<p>Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony</p>

Abstract

Purpose To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony. Methods This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony. Results Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening. Conclusion Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant ( P <0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.

Frequency of Post-Operative Hypotony with Sutureless Sclerotomy versus Intrascleral Hydration in 23-Gauge Pars-Plana Vitrectomy

“…For instance, Horowitz et al, tried diathermy and demonstrated its efficacy. 4 Felfeli et al and Zhang et al, reported use of scleral needling for wound closure post-TSV. 20,6 Sridhar et al, report on the relative efficacy of plain gut sutures versus the more standard polyglactin sutures.…”

“…This also leads to decreased conjunctival scarring, reduced post-operative inflammation and less postoperative astigmatism contributing to overall comfort for the patient. 4 Whereas TSV has its advocates, some complications have been noted in the form of hypotony and endophthalmitis resulting from poor wound closure. 5 Imperfect scleral wound closure can be quite common even if the recommended guidelines of using the angled-incision approach are used in addition to excellent conjunctival placement and appropriate massage of the surgical wound.…”

Reply

“…The second article was titled, “Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony”. 3 In this prospective study enclosing 327 patients (327 eyes), the diathermy technique proved to be safe and feasible to close 23-gauge sclerotomies. Boscia et al 4 also stated that the cauterization of the sutureless sclerotomies might prevent ocular surface fluid from penetrating the incisions and avoid leakage of intraocular fluid during the postoperative period.…”

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

“…16, No. 5, May 18, 2023 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: ijopress@163.com for suturing [12][13][14] . Substitutes for suturing include application of tissue adhesives [15][16] , conjunctival cauterization [17][18] , and scleral needling [19] .…”