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M. Shimozono, A. Oishi, H. Kimakura, M. Kimakura, K. Kumagai, Y. Kurimoto; Three-Step Incisions in 23-Gauge Vitrectomy Reduce Postoperative Hypotony: A Comparison With Oblique Incisions. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4198.
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The standard sclerotomy for the 23-gauge sutureless vitrectomy is created by a straight incision at an oblique angle. In this technique, potential wound leakage and subsequent postoperative hypotony remain as common complications. To achieve a completely water-tight incision, we attempted a three-step incision in a similar way to that in cataract surgery. The aim of this study was to compare the incidence of postoperative hypotony and other complications between the two techniques.
Patients with epiretinal membrane or macular hole, and no history of previous vitrectomy were included in the study. The conventional oblique incision procedure during 23-gauge vitrectomy was performed in 27 eyes of 27 consecutive patients (mean age, 66.2 ± 9.5 years) from January through November 2007, and the three-step incision procedure in 45 eyes of 43 consecutive patients (mean age, 67.7 ± 9.6 years) from November 2007 through October 2008. The surgical procedures were performed by a single surgeon. Intraocular pressure (IOP) was measured, and each sclerotomy site was evaluated with anterior segment optical coherence tomography (OCT) on the postoperative day.
No cases of hypotony (<6 mmHg) were recorded in the three-step group on the postoperative day, compared with 3 cases (11%) in the oblique group (P < 0.05). The three-step incision resulted in significantly higher mean IOP than the conventional incision did on the postoperative day (14.1 ± 6.7 mmHg vs. 10.9 ± 3.7 mmHg, P < 0.05). There was no hypotony in any of the eyes with fluid-gas exchange (three-step group: 0 of 16 eyes, oblique group: 0 of 8 eyes). In the eyes without fluid-gas exchange, the incidence of hypotony was 0% (0 of 29 eyes) in the three-step group, and 16% (3 of 19 eyes) in the oblique group (P = 0.056). OCT examination on the postoperative day revealed the well-sealed or non-detectable sclerotomies by three-step incisions and the partially gaped sclerotomies by oblique incisions both without vitreous incarceration. The three-step technique did not increase the incidence of other postoperative complications compared with the oblique technique.
The three-step incision in 23-gauge vitrectomy effectively prevented the incidence of postoperative hypotony and demonstrated a favorable safety profile.
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