Sclerotomy Sites Research Articles

ENDODIATHERMY PLUS PHOTOCOAGULATION AS TREATMENT OF SCLEROTOMY SITE VASCULARIZATION SECONDARY TO PARS PLANA VITRECTOMY FOR PROLIFERATIVE DIABETIC RETINOPATHY

To evaluate the results of surgery with pars plana vitrectomy (PPV), endodiathermy of sclerotomy site fibrovascularization and adjuvant photocoagulation of the peripheral retina to the pars plana as treatment of recurrent vitreous hemorrhage secondary to PPV for proliferative diabetic retinopathy (PDR). Tertiary care center, Barraquer Center of Ophthalmology, Barcelona, Spain. Prospective interventional study of 14 eyes of 14 consecutive patients aged 20 years to 47 years with recurrent vitreous hemorrhage because of sclerotomy site neovascularization secondary to PPV for PDR. All patients were treated by cataract, or transparent lens, extraction with intraocular lens implantation plus 20-gauge PPV of the vitreous base, including incarcerated vitreous of the sclerotomy site, together with endodiathermy of sclerotomy site fibrovascular tissue and adjuvant photocoagulation to the pars plana. Preoperative evaluation was performed by 20-MHz, high-resolution, anterior-segment ultrasonography of the neovascularized sclerotomy sites, pre- and postoperative visual acuity (logarithm of the minimum angle of resolution), and postoperative rebleeding rates. Recurrent vitreous hemorrhage appeared 8 ± 4 months after the initial PPV for PDR. Ten (71%) patients had isolated vascularization of a single sclerotomy site and 4 (29%) had vascularization of 2 sclerotomy sites. Nine of the 18 vascularized sites (50%) corresponded to optical fiber sclerotomies, 7 (39%) to vitreotome, and 2 (11%) to infusion sclerotomies. All the neovascularized sclerotomies presented sentinel vessels in the anterior segment. No patient showed postoperative recurrent vitreous hemorrhage during follow-up of 23 ± 10 months; all showed improved visual acuity, from initial 2.23 (±1.13 standard deviation) to final 0.23 (±0.09 standard deviation). According to our study, the technique of choice for the treatment of recurrent vitreous hemorrhage secondary to PPV for PDR is endodiathermy of sclerotomy site fibrovascularization and adjuvant photocoagulation of the peripheral retina to the pars plana. This technique treats the etiology of the problem, improves final best-corrected visual acuity, and, most importantly, helps prevent recurrent bleeding.

Effect of silicone oil removal on central corneal thickness.

To evaluate the effect of silicone oil removal(SOR) on central corneal thickness(CCT) in aphakic and pseudophakic eyes prospectively. Patients who underwent SOR surgery between June 2005 - August 2007 were included in this study. Silicon oil was actively removed behind the posterior capsule through the pars plana sclerotomy site (posterior approach) in pseudophakic eyes and through the pupil and the corneal tunnel incision (anterior approach) in aphakic eyes with the 18-gauge cannula. CCT was assessed with Orbscan II corneal topography system preoperatively and at one month and three months postoperatively. A total of 34 eyes of 34 patients (26 males, 8 females) comprised the study group. Mean age was (55.6±12.3) years (Range: 25-80 years). Twenty-six eyes (76.5%) were pseudophakic and 8 (23.5%) aphakic. Mean time between silicone oil injection and removal was (15.1±13.6) months (Range: 5-54 months). At baseline, CCT was 576.4±46.0µm in pseudophakic eyes and 611.6±36.2µm in aphakic eyes. At the first postoperative month CCT was (573.3±40.1)µm and (630.9±72.9)µm in pseudophakic and aphakic eyes respectively. At the third postoperative month, CCT was (582.7±49.5)µm and (614.5±82.4)µm in pseudophakic and aphakic eyes respectively. There was no statistically significant difference in CCT measurements one month and 3 months after SOR when compared to preoperative values in both aphakic and pseudophakic eyes (P>0.05). Active SOR either by anterior or posterior approach did not affect the CCT.

The 1-year incidence of rhegmatogenous retinal detachment post 23-gauge pars plana vitrectomy

ObjectiveThe purpose of this study was to evaluate the 1-year incidence of retinal tear or retinal detachment following 23-gauge pars plana vitrectomy (PPV) for epiretinal membrane (ERM), macular hole (MH), or vitreomacular traction (VMT). MethodsA retrospective chart review of all patients who underwent 23-gauge PPV for ERM, MH, or VMT between January 1, 2007, and December 31, 2007, was performed. Inclusion criteria included age greater than 50 years and absence of other significant ocular pathology. Exclusion criteria included confounding retinal pathology, laser treatment at the time of surgery, previous laser treatment of the retina, or previous PPV. ResultsA total of 272 eyes of 268 patients were eligible for inclusion: 159 eyes (58%) had the diagnosis of ERM; 108 (40%) had MH; and 5 (2%) had VMT. The average patient age was 70 years. Of the patients, 15 required additional surgery related to persistent macular pathology within 1 year (5 with ERM, 10 with MH). The incidence of retinal detachment after surgery was 1.1% (3 eyes of 3 patients). The mean time duration prior to development of retinal detachment was 159 days (range, 19 to 333 days). ConclusionsThe 1-year incidence of rhegmatogenous retinal detachment post 23-gauge vitrectomy for repair of macular pathology without prophylactic laser of sclerotomy sites is approximately 1%.

EVALUATION OF MICROINCISION VITRECTOMY WOUNDS MADE WITH MICROVITREORETINAL BLADE OR BEVELED TROCAR BY SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY

To compare the wound closure and postoperative hypotony after sclerotomy with a microvitreoretinal (MVR) blade trocar with those with a beveled trocar for microincision vitrectomy. The study design is a prospective randomized control study. Forty eyes of 40 patients with an epiretinal membrane that underwent 25-gauge transconjunctival sutureless vitrectomy were studied. One hundred and twenty sclerotomies were observed by swept source optical coherence tomography at 3 hours and at 1, 3, 7, and 14 days postoperatively. A closure of the sclerotomy site was defined as an absence of a scleral gap in the swept source optical coherence tomography images. The closure rate of the sclerotomies, intraocular pressures, and the incidence of complications were compared between the sclerotomies performed with an MVR blade and those with a beveled trocar. The rates of sclerotomy closure at 3 hours and at 1, 3, 7, and 14 days were 30.0%, 38.3%, 43.3%, 66.7%, and 95.0% with the MVR blade trocar and 21.7%, 26.7%, 36.7%, 53.3%, and 86.7% with the beveled trocar, respectively (P > 0.05 for all, Fisher exact test). The mean size of the sclerotomy was 143.9 ± 45.5 μm with the MVR blade and 158.7 ± 61.7 μm with the beveled trocar (P = 0.55, Mann-Whitney U test). The mean angle of the sclerotomies was significantly larger with the MVR blade trocar (48.9° vs. 45.8°; P = 0.049, Mann-Whitney U test). No significant difference in the speed of wound closure was found between the 2 groups (P = 0.174). Hypotony was not observed in both groups, and the intraocular pressure did not differ significantly between the two groups. The absence of significant better rates of self-sealing and faster recovery of sclerotomies made with the MVR blade trocar and the bevel trocar indicates that these factors are not related to the type of trocar.

Vitreous Incarceration in Patients Undergoing Second 20-Gauge Pars Plana Vitrectomy for Recurrent Retinal Detachment

Purpose. To observe and classify vitreous incarcerations in patients undergoing second 20-gauge pars plana vitrectomy (PPV) for recurrent retinal detachment. Methods. Retrospective noncomparative consecutive case series. Eighty-two consecutive patients with recurrent retinal detachment were included. The previous sclerotomy sites were examined by our sclera depression method and the vitreous incarceration were classified into Grade 0–IV by their severity under surgical microscope before second surgery. The relationship of vitreous incarceration and different ports was statistically investigated in our included patients. Results. Vitreous incarceration in the previous sclerotomy sites were found frequently. Vitreous cutter sites were most involved, but the infusion pipe sites were the least. According to our classification and definition, Grade III and IV of vitreous incarceration in all the three different sclerotomy sites accounted for 32.5%. Grade II of vitreous incarceration consisted of 12.6%. Grade 0 and I in all the three different sclerotomy sites were 54.8%. The frequency of all grades of vitreous incarceration in light port or vitreous cutter port was significant higher than that in infusion port. Conclusions. Vitreous incarceration in light port and vitreous cutter port are found more common than in infusion port for 20-gauge PPV with our new method.

INTRAOPERATIVE ENDOLASER RETINOPEXY AROUND THE SCLEROTOMY SITE FOR PREVENTION OF RETINAL DETACHMENT AFTER PARS PLANA VITRECTOMY

To investigate whether intraoperative endolaser retinopexy around the sclerotomy site during pars plana vitrectomy can prevent the postoperative complication of retinal detachment (RD). Two hundred and seventy-eight patients who had undergone 20-gauge pars plana vitrectomy for various vitreoretinal disorders were investigated retrospectively. Patients who had rhegmatogenous RD and who underwent panretinal photocoagulation for diabetic retinopathy were excluded. In Group 1, 152 patients had not undergone laser retinopexy around the sclerotomy site, and in Group 2, 126 patients had undergone laser retinopexy around the sclerotomy site. The incidence rates of postoperative RD were compared. In Group 1, 7 cases (4.6%) of RD developed: 6 cases (3.9%) of sclerotomy-related retinal breaks, and 1 of a sclerotomy-unrelated retinal break. In Group 2, superior RD developed in 1 case (0.8%), but no sclerotomy-related retinal break was observed. Endolaser retinopexy around the sclerotomy site is relatively simple to perform, without inducing particular complications. It is expected to reduce the development of postoperative RD (4.6% vs. 0.8%; P = 0.08) and especially sclerotomy-related RD (3.9% vs. 0%; P = 0.03).

COMBINED 23-GAUGE SUTURELESS VITRECTOMY AND CLEAR CORNEAL PHACOEMULSIFICATION IN PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY

To evaluate the results and complications of combined 23-gauge sutureless vitrectomy, clear corneal phacoemulsification, and intraocular lens implantation in patients with proliferative diabetic retinopathy. This was a retrospective, consecutive, noncomparative, interventional case series of 136 eyes of 108 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the complications of proliferative diabetic retinopathy. The main outcome measures were visual outcomes and surgical complications. Main indications for the combined surgery were vitreous hemorrhage (78 eyes, 57.4%) and tractional retinal detachment (36 eyes, 28.7%). The logarithm of the minimum angle of resolution visual acuity (mean ± SD) improved from 0.86 ± 0.59 preoperatively to 0.39 ± 0.52 six months postoperatively (P < 0.0001). Intraoperative retinal tear occurred in 7 eyes (5.1%) and postoperative vitreous hemorrhage in 10 eyes (7.5%). Even in the absence of suturing of sclerotomy sites, only 1 eye (0.7%) had postoperative hypotony (<6 mmHg). During the 6 months after surgery, only 1 eye (0.7%) developed neovascular glaucoma and 6 eyes (4.4%) required a repeat vitrectomy (3 for retinal detachment and 3 for vitreous hemorrhage). Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification in patients with proliferative diabetic retinopathy was safe and effective. It may have not only the known advantages of conventional combined surgery but also additionally those such as faster visual rehabilitation and less conjunctival fibrosis.

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

To investigate cases with conjunctival pigmentation originating from sclerotomy sites after 23-gauge microincisional vitrectomy surgery (MIVS). This is a retrospective study comprised of 185 eyes from 185 consecutive patients who underwent 23-gauge MIVS. The authors investigated the incidence and the clinical factors associated with conjunctival pigmentation, including indication of vitrectomy and surgical procedures. Eight eyes (4.3%) from 185 eyes showed conjunctival pigmentation after surgery within 7 days postoperatively. Light microscopic examination of excised tissue showed infiltration of abundant dark brownish colored melanophages with surrounding scattered, finely granular, melanin pigments. C3F8 gas tamponade (OR, 9.4; 95% CI, 1.9-44.5; P=0.005) was significantly associated with conjunctival pigmentation. The mean surface area (21.26±2.21 mm(2)) of three eyes with C3F8 tamponade was significantly larger than that of five eyes (2.51±0.73 mm(2)) without tamponade (P=0.025). Neither leakage nor hypotony was found. Intraocular melanin pigments could prolapse through the sclerotomy site and cause conjunctival pigmentation after 23-gauge MIVS. Thus, preoperative warning is necessary in patients with 23-gauge MIVS.

Surgical management of silicone oil migrated into suprachoroidal space after vitrectomy.

To report a successful surgical management of silicone oil migrated into suprachoroidal space after the repair of the retinal detachment with hemorrhagic choroidal detachment. Retrospective observational case report. A 30-year-old man with retinal detachment and hemorrhagic choroidal detachment due to severe corneal penetrating injury, underwent a pars plana lensectomy and vitrectomy, endolaser, and silicone oil tamponade followed by transscleral suprachoroidal hemorrhage drainage in the right eye. One week later, a localised temporal choroid elevation was noted. This persistent elevation was confirmed by operation research to be silicone oil migration into suprachoroidal space. The migrated silicone oil was drained via trans-scleral cut down, and the intravitreal silicone oil was removed and replaced by 16% C2F6. Over the next 2 weeks, the elevation vanished and the choroid became completely flat. The migration of silicone oil into suprachoroidal space is a rare complication of vitrectomy. The pathway of the migration is most likely through internal orifice of sclerotomy sites. Trans-scleral drainage surgery is an effective method to remove the migrated silicone oil from suprachoroidal space.

Endodiathermy plus photocoagulation as treatment of sclerotomy site vascularization secondary to vitrectomy for diabetis

Endodiathermy plus photocoagulation as treatment of sclerotomy site vascularization secondary to vitrectomy for diabetis

Comparative study of 23-gauge vitrectomy versus 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment

To compare the safety and efficacy of 20- and 23-gauge pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RD) with proliferative vitreoretinopathy (PVR) grade B or less. This comparative nested case-control study included 35 consecutive 23-gauge transconjunctival PPV cases matched (1:1) with 35 cases of 20-gauge PPV (from a prospective cohort of 1,150 patients) for the baseline visual acuity (VA), axial length, lens and macular status, the location and number of breaks, and PVR grade. All patients had complete PPV, cryotherapy, fluid-gas exchange, and a minimum follow-up of 6months. The exclusion criteria were eyes with previous vitreoretinal surgery, combined vitrectomy and cataract surgery, RD secondary to trauma or macular hole, diabetic retinopathy, aphakic eyes, giant tears, or posteriorly located breaks precluding treatment using transconjunctival cryotherapy. Baseline examination disclosed pseudophakia in 77.1%, high myopia in 11.4%, 2.7 ± 2.2 retinal breaks/eye, attached macula in 37.1%, and PVR grade B in 24.3% of the cases. The mean operative time and intraoperative complication rate (11.4%) were similar in both groups. In the 23-G group, we noted three cases of iatrogenic retinal tears and one case of choroidal detachment secondary to a dislodgment of the infusion line. Suturing the sclerotomy sites or the conjunctiva was required in 5.7 and 51% of the eyes, respectively. The single reattachment rate was similar in both groups, 74.3% in the 20-G group, and 80% in the 23-G group. The final anatomical success rate was 97% in the two groups. Mean preoperative VA of 1.2 ± 0.9 logMAR improved similarly in both groups to 0.4 ± 0.4 at the 6-month visit. A final vision of 20/40 or better was achieved similarly in 62.9% of the eyes in the 20-G group and 60% in the 23-G group. Twenty-three-gauge PPV provides anatomical and visual results similar to the 20-G technique for the management of uncomplicated rhegmatogenous RD.

EFFECT OF INTRAVITREAL GAS TAMPONADE FOR SUTURELESS VITRECTOMY WOUNDS

To investigate the effect of gas tamponade on wound closure and postoperative hypotony by comparing fluid-filled and gas-filled eyes after 25-gauge sutureless vitrectomy using three-dimensional corneal and anterior segment optical coherence tomography. Twenty-four eyes of 24 patients who underwent a 25-gauge transconjunctival sutureless vitrectomy were included in this prospective study. A total of 72 scleral wounds were observed using three-dimensional corneal and anterior segment optical coherence tomography at 3 hours and at 1, 3, 7, and 14 days postoperatively. Scleral wound closure was defined as the absence of a scleral gap at the sclerotomy site, as observed using three-dimensional corneal and anterior segment optical coherence tomography. The rate of wound closure, intraocular pressure, and the incidence of complications were compared between the fluid- and gas-filled eyes. The rates of scleral wound closure at 3 hours and at 1, 3, 7, and 14 days were 26.2%, 28.6%, 35.7%, 52.4%, and 85.7% in fluid-filled eyes and 53.3%, 73.3%, 76.7%, 83.3%, and 93.3% in gas-filled eyes; these rates were significantly higher for the gas-filled eyes. The intraocular pressure was significantly higher in the gas-filled eyes than in the fluid-filled eyes on postoperative Day 1 but did not differ significantly between the 2 groups on postoperative Day 3 and thereafter. Three-dimensional corneal and anterior segment optical coherence tomography provided clear images of 25-gauge sutureless vitrectomy wounds and revealed that the sclerotomies closed faster in gas-filled eyes than in fluid-filled eyes. Thus, gas tamponade might be effective for the closure of sutureless vitrectomy wounds.

Miyake-Apple view of inner side of sclerotomy during microincision vitrectomy surgery

To examine the inner surface of the sclerotomy during microincision vitrectomy surgery by Miyake-Apple view. The anterior half of porcine eyes was attached to a transparent acrylic plate with cyanoacrylate glue. Then, either a 23-gauge or a 25-gauge trocar-cannula was inserted through the sclera obliquely. The inner surface of the entrance site was observed posteriorly by Miyake-Apple view. These images were compared with the endoscopic view of two patients who underwent vitreous surgery for an epiretinal membrane. When the trocar-cannula was inserted obliquely, the Miyake-Apple view showed that the ciliary epithelium at the sclerotomy site was stretched. When the trocar-cannula was inserted vertically, the ciliary epithelium was folded, and the folds remained even after the trocar was removed. Vitreous strands were seen incarcerated into the sclerotomy site. In human eyes, a folding of the ciliary epithelium was not clearly seen with the endoscopic view but the incarcerated vitreous was seen. The Miyake-Apple view provided a precise, in vivo, observation of the inner surface of the entry site. It disclosed the morphological stress on the ciliary epithelium by the sclerotomy.

Non-vitrectomizing vitreous surgery for premacular haemorrhage

We report three cases illustrating an alternative treatment option for premacular haemorrhage. This retrospective interventional case study included three eyes in three patients with premacular haemorrhage caused by idiopathic thrombocytopenic purpura in the first case, trauma in the second case and retinal arterial macroaneurysm in the third case. All patients underwent non-vitrectomizing vitreous surgery. Visual acuity as well as slit-lamp and indirect ophthalmoscopic examinations were performed pre- and postoperatively to evaluate the resolution of premacular haemorrhage and changes in lenticular opacity. At postoperative day 1, visual acuity had improved from counting fingers (CF) to 6/12 in case 1, from CF to 6/20 in case 2 and from CF to 3/60 in case 3. Examination of the fundus showed resolution of the premacular haemorrhage with mild vitreous haemorrhage in all cases. Final best corrected visual acuities were 6/6, 6/7.5 and 6/15, respectively. The lens remained clear in two of two phakic eyes at the last follow-up visit. In these selected cases, non-vitrectomizing vitreous surgery was a useful and safe alternative for the treatment of premacular haemorrhage.

INTRAOCULAR GAS DYNAMICS AFTER 20-GAUGE AND 23-GAUGE VITRECTOMY WITH SULFUR HEXAFLUORIDE GAS TAMPONADE

The purpose of this study was to evaluate the intraocular gas dynamics after 23-gauge transconjunctival sutureless vitrectomy (TSV) as compared with 20-gauge pars plana vitrectomy (PPV). A consecutive series of 290 eyes that experienced 20-gauge or 23-gauge vitrectomy with 25% sulfur hexafluoride (SF6) gas tamponade were retrospectively reviewed. Intraocular gas bubble size on postoperative Day 1 and Gas50, the interval to dissipate to a 50% gas fill, were evaluated. The mean intraocular bubble size on postoperative Day 1 was 92.0 ± 8.3% in the 20-gauge PPV cases and 83.8 ± 13.7% in the 23-gauge TSV cases (P < 0.001). The mean Gas50 was 8.6 ± 1.6 days in the 20-gauge PPV cases and 6.6 ± 2.2 days in the 23-gauge TSV cases (P < 0.001). Thorough peripheral vitrectomy and 23-gauge TSV were significantly associated with Gas50 ≤ 4 days (odds ratio, 4.62 and 16.8; P = 0.036 and P = 0.007, respectively). Among thoroughly vitrectomized eyes, 13 eyes treated with 23-gauge PPV with intraoperative suture placement at the sclerotomy sites had gas longevity comparative to those with 20-gauge PPV. Eyes treated with 23-gauge TSV tend to have earlier gas disappearance or incomplete gas fill. Intraoperative suture placement would be a solution.

Histological changes in the healing process of sclerotomy sites after 20-gauge and transconjunctival 23- and 25-gauge incisions in experimental model*

To evaluate the healing mechanism and histological changes of the 20-gauge standard, and 23- and 25-gauge transconjunctival sutureless vitrectomy (TSV) incisions in rabbits. Materials and methods: Twelve of 16 albino rabbits’ right eyes underwent sclerotomy of either 20-gauge standard, or 23-gauge or 25-gauge TSV incisions. Four rabbits were tested as controls. The study eyes were examined clinically on the first postoperative day and in 3-day periods for 2 weeks. After 2 weeks, rabbits were euthanized; globes were enucleated and underwent histological examination. The sclerotomy sites were investigated histopathologically under light microscope for wound healing semicantitatively. Results: Pathological sections were examined to monitor the healing course of the sclerotomy sites. Edema, mononuclear inflammatory cell infiltration, fibroplasia, foreign body reaction, neovascularization, and reactive-regenerative changes on ciliary body were evaluated and scored. Fibroplasia and reactive-regenerative changes on ciliary body were statistically significant in eyes treated with 20-gauge standard sclerotomy (P < 0.05). For foreign body reaction results, there was no statistically significant difference between all groups (P > 0.05). Conclusion: Conventional 20-gauge sclerotomies required conjunctival peritomy and suturing. Transconjunctival 23-gauge and 25-gauge sclerotomy incision procedures without sutures and peritomy decrease overall surgical time, avoid the local inflammatory reaction to the suture materials, decrease postoperative inflammation, and support rapid healing recovery.

Aggressive amelanotic choroidal melanoma with extrascleral extension after brachytherapy.

The purpose of this study was to report a case of amelanotic choroidal melanoma, previously treated with brachytherapy, subsequently exhibiting local extension through pars plana vitrectomy sites. The authors present a retrospective interventional case report from a clinical practice. An amelanotic choroidal melanoma, previously responsive to brachytherapy, underwent two pars plana vitrectomies for nonclearing vitreous hemorrhage with double-freeze cryotherapy to sclerotomy sites. Recurrent melanoma extended through the sclerotomies presenting as subconjunctival nodules requiring exenteration. Vitrectomy sclerotomy sites may serve as a route of extrascleral extension in previous brachytherapy treatment-responsive choroidal melanomas. Caution should be exercised in performing vitrectomy for choroidal melanomas with subsequent vitreous hemorrhage.

Ultrasound Biomicroscopy Imaging of Sclerotomy in Children with Cataract Undergoing 25-Gauge Sutureless Pars Plana Anterior Vitrectomy

To investigate the healing course and features of sclerotomy in children with cataract undergoing 25-gauge sutureless pars plana anterior vitrectomy by ultrasound biomicroscopy (UBM) imaging. 25-Gauge sutureless pars plana anterior vitrectomy was performed in 15 eyes for congenital or developmental cataract surgery (mean age 6.9 years, range 5-10 years). Time of anterior vitrectomy, intraoperative and postoperative clinical observations, postoperative complications, and UBM imaging of sclerotomy sites were evaluated. The mean time of anterior vitrectomy was 40.9 seconds (range 26-53 seconds). A stable intraocular pressure and a slight disturbance on vitreous were found intraoperatively. Postoperative inflammation in anterior chamber was mild with fast postoperative recovery. Fluid leakage, vitreous incarceration, hypotony, or any other complications were not noted in any of the eyes. UBM imaging showed that the sclerotomy was detected as a gape through the sclera on day 3 and decreased in size obviously on day 7 after surgery. The internal opening of the gape was cured on postoperative week 2 with inability to detect its internal lip. The scleral wounds in 11 (73.3%) of the eyes were undetectable at week 3 by UBM imaging and all sclerotomy sites were cured at week 4 postoperatively. UBM imaging on pediatric cataract eyes showed that healing of a 25-gauge sclerotomy was rapid and no leakage or vitreous incarceration from the scleral wound was found.

Closure of Sclerotomies after 25- and 23-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy Evaluated by Optical Coherence Tomography

Aims: To evaluate sclerotomy closure after 25- and 23-gauge transconjunctival sutureless pars plana vitrectomy using optical coherence tomography (OCT). Methods: Forty-eight eyes (20 with a macular hole and 28 with an epiretinal membrane) of 47 patients (mean age, 66.5 years) who underwent one of the two procedures were included. Three sclerotomy sites in each eye were measured by cross-sectional OCT images vertical and parallel to the limbus on weeks 1 and 2 and months 1, 2 and 3 postoperatively. Results: After 25-gauge vitrectomy, the scleral wounds evaluated by OCT closed in 40.6% of the eyes at 1 week, 53.3% at 2 weeks, 60.5% at 1 month, 63.6% at 2 months and 63.9% at 3 months. There were significant differences in the closure rates between 1 week and 1 month (p = 0.015), 2 months (p = 0.007) and 3 months (p = 0.006) postoperatively. After 23-gauge vitrectomy, the scleral wounds closed in 31.6% of the eyes at 1 week, 50.0% at 2 weeks, 57.4% at 1 month, 63.0% at 2 months, and 61.1% at 3 months postoperatively. There were significant differences in the closure rates between 1 week and 1 month (p = 0.011), 2 months (p = 0.001) and 3 months (p = 0.002) postoperatively. The wound closure rates did not differ significantly between the two procedures. Conclusions: Scleral wounds after 25- and 23-gauge transconjunctival sutureless pars plana vitrectomy can be evaluated with OCT. Wound healing seems to be complete 2 weeks postoperatively.

THE SAFETY AND EFFICACY OF PASSIVE REMOVAL OF SILICONE OIL WITH 23-GAUGE TRANSCONJUNCTIVAL SUTURELESS SYSTEM

To evaluate the safety and efficacy of passive removal of silicone oil with 23-gauge (G) transconjunctival sutureless system. This is a single-center, prospective, interventional, randomized control study. Forty eyes of 40 patients were enrolled in this study and randomized into 2 groups. Group 1 (n = 20) patients underwent passive removal of silicone oil with 23-G transconjunctival sutureless system. Group 2 (n = 20) underwent 20-G active silicone oil removal using all three 20-G ports. In both groups, air-fluid exchange was performed and the globe was left air filled at the end of surgery. All eyes in both groups received 360 degrees endolaser. We recorded surgical time, time for silicone oil removal, number of sutured 23-G sclerotomy sites, presence of preoperative scarring at sclerotomy site, postoperative hypotony, endophthalmitis, and inflammation at sclerotomy site. Opening and closing times were significantly shorter in Group 1 than in Group 2. Only 3 cases (15%) in Group 1 required 1 additional suture each in the superior sclerotomy site. Both groups were similar in safety in terms of chance of endophthalmitis, redetachment rate, and postoperative hypotony. Only 1 patient of Group 1 (5%) and 5 patients of Group 2 (25%) showed significant conjunctival inflammation at the end of 2 weeks. Passive removal of silicone oil with 23-G transconjunctival sutureless system may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. It is a safe and effective procedure when compared with 20-G active silicone oil removal for 1000 centistoke oil.