Risk Factors Associated With Sclerotomy Leakage and Postoperative Hypotony After 23-Gauge Transconjunctival Sutureless Vitrectomy

Woo, Se Joon; Park, Kyu Hyung; Hwang, Jeong Min; Kim, Jeong Hun; Yu, Young Suk; Chung, Hum

doi:10.1097/iae.0b013e318195cb28

Cited by 135 publications

(104 citation statements)

References 15 publications

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“…[7][8][9][10][11] However, there have been questions regarding the self-sealing characteristics and postoperative hypotony in some of the cases. 8,12,13 Previously localized conjunctival and episcleral pigmentation after 20-gauge conventional vitrectomy has been considered owing to a reaction to the sutures used to close the sclerotomy site. 14 Recently, a case of conjunctival pigmentation after 23-gauge MIVS for retinal detachment surgery was reported.…”

Section: Introductionmentioning

confidence: 99%

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

Park

Shin

Kim

2011

Eye

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Aim To investigate cases with conjunctival pigmentation originating from sclerotomy sites after 23-gauge microincisional vitrectomy surgery (MIVS). Methods This is a retrospective study comprised of 185 eyes from 185 consecutive patients who underwent 23-gauge MIVS. The authors investigated the incidence and the clinical factors associated with conjunctival pigmentation, including indication of vitrectomy and surgical procedures. Results Eight eyes (4.3%) from 185 eyes showed conjunctival pigmentation after surgery within 7 days postoperatively. Light microscopic examination of excised tissue showed infiltration of abundant dark brownish colored melanophages with surrounding scattered, finely granular, melanin pigments. C3F8 gas tamponade (OR, 9.4; 95% CI, 1.9-44.5; P ¼ 0.005) was significantly associated with conjunctival pigmentation. The mean surface area (21.26 ± 2.21 mm 2 ) of three eyes with C3F8 tamponade was significantly larger than that of five eyes (2.51 ± 0.73 mm 2 ) without tamponade (P ¼ 0.025). Neither leakage nor hypotony was found. Conclusions Intraocular melanin pigments could prolapse through the sclerotomy site and cause conjunctival pigmentation after 23-gauge MIVS. Thus, preoperative warning is necessary in patients with 23-gauge MIVS.

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Section: Introductionmentioning

confidence: 99%

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

Park

Shin

Kim

2011

Eye

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“…Gupta et al reported that sclerotomy sutures were required intraoperatively in 22% out of 92 patients (5). Woo et al performed suture placements in 11.2% of their patients, and found that a younger age (less than 50 years), vitreous base dissection, and history of prior vitrectomy were risk factors for requirement of suture placement (6). The mean age of our patients was 68.12 ± 12.4 and a total of 24 patients were younger than 50 years old.…”

Section: Discussionmentioning

confidence: 99%

“…Our postoperative hypotony incidence is correlated with other series. Woo et al observed postoperative hypotony in 11.3% of cases at 2 h, 6.5% at 5 h, and 3.8% at day 1 (6). It is well known that the level of IOP may change due to diurnal variation.…”

Section: Discussionmentioning

confidence: 99%

Early surgical results of a 23-gauge trocar combined with a one-directional valve system in primary and secondary pars plana vitrectomy

Altıntaş¹,

Arifoğlu²,

Köklü³

et al. 2014

Turk J Med Sci

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Background/aim: To elucidate the early surgical advantages of a 23-gauge trocar combined with a one-directional valve system in transconjunctival pars plana vitrectomies.Materials and methods: Early surgical results of 432 eyes of 432 patients (190 female and 242 male) who underwent 23-gauge (23G) transconjunctival sutureless vitrectomies (TSV) were evaluated. Sixty-three patients out of 432 underwent a second operation, 29 of them underwent silicone oil extraction, and 34 had phacoemulsification surgery with the help of vitreous infusion. If any sign of leakage was observed after the withdrawal of the cannulae, a suture was applied at the conjunctiva-scleral opening site.Results: A total of 21 (4.8%) patients in the first operation and 7 (11.1%) cases in the second operation needed suture in at least 1 sclerotomy site. No one had intraoperative hypotony. On postoperative day 1, 37 initial surgery patients and 3 second TSV patients had hypotony; all of them resolved spontaneously 1 week after surgery. No one developed choroidal effusions or detachment. Intraocular pressure spikes more than 22 mmHg in day 1 occurred in 18 eyes after initial TSV; 6 of them had gas and 4 eyes had silicone tamponade. Conclusion: 23GTSV is an effective and safe procedure for both first vitreoretinal surgery and second intraocular surgeries in eyes that had TSV previously.

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“…67 In the 23G technique, hypotony was demonstrated in a range of 3.3-11.3 %, scleral sutures were placed in 11.2-38 % in the various studies. [68][69][70][71][72] In a comparative study, Haas et al showed that post-operative hypotony occurred significantly more often after 23G vitrectomy than after 20G vitrectomy. 73 76 Those authors assumed that open sclerotomies, combined with use of low-flow rate cutters, facilitated the invasion of bacteria to the vitreous cavity.…”

Section: Post-operative Complications Hypotonymentioning

confidence: 99%

Micro-incision Vitrectomy Surgery – Past, Present and Future

Nagpal¹,

Verma²,

Goswami³

2015

European Ophthalmic Review

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The advent of micro-incision vitrectomy surgery (MIVS) changed the approach, indications and complications of vitreoretinal surgeries forever. Since its introduction in 2002, MIVS has been gaining popularity amongst retinal surgeons for managing a wide variety of vitreoretinal disorders. MIVS allows for more efficient surgery, faster recovery time and better visual outcomes than 20G vitrectomy. The use of instrumentation having small diameters reduced trauma from conjunctival and scleral manipulation as well as post-operative inflammation and corneal astigmatism. Further refinement of techniques with the introduction of 27G for routine procedures increases the comfort for the patient and minimises the recovery time. In this review, we briefly summarise the journey of MIVS to its present status and discuss the various advances that have taken place to achieve better efficiency and results.

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Risk Factors Associated With Sclerotomy Leakage and Postoperative Hypotony After 23-Gauge Transconjunctival Sutureless Vitrectomy

Cited by 135 publications

References 15 publications

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

Early surgical results of a 23-gauge trocar combined with a one-directional valve system in primary and secondary pars plana vitrectomy

Micro-incision Vitrectomy Surgery – Past, Present and Future

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