Ultrasound Biomicroscopy Study of Direct and Oblique 25-Gauge Vitrectomy Sclerotomies

López-Guajardo, Lorenzo; Vleming-Pinilla, Eduardo; Pareja-Esteban, J.; Teus, Miguel A.

doi:10.1016/j.ajo.2006.12.036

Cited by 70 publications

(47 citation statements)

References 6 publications

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“…In another study, no differences were observed by UBM regarding the signs of healing after direct and oblique 25-G sclerotomies 15 days after surgery. 4 In our study, vitreous incarceration was evident in 70% of the sclerotomy sites in UBM after 25-G PPV, in contrast to 20% after 23/2-and 20-G PPV and 40% after 23/1-G PPV. It can be speculated that vitreous entrapment and subconjunctival bleb formation facilitate intraocular infection.…”

Section: Discussionmentioning

confidence: 47%

“…One sclerotomy was chosen for the ultrasound biomicroscopic examination, the temporal superior sclerotomy for right eyes and the nasal superior sclerotomy for left eyes to reduce examination times, patient discomfort, and possible pressure on the globe. Furthermore, there may be more manipulation at the aforementioned sclerotomy sites than for other sclerotomies in most right-handed surgeons from changing instruments, as speculated by Lopez-Guajardo et al, 4 who found that most blebs appeared in superior sclerotomies. Sclerotomy sites were examined by orienting the probe perpendicular and parallel to the limbus to intersect the entire sclerotomy tract.…”

Section: Methodsmentioning

confidence: 81%

“…It has been previously shown that sclerotomies with angled incisions may seal quicker compared with direct incisions after 25-G PPV, because the sclera fibres are separated from each other rather than cut, resulting in better realignment after removing microcannulas. 5,4 Anatomical and histopathological analysis in rabbits has shown that angled incisions were superior to straight incisions especially in 23-G systems. 15 At the end of the follow-up period, complete closure was achieved and no bleb formation was seen in UBM in all patients after TSV and conventional 20-G PPV.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound biomicroscopy (UBM) has been used to examine the architecture of sclerotomies in vivo after 25-G [3][4][5][6] and 20-G PPV. [6][7][8][9][10][11] In addition to the typical intra-operative disadvantages such as difficulties faced while inserting the trocars, slipping out of cannulas, or flexible instruments, these studies have shown that wound closure from sutureless sclerotomies might be incomplete, subconjunctival blebs can form, and vitreous incarceration can develop.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound biomicroscopic findings of conventional and sutureless sclerotomy sites after 20-, 23-, and 25-G pars plana vitrectomy

Gutfleisch

Dietzel

Heimes

et al. 2009

Eye

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Section: Discussionmentioning

confidence: 47%

Section: Methodsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound biomicroscopic findings of conventional and sutureless sclerotomy sites after 20-, 23-, and 25-G pars plana vitrectomy

Gutfleisch

Dietzel

Heimes

et al. 2009

Eye

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“…Previously, studies that analyzed TSV sclerotomies by ultrasound biomicroscopy (UBM) 14,15 did not find significant association between the presence of a conjunctival bleb and vitreous incarceration. However, they evaluated the sclerotomies one day after the surgery, so factors involved in subconjunctival bleb resolution, such as postoperative pressure patching and subconjunctival fluid expression by blinking were not avoided.…”

Section: Discussionmentioning

confidence: 99%

Influence of Incisional Vitreous Incarceration in Sclerotomy Closure Competency After Transconjunctival Sutureless Vitrectomy

Benítez-Herreros

López-Guajardo

Camara-Gonzalez

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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Citation: Benitez-Herreros J, LopezGuajardo L, Camara-Gonzalez C, et al. Influence of incisional vitreous incarceration in sclerotomy closure competency after transconjuctival sutureless vitrectomy. Invest Ophthalmol Vis Sci. 2013;54:4366-4371. DOI:10.1167/iovs.13-12008 PURPOSE. To evaluate the influence that vitreous incarceration may exert on the presence of postoperative conjunctival blebs over sclerotomies after transconjunctival sutureless vitrectomy (TSV). Blebs are formed by incisional leakage due to incompetent closure. METHODS.Experimental study in which 23-gauge TSV was performed in 146 cadaveric pig eyes. Once the vitrectomy was finished, triamcinolone was injected inside the vitreous cavity for staining residual vitreous, one of the superior cannulas was extracted over the light probe, and the other cannula was removed with the plug inserted. Postoperative conjunctival blebs in superior sclerotomies were assessed by anterior-segment optical coherence tomography (AS-OCT) in a masked fashion; nondetectable blebs were classified as grade 0 (B0), thin bleb (half scleral thickness) as grade 1 (B1), and thick bleb (>half scleral thickness) as grade 2 (B2). Postoperative incisional vitreous entrapment was evaluated by slit-lamp photographs in a masked way; no incarceration was classified as grade 0 (V0), thin incarceration as grade 1 (V1), and thick incarceration as grade 2 (V2).RESULTS. Conjunctival blebs were found in 13.7% of the sclerotomies (11.3% bleb-B1, 2.4% bleb-B2). Vitreous incarceration was found in 96.5% of the sclerotomies without bleb (B0), 81.8% of the incisions with bleb-B1, and 14.3% of the wounds with bleb-B2. Vitreous incarceration was significantly associated with the absence of conjunctival bleb (P < 0.001).CONCLUSIONS. Vitreous incarceration in sclerotomies is related to less incisional leakage in our experimental model. Maneuvers that reduce vitreous entrapment, such as the interposition of a nonhollow probe during the cannula extraction, could decrease the sclerotomy closure competency.Keywords: vitrectomy, vitreous incarceration, conjunctival bleb, sclerotomy closure, experimental model D uring the last decade, 23-and 25-gauge transconjunctival sutureless vitrectomies (TSV) have gained popularity and acceptance.1,2 In contrast to conventional 20-gauge sclerotomies, 23-and 25-gauge incisions allow minimally invasive vitreoretinal surgery using smaller sutureless incisions, as compared with conventional pars plana vitrectomy 3,4 ; however, they have been related to higher rates of endophthalmitis and hypotony, due to the occasional lack of incisional closure. 5-7Recently, some authors have studied the conjunctival bleb formation over sutureless sclerotomies after vitrectomy, resulting from sclerotomy occlusion incompetency. [8][9][10][11][12][13][14][15] These studies have identified parameters related to the sclerotomy architecture 11,14 and the surgery 9 as factors involved in the postoperative sclerotomy leakage. However, other factors may influence the sclerotomy closure comp...

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Current Clinical Data and Future (for Small-Gauge Vitreoretinal Surgery)

Binder

Wimpissinger

Kellner

2009

Essentials in Ophthalmology

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Ultrasound Biomicroscopy Study of Direct and Oblique 25-Gauge Vitrectomy Sclerotomies

Cited by 70 publications

References 6 publications

Ultrasound biomicroscopic findings of conventional and sutureless sclerotomy sites after 20-, 23-, and 25-G pars plana vitrectomy

Ultrasound biomicroscopic findings of conventional and sutureless sclerotomy sites after 20-, 23-, and 25-G pars plana vitrectomy

Influence of Incisional Vitreous Incarceration in Sclerotomy Closure Competency After Transconjunctival Sutureless Vitrectomy

Current Clinical Data and Future (for Small-Gauge Vitreoretinal Surgery)

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