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Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.
Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.
AIM: To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. METHODS: Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. RESULTS: A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. CONCLUSION: In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.
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