Wound construction.

Abstract

Wound construction is critical in microincision vitrectomy surgery. The three main steps in constructing a proper wound include displacing the conjunctiva away from the sclera, flattening the sclera on insertion, and angling the incision. Each one of these steps helps create wounds that will not leak. Misaligning the conjunctiva from the scleral hole prevents a vitreous wick from extending external to the conjunctiva. Flattening the sclera on trocar insertion provides a longer wound cord length, which is less likely to leak, and angling the incision has been proven to seal better in both anterior and posterior segment incisions. When you make an angled incision, you initially insert the blade at a 30° angle (at least). This will make the wound more stable because it is less likely to cause internal disruption of the wound edges. These three basic steps are simple, but very important to follow when constructing a microincision wound in order to limit postoperative complications including wound leakage, gas leak, hypotony, and endophthalmitis.