Intraocular Gas Dynamics After 20-Gauge and 23-Gauge Vitrectomy With Sulfur Hexafluoride Gas Tamponade

Abstract

Eyes treated with 23-gauge TSV tend to have earlier gas disappearance or incomplete gas fill. Intraoperative suture placement would be a solution.

Diathermy of Leaking Sclerotomies After 23-Gauge Transconjunctival Pars Plana Vitrectomy

“…This could be related to subclinical loss of air or gas, as previously reported. 12 After 23-gauge TSV, the reported incidence of hypotony is 6.5% to 11.3% in the early postoperative period, 12,25 and 0% to 10% at 1 day, [12][13][14][19][20][21][22]24,25,28,[35][36][37][38] with a resolution within 1 week. We found hypotony in 4.5% of the treated eyes at 6 hours, in 1.5% at day 1, and in no eye at 3 days; the only factor associated with the occurrence of hypotony at 6 hours was the age younger than 50 years.…”

“…[6][7][8][9][10][11][12][13][19][20][21][22] Risk factors for a leaking sclerotomy during 23-gauge TSV are myopia, thin sclera, history of previous vitrectomy, a young age at operation, vitreous base dissection, the use of intravitreal triamcinolone, multiple exchanges of instruments, pseudophakia, combined phacoemulsification and vitrectomy procedures, and absence of tamponade. 3,[12][13][14][15]23 The incidence of leaking sclerotomy requiring intraoperative suture placement in 23-gauge TSV ranges between 0% and 38.0% 6,12,19,20,22,[24][25][26][27][28] ; this variability is probably related to different inclusion criteria, such as surgical indications, vitreous base dissection, tamponading agents, and reoperations.…”

“…1,[3][4][5] However, the method has some potential drawbacks, such as a higher incidence of wound leaks, with ensuing incomplete filling with tamponading agents, earlier disappearance and subconjunctival migration of tamponading agents, hypotony, choroidal detachment, retinal detachment, vitreous incarceration, and endophthalmitis. [6][7][8][9][10][11][12][13] Even with recent advances in incision techniques, such as oblique incisions, biplanar cannula insertions, and slit-shaped scleral tunnel incisions, it may be difficult to ensure perfect self-sealing of every entry site, especially in particular cases, such as eyes with myopia or thin sclera, reoperation on a vitrectomized eye, multiple exchanges of instruments, young patients, and extensive vitreous base dissection. 2,3,[12][13][14][15] Furthermore, subclinical leakage occurs even after successful self-sealing on the operating table, and delayed hypotony may develop the next day and last for several days thereafter.…”

Outcome of 2 cc pure sulfur hexafluoride gas tamponade for macular hole surgery

“…Intraocular gas volume on the first postoperative day is an important index of postoperative gas dynamics because less gas volume would lead to insufficient tamponade to the retina [ 16 ]. A gas bubble size of 73 % obtained on the first postoperative day in this study is lower than 83.8 % reported by Kusuhara et al [ 16 ] with 25 % SF 6 . Eyes treated with 23-gauge transconjunctival vitrectomy tend to have earlier gas disappearance or incomplete gas fill as a result of postoperative gas leakage through unsutured sclerotomies.…”

Use of 25% sulfur hexafluoride gas mixture may minimize short-term postoperative hypotony in sutureless 25-gauge pars plana vitrectomy surgery

“…A recent report by Kusuhara et al shows that leakage and hypotony remain a significant complication requiring frequent suturing of the sclerotomy in 23-gauge pars plana vitrectomy even with 25% SF 6 15. Our different results using the 25-gauge system may stem from the different technique used, ie, introducing a trocar, but it is more likely that the 10% leak reported by Kusuhara et al was secondary to the 20% larger diameter of the 23-gauge trocar compared with the 25-gauge one (0.573 mm versus 0.455 mm).…”