Sclerotomy Site Leakage According to Wound Shape in 23-Gauge Microincisional Vitrectomy Surgery

Abstract

Purpose: To compare the shape and self-sealing nature of scleral incision sites according to bevel shape and trocar blade direction in 23-gauge microincisional vitrectomy surgery.

Methods: Twenty-three-gauge microincisional vitrectomies were performed in 60 eyes using a single-step entry system (Alcon Surgical, USA) and a 23-gauge two-step Eckardt vitrectomy system (DORC, the Netherlands). Trocar cannula were inserted using trocar blades bevel-up (20 eyes) or bevel-down (20 eyes). In 20 eyes, trocars were inserted after sclerotomies were performed using a microvitreoretinal (MVR) blade. After removing the cannula, we compared the scleral wound shapes and looked for leakage.

Results: A total of 180 sclerotomies were done: 60 in the bevel-up direction (group 1), 60 in the bevel-down direction (group 2), and 60 using an MVR blade (group 3). Bevel-up insertion produced a V-shaped sclerotomy wound, whereas bevel-down insertion produced a reverse V-shaped wound. The MVR blade produced a slit-shaped wound. Wound leakage was identified in 21 V-shaped wounds, seven reverse V-shaped wounds, and four slit-shaped wounds. We observed no cases of hypotony, vitreous incarceration, or endophthalmitis.

Conclusions: The self-sealing effect of slit-shaped wounds and reverse V-shaped wounds was superior to that of V-shaped wounds.

KEYWORDS::

• Bevel direction
• Sclerotomy
• Trocar blade
• 23-gauge microincisional vitrectomy
• Wound leakage

ACKNOWLEDGMENTS

No grants or sponsoring organizations have been involved in the work described in this submission. The authors have no proprietary or commercial interests related to the manuscript. It has not been published elsewhere.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.