataract surgery, nine eyes (64.3%) underwent SOR while 2 eyes (14.3%) had epiretinal membrane (ERM) under oil during follow-up.Conclusion:25G PPV combines the advantages of minimally invasive vitrectomy surgery while offering improved anatomic outcomes in patients with ARN-related RRD. The functional outcome varies depending on the status of the optic disc and macula.     

25-gauge transconjunctival diagnostic vitrectomy in suspected cases of intraocular lymphoma:a case series and review of the literature

AIM: To report the cytology results of 25-gauge transconjunctival (25G-TSV) diagnostic vitrectomy in cases suspicious for intraocular lymphoma (IOL), and compare the results to those reported in the literature.METHODS: Clinical and cytopathological records of 18 vitreous biopsy specimens obtained via 25G-TSV diagnostic vitrectomy in 12 patients suspicious for IOL were reviewed retrospectively. A review of the literature in regards to the diagnostic yields of vitreous specimens obtained via 25-gauge and 20-gauge diagnostic vitrectomy in suspected cases of IOL was performed.RESULTS: Eighteen eyes from 12 patients with clinical suspicion of IOL underwent diagnostic 25G-TSV. The cytopathological investigations demonstrated IOL in 15 eyes (83.3%). Vitreous analysis was non-diagnostic in 3 eyes (16.7%).CONCLUSION: Twenty-five-gauge diagnostic vitrectomy yields adequate sample for cytological evaluation of the vitreous in cases suspicious for IOL. The diagnostic results of the 25G-TSV in the current study are superior to those reported for 20-gauge vitrectomy but equivalent to those reported for 25G-TSV in the published literature.     

Illuminated curved 25-gauge vitrectomy probe for removal of subsclerotomy vitreous in vitreoretinal surgery

Incarceration of vitreous in sclerotomy sites during pars plana vitrectomy can lead to wound-related complications similar to vitreous incarceration in cataract surgery. We describe an illuminated curved 25-gauge vitrectomy probe for removing vitreous from sclerotomy sites. Polyester tubing is used to secure a fiber optic endoilluminator (0.5 mm) with the curved 25-gauge vitrector (0.5 mm). The resultant illuminated curved vitrector (20 G) has a diameter of 1.0 mm. It facilitates complete removal of vitreous around the internal sclerotomies under direct visualization in both phakic and pseudophakic eyes. The same was confirmed with ultrasound biomicroscopy of the sclerotomy sites. Curved vitrector reduces postoperative complications related to incarcerated vitreous in phakic and pseudophakic eyes and other sclerotomy-related wound complications.     

Sutureless 25-gauge vitrectomy for idiopathic macular hole repair

Background We investigated the feasibility and safety of a 25-gauge, transconjunctival sutureless vitrectomy system for macular hole repair. Methods Eighty-four eyes of 77 consecutive patients with idiopathic macular hole were operated on using a transconjunctival sutureless 25-gauge vitrectomy system. A complete vitrectomy was performed using triamcinolone acetonide to visualize the vitreous gel and to remove the posterior vitreous cortex. The macular hole was covered with autologous whole blood, and the internal limiting membrane (ILM) was stained with indocyanine green. The ILM was peeled and a fluid-air exchange performed. The globe was filled with gas, and the patient was kept in a prone position for 1 week. Surgery-related complications, macular hole closure on optical coherence tomography (OCT) and visual outcome were evaluated. Results No intra- or postoperative complications were recorded. It was noted in particular that sclerotomies did not require sutures. No postoperative hypotony or endophthalmitis was observed. OCT showed macular hole closure in 93% of the cases. The median preoperative best-corrected visual acuity was 20/200 and improved significantly (p<0.05) to a median best-corrected visual acuity of 20/67 (median follow-up 6.5 months). Conclusion A 25-gauge transconjunctival sutureless vitrectomy, visualization of the vitreous with triamcinolone acetonide, protection of the macular hole with autologous whole blood and staining of the ILM using indocyanine green are safe and efficient techniques for macular hole repair. This is an original article; it has not been published previously. The authors have no financial interest related to this publication and transfer all copyright to the publisher upon acceptance.     

Presumed sclerotomy site bleeding inflowing into the anterior chamber after the removal of a 23-gauge microcannula in 23-gauge sutureless vitrectomy

We experienced two cases of the influx of the sclerotomy site bleeding into the anterior chamber during 23-gauge sutureless vitrectomy for pseudophakic rhegmatogenous retinal detachment. Soon after the removal of a 23-gauge microcannula at the end of the surgery, presumed sclerotomy site hemorrhage was rapidly fluxed into the anterior chamber. The anterior chamber bleeding might come from the sclerotomies rather than from episcleral vessels. The posterior pressure in the gas-filled pseudophakic eye might have pushed the sclerotomy site bleeding into the anterior chamber. We could not find any vitreous hemorrhages. The hemorrhage within the anterior chamber spontaneously absorbed within 14 days.