Subclinical Choroidal Detachment at Sclerotomy Sites after 23-Gauge Vitrectomy: Analysis by Anterior Segment Optical Coherence Tomography

Abstract

Purpose: Transient ocular hypotony commonly occurs after 23-gauge (23G) vitrectomy. To assess possible causes, we visualized the sclerotomy site and pars plana by anterior segment optical coherence tomography (AS-OCT). Procedures: We prospectively analyzed the intraocular pressure (IOP) and findings related to clinical hypotony, assessed by AS-OCT, in 13 consecutive eyes of 13 patients receiving 23G vitrectomy. Five patients receiving a 20G vitrectomy served as controls. Results: The mean IOP after 23G vitrectomy was 11 mm Hg (range: 5–32 mm Hg; 13 eyes) at postoperative day 1. In contrast to controls, AS-OCT showed a scleral gap at the incision site in 22/39 sclerotomies (10/13 eyes), and subclinical choroidal detachment in 9/13 eyes. Conclusions: A scleral gap and choroidal detachment at the incision site are frequent findings following 23G vitrectomy. These subclinical features may account for postoperative hypotony as they are absent in 20G vitrectomy and scleral sutures. Hypotony following 23G vitrectomy is a self-limiting phenomenon and usually does not require therapeutic intervention.

Comparison of Clinical Features After 20-Gauge Vitrectomy Versus 23-Gauge Vitrectomy

“…14,16,17 Interestingly, this phenomenon did not appear in our cases. On the contrary, the inner site of the incision was always seen as a gape (Fig.…”

“…This time matched the time taken for the sclerotomies to heal. 4,14,16 The 3 sutured eyes in the 23G group did not show hypotony. All the evidence hinted at a relationship between leakage and hypotony.…”

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).…”

In VivoComparison of 23- and 25-Gauge Sutureless Vitrectomy Incision Architecture Using Spectral Domain Optical Coherence Tomography

“…Recently, ultrasound biomicroscopy (UBM) [21] and time-domain optical coherence tomography (OCT) [22–24] have been used to evaluate wound architecture in vivo . The aim of this study was, therefore, to use the high-resolution anterior segment (AS) spectral domain OCT (SD-OCT) to investigate the wound architecture of both 23-ga and 25-gauge TSPPV in order to gain further insight into the sclerotomy wound construction.…”