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Caporossi T, Governatori L, Baldascino A, Savastano A, De Vico U, Rizzo S. Wedge-Shaped Pars Plana Sclerotomies: Is It Still an Actuality in the Era of Microincision Vitrectomy? Retina 2023; 43:1811-1815. [PMID: 34101694 DOI: 10.1097/iae.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Tomaso Caporossi
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Lorenzo Governatori
- Department of NEUROFARBA, Ophthalmology, University of Florence, Florence, Italy
| | - Antonio Baldascino
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Alfonso Savastano
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Umberto De Vico
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
| | - Stanislao Rizzo
- Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy; and
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SUTURELESS CLOSURE OF 23- AND 25-GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE. Retina 2021; 40:838-844. [PMID: 30821730 DOI: 10.1097/iae.0000000000002484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery. METHODS A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed. RESULTS A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P < 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period. CONCLUSION The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.
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Rate of hypotony and intraocular pressure fluctuation immediately after intravitreal dexamethasone implantation in vitrectomized eyes. J Fr Ophtalmol 2020; 43:103-110. [DOI: 10.1016/j.jfo.2019.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
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Horowitz S, Damasceno NA, Muralha F, Pereira MB, Maia M, Damasceno EF. Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony. Clin Ophthalmol 2019; 13:1703-1710. [PMID: 31564819 PMCID: PMC6732740 DOI: 10.2147/opth.s209813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony. Methods This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony. Results Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening. Conclusion Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P<0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.
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Affiliation(s)
- Soraya Horowitz
- Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
| | - Nadyr A Damasceno
- Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
| | - Felipe Muralha
- Department of Ophthalmology, The Universidade Federal de São Paulo, Brazil
| | - Maurício B Pereira
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, The Universidade Federal de São Paulo, Brazil
| | - Eduardo F Damasceno
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
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Kanclerz P, Grzybowski A. Complications Associated with the Use of Expandable Gases in Vitrectomy. J Ophthalmol 2018; 2018:8606494. [PMID: 30581605 PMCID: PMC6276446 DOI: 10.1155/2018/8606494] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/08/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Intraocular gases have been used in vitreoretinal surgery for over 40 years. The aim of this study was to review the complications related to the use of expandable gases in vitrectomy and their management. A PubMed, Cochrane Library, and Embase search was conducted using the terms "intraocular gas" and "vitrectomy for retinal detachment." Of the articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Intraocular pressure elevation was reported in up to 58.9% patients after vitrectomy with expandable gas administration for retinal detachment. Vitreoretinal surgery is known to induce cataract development. With that, cataract progression is associated with lens exposure to intraocular gas, the duration of such exposure, patient's age, and the magnitude of vitreous removal. With intraocular gas, the posterior surface of the lens becomes a strongly refractive factor, resulting in high myopia and temporary vision impairment. Other complications related to the use of expandable gases include anterior chamber and subconjunctival gas displacement. Single reports on subretinal and cranial gas migration were published. In vitrectomy for uncomplicated retinal detachments, attempts to shift from expandable gases towards air are observed. Nevertheless, gas tamponade remains a reasonable choice for patients suffering from retinal detachment.
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Affiliation(s)
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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A PROSPECTIVE, RANDOMIZED TRIAL COMPARING PLAIN GUT TO POLYGLACTIN 910 (VICRYL) SUTURES FOR SCLEROTOMY CLOSURE AFTER 23-GAUGE PARS PLANA VITRECTOMY. Retina 2018; 38:1216-1219. [DOI: 10.1097/iae.0000000000001684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Taleb EA, Nagpal MP, Mehrotra NS, Bhatt K, Goswami S, Babalola YO, Noman A. Comparison of clinical outcome between 23-G and 25-G vitrectomy in diabetic patients. Oman J Ophthalmol 2017; 10:213-219. [PMID: 29118498 PMCID: PMC5657165 DOI: 10.4103/ojo.ojo_42_2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To compare the clinical outcomes and complications between 23-G and 25-G vitrectomy in patients with diabetic vitreous hemorrhage (VH). MATERIALS AND METHODS: A retrospective comparative study comprising 69 eyes (36 eyes in 23-G group and 33 eyes in 25-G group) of 65 patients who underwent vitrectomy with air tamponade for diabetic vitreous hemorrhage (VH) with at least 6 months of follow-up was conducted. RESULTS: There were no significant differences between the two groups in age, gender, bilaterality, type of diabetes, presence of hypertension, lens status, and previous argon laser photocoagulation state (P > 0.05). Best-corrected visual acuity (BCVA) of both groups at postoperative 1 month logarithm of the minimum angle of resolution (logMAR) (1.06 ± 0.99, 0.90 ± 0.96), 3 months logMAR (1.07 ± 0.93, 0.83 ± 0.85), and 6 months logMAR (1.03 ± 0.89, 0.83 ± 0.85) significantly improved from the preoperative BCVA logMAR (2.03 ± 0.83, 2.15 ± 0.99) for 23-G group, 25-G group, respectively (P < 0.0001). There was no significant difference in BCVA between the two groups preoperatively and at 1, 3, and 6 months postoperatively (P = 0.566, 0.506, 0.333, and 0.445, respectively), incidence of intraoperative wound suturing (21.4%, 15.2%), postoperative hypotony (0.0%, 0.0%), early postoperative VH (POVH) (11.1%, 15.2%), late POVH (5.6%, 0.0%), retinal detachment (2.8%, 6.1%), neovascular glaucoma (92.8%, 9.1%), and endophthalmitis (0.0%, 0.0%) for 23-G group, 25-G group, respectively (P > 0.05). CONCLUSION: 25-G vitrectomy is as effective for PDR as 23-G vitrectomy.
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Affiliation(s)
- Eman Abo Taleb
- Retina Foundation, Asopalav Eye Hospital, Ahmedabad, Gujarat, India
| | - Manish P Nagpal
- Retina Foundation, Asopalav Eye Hospital, Ahmedabad, Gujarat, India
| | | | - Kalyani Bhatt
- Retina Foundation, Asopalav Eye Hospital, Ahmedabad, Gujarat, India
| | - Sangeeta Goswami
- Retina Foundation, Asopalav Eye Hospital, Ahmedabad, Gujarat, India
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Küçük E, Yılmaz U, Zor KR, Kalaycı D, Sarıkatipoğlu H. Risk factors for suture requirement and early hypotony in 23-gauge vitrectomy for complex vitreoretinal diseases. Int Ophthalmol 2016; 37:989-994. [PMID: 27696087 DOI: 10.1007/s10792-016-0361-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To find out the rate of suture requirement and post-operative hypotony in a series of 23-gauge pars plana vitrectomy cases and analyze the factors affecting post-operative hypotony and leakage of sclerotomy leading to suture placement. METHODS This is a single-center retrospective interventional case series. Eighty-four eyes underwent 23-gauge vitrectomy. Primary endpoint measures were rate of leakage of 23-gauge sclerotomies requiring suture placement at the end of surgery and rate of early post-operative hypotony. Secondary endpoint measures were risk factors for early hypotony and leakage requiring suture placement at the end of surgery. RESULTS Suture placement in at least one sclerotomy because of sclerotomy leakage was required in 28.6 % (24 of 84) of eyes at the end of surgery. Early post-operative hypotony was seen in 14.3 % (12 of 84). Silicone oil endotamponade and single-step surgery were found as factors increasing the risk of sclerotomy leakage leading to suture placement. Suture placement was the only significant factor increasing the risk of early post-operative hypotony. CONCLUSION Sclerotomy sutures may be required in 23-gauge surgery, more frequently in cases of single-step sclerotomy and/or silicone oil endotamponade. Meticulous suturation of leaking sclerotomies may decrease the rate of post-operative hypotony.
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Affiliation(s)
| | | | | | - Defne Kalaycı
- Ankara Numune Training and Research Hospital, Ankara, Turkey
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Hoshi S, Okamoto F, Arai M, Hirose T, Fukuda S, Sugiura Y, Oshika T. Polyethylene Glycol-Based Synthetic Hydrogel Sealant for Closing Vitrectomy Wounds: An In Vivo and Histological Study. Transl Vis Sci Technol 2016; 5:7. [PMID: 27226931 PMCID: PMC4874449 DOI: 10.1167/tvst.5.3.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/03/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose We conducted an in vivo study using Dutch pigmented rabbit eyes to test the usefulness of polyethylene glycol (PEG) sealant for the closure of sutureless sclerotomies in microincisional vitrectomy surgery (MIVS). Methods Three-port, 23-gauge vitrectomy was performed on rabbit eyes. After air leakage was confirmed by the application of 0.625% povidone–iodine at the sclerotomy site, PEG sealant was subconjunctivally injected using a 27-gauge needle through conjunctival incisions to cover the sclerotomy wounds, following which it was polymerized by the application of xenon light for 60 seconds. Ophthalmological examinations and intraocular pressure measurements were conducted the day before and 1, 3, 5, and 7 days after surgery. The eyes were enucleated for histological evaluation 7 days after surgery. Results PEG sealant was rapidly polymerized by the application of xenon light after subconjunctival injection, and it firmly sealed the sclerotomies without air leakage, as confirmed by povidone–iodine dropping, in all cases. Conjunctival and scleral wounds closed with PEG sealant were successfully attached and remained intact till the end of the follow-up period. There was no sign of postoperative hypotony or infection in any eye, and no adverse effects of PEG sealant were found. In histological examination, linear scar formation and eosinophilic staining of collagen fibers were observed at the sclerotomy sites, while the sclerotomy tunnels appeared tightly closed. Conclusions PEG sealant can be useful for the closure of sutureless 23-gauge vitrectomy incisions in rabbits. Translational Relevance The PEG sealant may become an effective option for closing vitrectomy incisions including pediatric cases.
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Affiliation(s)
- Sujin Hoshi
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mikki Arai
- Arai Eye Clinic, Fukuoka, Japan ; The Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Tatsuo Hirose
- The Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA ; Boston Eye Group, Brookline, MA, USA
| | - Shinichi Fukuda
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshimi Sugiura
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Celik E, Sever O, Horozoglu F, Yanyalı A. Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy. Clin Ophthalmol 2016; 10:903-10. [PMID: 27274192 PMCID: PMC4876088 DOI: 10.2147/opth.s95145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results The mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. Conclusion The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.
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Affiliation(s)
- Erkan Celik
- Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Ozkan Sever
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Fatih Horozoglu
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ates Yanyalı
- Haydarpasa Numune Medical Education and Research Hospital, Istanbul, Turkey
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Alagöz N, Alagöz C, Yılmaz I, Yıldırım Y, Baz Ö, Altan Ç, Yazıcı AT, Taşkapılı M. Immediate Intraocular Pressure Changes Following Intravitreal Dexamethasone Implant. J Ocul Pharmacol Ther 2016; 32:44-9. [DOI: 10.1089/jop.2015.0087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Neşe Alagöz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Alagöz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Yılmaz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yıldırım
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ökkeş Baz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Çiğdem Altan
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
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