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C. J. Chen, A. Lin, D. Ghate, Z. M. Robertson, R. Chiu, K. Turaga; Factors Affecting Wound Leakage in 23-Gauge Sutureless Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2066.
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To evaluate risk factors for sclerotomy leakage in 23-gauge sutureless pars plana vitrectomy.
This was a nested case control study with 219 patients that underwent 23-gauge sutureless vitrectomy at the University of Mississippi Medical Center from January 2007 to January 2008. There were 48 cases with wound leaks (defined as visible on-table sclerotomy leakage needing sutures) and 171 controls without wound leaks. Patients received either a conventional sclerotomy incision (CSI) at 45° which was then changed to 90° mid-incision or an extremely oblique sclerotomy incision (OSI) at 10° which was then changed to 30° mid-incision. The main outcome measure was wound leakage on table after surgery. Risk factors studied included age, gender, laterality, duration of surgery, sclerotomy incision (OSI vs. CSI), preoperative diagnosis (surgery for epimacular membranes (EMM) and macular holes (MH) vs. surgery for diabetic retinopathy(DR) and retinal detachment(RD)), and primary surgeon (attending vs. supervised resident).
Multivariate logistic regression analysis found that significant (p≤0.05) factors that were protective for wound leakage included preoperative diagnosis of EMM or MH(Odds ratio (OR) = 0.03, 95% confidence intervals (CI) = 0.004 - 0.3) and OSI (OR = 0.3, CI = 0.1-0.8). Surgical duration of 45 minutes or longer (OR = 2.5, CI = 1.0-6.4) was also a significant risk factor for wound leakage.
Increased duration of surgery and a preoperative diagnosis that requires increased intraocular manipulation (DR and RD as compared to EMM and MH) predispose to increased sclerotomy wound leakage in 23 G sutureless vitrectomy. An extremely oblique sclerotomy incision (10° which was then changed to 30° mid-incision) protects against wound leakage.
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