PURPOSE: To investigate the in vivo sutureless vitrectomy incision architecture using optical coherence tomography (OCT) in the immediate postoperative period. DESIGN: Prospective, randomized, observational case series.
METHODS: 35 patients underwent three-port pars plana vitrectomy using 23-gauge instrumentation combined with 25-gauge infusion at the Wenzhou Eye Hospital. All incisions were evaluated using the Carl Zeiss Visante anterior segment OCT imaging system within 5 hours postoperatively. The main outcome measures were wound architecture (eg, the length and angle of the incision, presence of gaping), and presence of cilio-choroidal detachment and vitreous incarceration. Seidel test and intraocular pressure (IOP) measurements were performed immediately afterward. Surgical parameters were also recorded.
RESULTS: The mean incision length was 1.15±0.22 mm (range 0.80 to 1.55 mm). The mean incision angle was 54.6±13.0 degrees (range 28.6 to 80.7 degrees). No statistical difference in incision length or angle was found between different quadrants or between 25 gauge and 23 gauge. The presence of internal or external gaping and misalignment of the roof and floor of the incisions accounts for 38.1% loss of wound apposition in a bidimensional image. 4 eyes (11.4%) had local shallow cilio-choroidal detachment and 2 eyes (5.7%) had minimal vitreous incarceration. The mean postoperative IOP was 12.1±6.2 mmHg (range 3.5 to 28.0 mmHg). IOP was significantly higher in eyes with good wound apposition than in those with loss of wound apposition (P=.011). One of 4 eyes with hypotony presented leakage with positive Seidel test and gaping of incisions in OCT image.
CONCLUSIONS: OCT architectural features of gaping, misalignment and great variation in incision angle theoretically reduce the security of sutureless sclerotomy in the immediate postoperative period. These features appeared to predispose lower IOP and higher risk of wound leakage |
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