Closure of Sclerotomies after 25- and 23-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy Evaluated by Optical Coherence Tomography

Abstract

Aims: To evaluate sclerotomy closure after 25- and 23-gauge transconjunctival sutureless pars plana vitrectomy using optical coherence tomography (OCT). Methods: Forty-eight eyes (20 with a macular hole and 28 with an epiretinal membrane) of 47 patients (mean age, 66.5 years) who underwent one of the two procedures were included. Three sclerotomy sites in each eye were measured by cross-sectional OCT images vertical and parallel to the limbus on weeks 1 and 2 and months 1, 2 and 3 postoperatively. Results: After 25-gauge vitrectomy, the scleral wounds evaluated by OCT closed in 40.6% of the eyes at 1 week, 53.3% at 2 weeks, 60.5% at 1 month, 63.6% at 2 months and 63.9% at 3 months. There were significant differences in the closure rates between 1 week and 1 month (p = 0.015), 2 months (p = 0.007) and 3 months (p = 0.006) postoperatively. After 23-gauge vitrectomy, the scleral wounds closed in 31.6% of the eyes at 1 week, 50.0% at 2 weeks, 57.4% at 1 month, 63.0% at 2 months, and 61.1% at 3 months postoperatively. There were significant differences in the closure rates between 1 week and 1 month (p = 0.011), 2 months (p = 0.001) and 3 months (p = 0.002) postoperatively. The wound closure rates did not differ significantly between the two procedures. Conclusions: Scleral wounds after 25- and 23-gauge transconjunctival sutureless pars plana vitrectomy can be evaluated with OCT. Wound healing seems to be complete 2 weeks postoperatively.

Scleral fixation of intraocular lenses using Gore-Tex suture: clinical outcomes and safety profile

“…Four of these eight eyes had a history of prior or concurrent ocular surgery, with 3/8 eyes (38%) undergoing concurrent DSEK or PK and one patient with a prior ruptured globe repair. While the precise mechanism is speculative, a likely explanation involves temporary incompetence of one or more sclerotomy sites, which ultimately self-seals during the early postoperative period, similar to what has been described with sutureless microincision vitrectomy surgery 24. Two recent reports of sutureless scleral-fixated techniques noted a hypotony rate of 4%21 and 22%,22 respectively, both in range of the 9.4% hypotony rate in this series.…”

Comparison of 23‐gauge sutureless sclerotomy architecture and clinical outcomes in macular and non‐macular surgery using spectral‐domain optical coherence tomography

“…epiretinal membrane and macular hole) and non-macular surgery (e.g. retinal detachment) (Chen et al 2010;Guthoff et al 2010;Sawada et al 2011;Yamane et al 2011;Awan et al 2012).…”

Complications of Secondary Scleral-fixated Intraocular Lens Placement

“…Transient hypotony may occur, and is likely caused by temporary incompetence of sclerotomies which eventually self-seal. 46 While all techniques in this review have studies which report transient hypotony, the Gore-Tex suture technique reports up to a 12% incidence of this complication. To prevent this complication, smaller gauge instrumentation can be used.…”