Abstract
Purpose: :
Pars plana vitrectomy (PPV) may require sutures for sclerotomy closure to maintain normal intraocular pressure and lower infection risk. Adverse suture reactions (ASR) relating to sclerotomy sutures include local inflammatory reactions leading to focal conjunctivitis, episcleritis, patient discomfort, and cosmetic defect. This study evaluated the frequency of ASR in sclerotomies after PPV and its relationship to suture material type. Recently, plain gut 6-0 has been proposed as an intrascleral "tape" for closure of small gauge sclerotomy sites (Ryan 2011), and its role in sclerotomy closure is explored further herein.
Methods: :
An IRB-approved, retrospective review of surgical records of a single academic vitreoretinal surgeon was performed for procedures done from 10/2008 to 1/2011, during a period of transition between use of synthetic sutures to plain gut sutures. Data collection included identification of suture material type for sclerotomy closure, and whether or not an ASR occurred postoperatively with a minimum follow-up of 30 days post surgery. ASR was defined as inflammation localized to a sclerotomy suture site of moderate to severe degree or of sufficient severity to require immediate suture removal or a recommendation thereof. Fischer's exact test was used to compare the rate of ASR among suture material types.
Results: :
A total of 209 records were identified and reviewed. Of these, 161 records were found to have sufficient data for analysis. Three suture materials were primarily used for sclerotomy closure: braided polyglactin 910 8-0 (Vicryl), plain gut 6-0 (Ethicon), and braided polyglycolic acid 8-0 (Biosorb), usually placed as a single interrupted stitch passed through partial thickness sclera and tied squarely with tag ends trimmed to 0.5 mm and left flat to the ocular surface. ASR was noted to be present between 1 and 41 days postoperatively (mean 22, median 29). Rates of ASR for polyglactin 910, plain gut, and polyglycolic acid, respectively, were 11/83 (13%), 1/49 (2%), and 6/22 (27%) (p=0.03, 0.003, and 0.19, Fisher’s exact test on difference between polyglactin 910 and plain gut, polyglycolic acid and plain gut, and polyglactin 910 and polyglycolic acid, respectively).
Conclusions: :
Plain gut suture had a lower ASR rate when compared to polyglactin 910 and polyglycolic acid. Polyglactin 910 and polyglycolic acid are synthetic materials while plain gut is made of sheep or bovine intestinal tissue. We speculate that chemical composition of suture material may influence its bioreactivity. Plain gut 6-0 suture appears suitable for sclerotomy closure at PPV and may be associated with lower postoperative suture-related morbidity.
Keywords: wound healing • sclera • vitreoretinal surgery