Abstract
Purpose: :
To evaluate the influence of 23-gauge sutureless vitrectomy incision architecture on postoperative variation of intraocular pressure (IOP) in macular and nonmacular surgery, using anterior segment spectral-domain OCT.
Methods: :
In this prospective observational case series, forty-three patients underwent primary transconjunctival 23-G pars plana vitrectomy for macular and nonmacular diseases. All sclerotomy wounds were imaged 1 day after surgery using a prototype of an anterior segment module of spectral-domain OCT (OCT Spectralis, Heidelberg Engineering, Heidelberg, Germany). Incision architecture, including good wound apposition, presence of gaping, and misalignment of the roof and floor of the incisions were evaluated. Preoperative, intraoperative, and postoperative medical record data were also prospectively collected.
Results: :
Incision gaping and misalignment of the roof and floor occurred more frequently in the superotemporal and superonasal quadrants than in the inferotemporal quadrant (p<0.05) and was more frequent in the nonmacular group than in the macular group (p<0.05). The incidence of incision gaping significantly increased as the incision angle degree increased (p=0.025). In the macular group, the mean postoperative IOP did not change from the preoperative value, whereas in the nonmacular group, the mean IOP decreased significantly from 15.09 ± 2.58 mmHg preoperatively to 12.18 ± 3.25 mmHg on the first postoperative day (p<0.005). When the eye was gas-filled, there was no difference in IOP change between eyes with and without incision gaping, while in the fluid-filled eyes, the decrease in IOP was greater in eyes with gaping than in eyes without gaping. Stepwise logistic regression found that surgical duration (adjusted OR=9.17, p=0.020) and loss of wound apposition (adjusted OR=15.12, p=0.022) were risk factors for a significant postoperative IOP decrease (≥3 mmHg) 1 day after surgery.
Conclusions: :
In 23-G pars plana vitrectomy, the early postoperative variation in IOP is influenced by surgery duration and the self-sealing nature of the sclerotomy, which depends of the postoperative incision angle. This postoperative IOP variation is greater in absence of gas tamponade.
Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • imaging/image analysis: clinical • wound healing