Effects on ocular discomfort and tear film dynamics of suturing 23-gauge pars plana vitrectomies

Abstract

To evaluate the effects of suturing 23-gauge pars plana vitrectomies on ocular discomfort and tear film dynamics. Methods: This retrospective chart review involved data from 50 procedures in 50 patients who underwent 23-gauge pars plana vitrectomy from January to November 2016. We divided the eyes into two groups according to the presence or absence of sutures; 35 eyes underwent sutureless vitrectomies (Group 1), and 15 eyes underwent vitrectomy with at least one sclerotomy suture site (Group 2). In each group, we assessed objective variables including tear film break-up time, Schirmer test I, corneal surface grading with Oxford system, and a quantitative method evaluating subjective dry eye symptoms using ocular surface disease index questionnaires preoperatively 1 week, and 1 and 3 months after surgery. Results: The tear film break-up time showed a significant difference at the 3-months follow-up (p=0.026). The Schirmer test I and corneal surface staining score showed no statistically significant differences between two groups at any time after the operations. The ocular surface disease index score was significantly lower in Group 1 than in Group 2 at 1 week (p=0.032), 1 month (p=0.026), and 3 months (p=0.041) after the operation. Conclusion: Sclerotomy suturing caused ocular discomfort and had a negative effect on tear film dynamics during the late postoperative period. Sclerotomies without suturing seem to reduce the ocular surface changes.

Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

“…Suturing of the conjunctiva and the Tenon capsule can elicit a transient inflammatory response, which can subsequently impair surface goblet cells. 25,29 In addition, these symptoms seem to improve over time, as reported by Fujita et al, 30 who documented a recovery of inflammatory cytokines within a week post-PPV with treatment with bethamethasone.…”

“…These factors also increase postoperative discomfort and inflammation, negatively impacting the ocular surface. [23][24][25][26] It is possible that ocular surface disease arising after vitreoretinal surgery may be in part due to the underlying presence of neurotrophic keratopathy, as discussed above. 16 Similar to other ocular surgeries such as phacoemulsification 27 and keratorefractive procedures, 28 dry eye symptoms can occur following vitreoretinal surgery during the immediate postoperative period.…”

“…16 Similar to other ocular surgeries such as phacoemulsification 27 and keratorefractive procedures, 28 dry eye symptoms can occur following vitreoretinal surgery during the immediate postoperative period. [23][24][25] Lee et al 25 reported a decrease in tear film stability and worsening of dry eye symptoms as determined by the Ocular Surface Disease Index questionnaire (OSDI; Allergan Inc., Irvine, CA) in individuals receiving sutures after 23-G vitrectomy, compared with individuals that did not require sutures. Suturing of the conjunctiva and the Tenon capsule can elicit a transient inflammatory response, which can subsequently impair surface goblet cells.…”

The Effect of Therapy on the Ocular Surface in Patients with Unilateral Paediatric Glaucoma

“…V současné době se věnuje značná pozornost rovněž vlivu očních operací na homeostázu povrchu oka a rozvoj příznaků SSO. Přestože výsledky nejsou jednoznačné, byla popsána zvýšená incidence subjektivních i objektivních příznaků SSO po antiglaukomových operacích, po operaci katarakty i po pars plana vitrektomii [15][16][17][47][48][49][50][51][52][53]. Naše výsledky tak nemusí dokumentovat jen nežádoucí účinek lokálně podávaných léků, ale může jít i o důsledek předchozích operačních zákroků na postiženém oku.…”

The Application of Artificial Neural Networks and Logistic Regression in the Evaluation of Risk for Dry Eye after Vitrectomy

“…With advances in the instrumentation available, vitrectomy has become a well-established procedure. Serious vitrectomy-associated complications are very rare [1,3]; however, like other types of ocular surgeries, vitrectomy may traumatize the conjunctival tissues, often resulting in the development of secondary dry eye disease (DED) [4][5][6]. Using the demographic and clinical features of patients to predict risk for vitrectomy-related DED will facilitate decision-making in the management of vitrectomy patients and improve the relationship between doctors and patients.…”