Non-perforating Intrascleral Stabbing for Sutureless 23G Sclerotomy Closure.

Abstract

The need for suturing leaking sclerotomies have not been eliminated completely in transconjunctival sutureless vitrectomy (TSV). This study aims to describe a novel technique for 23 gauge (G) sclerotomy closure in TSV surgery and discuss its effectiveness. Two hundred and thirty cases of 180 patients who underwent 23G TSV with various diagnoses were included to the study. Cases with connective tissue diseases, thin sclera and significant conjunctival and scleral scarring were excluded. Non-perforating intrascleral stabbing (NIS) was performed to leaking 23G sclerotomies (n=650) and 27G chandeliers (n=84). Demographics, rate of sclerotomy closure with NIS procedure, the need for suturing and complications of the procedure were recorded. The overall success of NIS was found to be 91.0% in sclerotomies. While 9.1% of sclerotomies required sutures, 592 of the 650 sclerotomies could be closed with NIS procedure (p<0.001). NIS procedure helped close 98.8% of leaking 27G chandeliers. An average of 1.28+0.52 NIS attempts were needed for succesful sclerotomy closure. Closure of sclerotomies with the NIS technique were somewhat related to the location of the sclerotomy, previous history of TSV and NIS, duration of TSV, and type of endotamponade. Hypotonia and choroidal detachment were seen in 1 case. No additional interventions were needed to normalise intraocular pressure in any case. Subconjunctival hemorrhage happened to be the leading complication of the procedure. NIS procedure seems as a practical, reproducible, cost-effective and uncomplicated approach which significantly reduces the need to suture 23G sclerotomies. Further studies are required.