Wedge-Shaped Pars Plana Sclerotomies: Is It Still an Actuality in the Era of Microincision Vitrectomy?

Abstract

Purpose: To describe and evaluate the effectiveness of wedge-shaped sclerotomies to close 25-gauge and 23-gauge transconjunctival pars plana vitrectomies. Materials and Methods: This prospective, consecutive, interventional study examined 50 eyes of 50 patients who underwent 25-gauge and 23-gauge vitrectomy with wedge-shaped sclerotomies. Results: The number of eyes requiring a wedge shape for sclerotomy closure and sclerotomies requiring sutures was collected. Three eyes had hypotony on Day 1. No statistically significant difference was observed between preoperative intraocular pressure and postoperative intraocular pressure on Days 15 and 30. No postoperative complications were observed during the follow-up period. Conclusion: The wedge-shaped sclerotomy is a simple, fast, and effective technique that does not require extra surgical materials and could be applied to microincision vitrectomy.

Nonperforating Intrascleral Stabbing for Sutureless 23g Sclerotomy Closure

“…In this context, scleral wound hydration, adhesive application, polyethylene glycol-based hydrogel bandage, and cauterization of sclerotomy sites aim to provide closure by changing the external scleral wound configuration, whereas techniques, such as wedge-shaped sclerotomies, scleral needling, and her-metic closure, aim to reconstruct the intrascleral architecture of sclerotomy. 12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] The techniques in the first group seem to offer a reasonable closure but present some difficulties. In particular, the need to apply heat or light to polymerize thermally sensitive polymers, necessity of conjunctival dissection in some cases, and cost issues of bioadhesives can be counted among them.…”

“…Success rates with these perforating procedures, namely, wedge-shaped sclerotomies, scleral needling, hermetic closure, and refashioning of 23G sclerotomies, have been reported between 92% and 99.3%. 13,[17][18][19]29 It has been suggested that vitreous plug formation in the reconstructed sclerotomy or reversal of flow from the wound to the new opening induces sutureless closure. 13 Our NIS procedure is also related to the sclerotomy architecture and is comparable with the techniques outlined above for overall success and similarity of maneuvers.…”

“…In this context, scleral wound hydration, adhesive application, polyethylene glycol–based hydrogel bandage, and cauterization of sclerotomy sites aim to provide closure by changing the external scleral wound configuration, whereas techniques, such as wedge-shaped sclerotomies, scleral needling, and hermetic closure, aim to reconstruct the intrascleral architecture of sclerotomy. 12,13,16–29…”

“…14,15 To date, various efforts to optimize sutureless sclerotomy closure, including scleral wound hydration, application of bioadhesives and polyethylene glycolbased hydrogel bandage, cauterization of sclerotomy sites, wedge-shaped sclerotomies, transconjunctival plain gut tape procedure, scleral needling, refashioning of 23G sclerotomies, and hermetic closure, have been reported. 12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although these techniques offer bright perspectives for achieving closure of the sclerotomy, there may be potential limitations for cost and patient discomfort.…”