Intraoperative endoscopic observation of sclerotomy site after cannula removal for 23-gauge vitrectomy

Abstract

BackgroundThe purpose of this study was to determine the incidence of vitreous incarceration in sclerotomy after cannula removal during 23-gauge vitrectomy.MethodsThirty-seven eyes underwent 23-gauge sutureless vitrectomy. Oblique sclerotomies were made parallel to the limbus and tangentially to the sclera. Once past the trocar sleeve, the angle was changed to 90 degrees perpendicular to the surface and the trocar and cannula inserted. Vitreous gel was removed until the intraocular edge of the infusion cannula was free from the gel. The cannula was extracted with insertion of a light probe. The sclerotomy site was evaluated endoscopically through another cannula in 32 eyes; in five eyes, another infusion tube was inserted into the cannula to maintain intraocular pressure, the original infusion was removed, and the sclerotomy site observed.ResultsNo vitreous incarceration occurred in 30 (94%) eyes when one cannula was removed with insertion of a light probe, and minimal incarceration occurred in two (6%) eyes. No incarceration occurred in five eyes with observation of the infusion site.ConclusionThe incidence of vitreous incarceration is low when a light probe or vitreous cutter is inserted. Inserting the light probe through the cannula during its removal and creating an oblique sclerotomy may reduce vitreous incarceration.

Globe stability during simulated vitrectomy with valved and non-valved trocar cannulas

“… 10 A study in patients evaluating the sclerotomy site endoscopically through another cannula in 32 eyes that underwent 23-gauge non-valved cannula vitrectomy found no vitreous incarceration in 30 eyes (94%) when one cannula was removed with insertion of a light probe, with only minimal vitreous incarceration observed in the other two eyes. 11 Experimental models in porcine cadaver eyes showed that interposing a light probe through the cannula during its removal reduced the rate and severity of vitreous incarceration. 12 , 13 …”