Evaluation of Wound Morphology of Sclerotomy Sites of Sutureless Vitrectomy Using Spectralis Anterior Segment Optical Coherence Tomography

Nagpal, Manish; Paranjpe, Gaurav; Mehrotra, Navneet; Bhardwaj, S. B.

doi:10.1097/apo.0b013e3182a141e7

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…OCT images of the 23-gauge MVR blade incisions also showed earlier wound closure compared with beveled trocars 26. In a recent study of wound morphology in human eyes undergoing vitrectomy with incisions created using a 23- or 25-gauge ridged MVR blade, both gauge MVR blades led to complete wound closure and no leakage;29 our results are in general agreement with these findings. Together, these studies suggest that the morphologic differences among incisions created with trocar blades of different designs may influence wound closure.…”

Section: Discussionsupporting

confidence: 90%

Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

Inoue

Abulon

Hirakata

2014

OPTH

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PurposeTo compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture.MethodsWe tested one ridged microvitreoretinal (MVR), one non-ridged MVR, one pointed beveled, and one round-tipped beveled blade (n=10 per blade design per incision type). Each blade’s straight and oblique incision architecture was assessed in a silicone disc simulating the sclera. Wound leakage under pressure and endoscopic observations were conducted on sclerotomy sites of isolated porcine eyes (n=4 per blade design) after simulated vitrectomy.ResultsDifferences in blade design created distinct incision architecture. Incisions were linear with the ridged MVR blade, flattened “M-shaped” with the non-ridged MVR blade, asymmetrical chevron-shaped with the pointed beveled blade, and curved with the round-tipped beveled blade. With the exception of oblique entry incision thickness, both MVR blade designs created thinner incisions than the beveled blades at entry and exit sites. Only the ridged MVR blade created incisions with no leakage. Vitreous incarceration was observed with all trocar cannula systems.ConclusionWound closure in porcine eyes was similar with all blades despite differences in incision architecture. Wound leakage occurred at low to moderate infusion pressures with most blades; no wound leakage was observed with ridged MVR blades.

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Section: Discussionsupporting

confidence: 90%

Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

Inoue

Abulon

Hirakata

2014

OPTH

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“…[ 2 ] Wound healing in 25G sclerotomies, as graded by the AS-OCT, is seen to be complete by 2 weeks to 1 month after surgery. [ 25 ] Among the gradable sclerotomies in our study, irrespective of the quadrant analyzed, the odds of having an open sclerotomy tract was found to be more than 5 in patients who had circumferential sclerotomies and a statistically significant difference was found in SNQ. Research has shown that centrifugal forces directed outward from within the eye are important for the closure of a beveled incision on the eye wall.…”

Section: Discussionmentioning

confidence: 64%

Influence of orientation of the external linear incision created by the 25-gauge trocar and related factors on sclerotomy closure: A clinical and optical coherence tomographic study

Madanagopalan

Nagesha

Khodifad

et al. 2018

Indian J Ophthalmol

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Purpose:To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS).Methods:A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed.Results:Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ≥5 when circumferential sclerotomies were used.Conclusion:Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.

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“…Since then, the instrumentation has evolved from the original 17-gauge cutter to micro-incision vitrectomy surgery (MIVS) [6, 7]. Smaller sutureless sclerotomy wounds result in less postoperative inflammation, greater postoperative patient comfort, and possibly faster postoperative visual recovery [8, 9]. On the other hand, innovations to the viewing system have included the contact lens and noncontact lens wide angle viewing systems (WAVS).…”

Section: Introductionmentioning

confidence: 99%

Outcome of primary rhegmatogenous retinal detachment using microincision vitrectomy and sutureless wide-angle viewing systems

et al. 2019

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BackgroundTo evaluate the efficacy of micro-incision vitrectomy surgery (MIVS) using Lumera and Resight non-contact sutureless wide-angle viewing systems (WAVS) for primary rhegmatogenous retinal detachment (RRD), and to analyze the anatomical and visual outcomes.MethodsThe retrospective, non-comparative, interventional case series reported here was conducted from June 2014 through November 2016. Enrolled patients presented with primary RRD and received MIVS with/without cryopexy by one surgeon using the Lumera and Resight non-contact sutureless WAVS. All patients were followed-up for a minimum of 12 months. Variables collected included patient demographics, best-corrected visual acuity, and macular status. The number and position of retinal break(s), and the use of cryopexy, were also recorded. Outcome measures included operative time, single-operation anatomical success rate, final anatomical success rate, recurrent rate, postoperative best-corrected visual acuity, and surgical complications. The end points were operative time, anatomical outcome, and functional outcome.ResultsIn total, 110 eyes from 110 patients (68 men and 42 women) were treated. Of these, 103 (93%) eyes were reattached after primary vitrectomy. One hundred ten eyes (100%) reached final anatomical success. The mean operative time was 50.55 min. Multivariate analyses were performed with best model selection principle based on general linear model by Akaike Information Criteria for detecting possible factors related to operation time, and with multivariate logistic regression analysis for revealing probable clinical parameters which might influence the anatomical outcome after first operation and final visual outcome. Intraoperative cryopexy and multiple breaks increased operative time significantly. More favorable BCVA was significantly correlated with shorter operation time and the preoperative macula-on status. Multivariate logistic regression on the group of patients who have received the cataract surgery revealed that the pre-operative BCVA is a significant factor which can predict the visual outcome after MIVS.ConclusionsThe outcome of primary RRD repaired by MIVS using the Lumera and Resight sutureless WAVS was not inferior to any other published method. This instrument combination resulted in a relatively rapid and comfortable procedure without serious postoperative complications. Cryopexy and multiple breaks affected operative time significantly. Shorter operative times and preoperative macula-on status are associated with better final visual outcomes.

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Evaluation of Wound Morphology of Sclerotomy Sites of Sutureless Vitrectomy Using Spectralis Anterior Segment Optical Coherence Tomography

Abstract: In both groups, the sclerotomy incisions showed good healing at 1-month duration. The 25-gauge sclerotomies showed better healing characteristics of wound morphology as compared with the 23-gauge sclerotomies.

Cited by 6 publications

References 18 publications

Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

Influence of orientation of the external linear incision created by the 25-gauge trocar and related factors on sclerotomy closure: A clinical and optical coherence tomographic study

Outcome of primary rhegmatogenous retinal detachment using microincision vitrectomy and sutureless wide-angle viewing systems

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