Sutureless Vitrectomy Incision Architecture in the Immediate Postoperative Period Evaluated In Vivo Using Optical Coherence Tomography

Abstract

To investigate the in vivo sutureless vitrectomy incision architecture using optical coherence tomography (OCT) in the immediate postoperative period. Prospective, observational case series. Thirty-five patients underwent 3-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 (Dublin, CA) anterior segment OCT imaging system within 5 hours postoperatively. Wound architecture (e.g., the length and angle of the incision, presence of gaping), and presence of ciliochoroidal detachment and vitreous incarceration. Seidel test and intraocular pressure (IOP) measurements were performed immediately afterward. Surgical parameters were also recorded. The mean incision length was 1.15 ± 0.22 mm (range, 0.80-1.55). The mean incision angle was 54.6 ± 13.0 degrees (range, 28.6-80.7). No difference in incision length or angle was found between different quadrants or between 25-gauge and 23-gauge instrumentation. The presence of internal or external gaping and misalignment of the roof and floor of the incisions accounted for 38.1% loss of wound apposition in a bidimensional image. Four eyes (11.4%) had shallow local ciliochoroidal detachments and 2 eyes (5.7%) had minimal vitreous incarceration. The mean postoperative IOP was 12.1 ± 6.2 mmHg (range, 3.5-28.0). The IOP was significantly higher in eyes with good wound apposition as opposed to those with loss of wound apposition (P = 0.011). Of the 4 eyes with hypotony, only 1 presented with leakage, as demonstrated by a positive Seidel test, and incision gaping, as shown by OCT imaging. The architectural features of gaping, misalignment, and great variation in incision angle on OCT theoretically reduce the security of sutureless sclerotomy in the immediate postoperative period. These features presumably predispose the patient to lower IOP and greater risk of wound leakage.