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L. J. Rao, S. S. Huang, P. J. Ferrone; A Histopathologic and Endoscopic Analysis of Transconjunctival Sutureless Vitrectomy Wounds. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2240.
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The purpose of this experiment was to analyze wounds generated by 3 different 23-gauge transconjunctival sutureless surgical systems. 20-gauge technique has classically been utilized, but with the advent of 23 and 25-gauge technology, vitreoretinal surgery is now possible without sutures. Histopathologic examination was conducted to study healing and stability of these sutureless wounds.
4 rabbits were used with 3 different style trocar/cannulas. 2 Dorc (old and new design) and 1 Alcon system were inserted into each eye through the pars plana. The old Dorc style trocar/cannula was inserted at the nasal meridian, and the cannula was plugged. The new Dorc style trocar/cannula was then inserted at the temporal meridian, followed by the Alcon trocar/cannula at the superior meridian, in a similar fashion. The old Dorc style plug was then removed, and the handle of the trocar maneuvered in the cannula for 5 minutes to stretch the wound as in surgery. A 23-gauge vitrector was then inserted and vitreous (≈ 0.1 cc) was removed. The cannula was then plugged. A similar procedure was repeated for the Alcon cannula in the superior meridian, and then the new Dorc style cannula in the temporal meridian. The new Dorc style cannula was removed and the conjunctiva placed over the wound, followed by removal of the other 2 cannulas in a similar fashion. 2 animals were sacrificed at week 1 and the other 2 sacrificed at week 3, with study eyes fixed and sent for processing for light microscopy at the time of euthanasia. At week 1, the 2 non-operative eyes from the animals scheduled for euthanasia underwent 23-gauge pars plana wound construction under endoscopic visualization. At 3 weeks, the remaining 2 rabbits underwent a similar endoscopically visualized procedure. A lensectomy was performed prior to the endoscopically visualized wound construction in all eyes, to better visualize and record the procedure.
Wound architecture for all 3 systems was examined with histopathologic emphasis on healing. Direct endoscopic visualization of wound generation was recorded to examine the anatomic and physiologic response to the procedure.
This study directly visualized the creation of 23-gauge pars plana vitrectomy wounds in vivo via endoscopy. As such, observation of tissue behavior during wound construction was carefully documented and analyzed. We also obtained a better understanding of 23-gauge wound creation, stability, and healing through histopathologic analysis.
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