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G. Javey, A. J. Barkmeier, J. L. Heffez, P. E. Carvounis; Sclerotomy Leakage in 25-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy: Effect of Removing Cannulae Over the Light Pipe. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2561.
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To determine the effect of cannula removal over the light-pipe and other intraoperative factors on the incidence of sclerotomy leakage and hypotony upon conclusion of 25-gauge transconjunctival sutureless vitrectomy (25-GA TCSV).
Retrospective, interventional clinical study of consecutive patients that underwent 25-GA TCSV at a single academic center. Eyes were divided into two groups (Group L: cannulae removed over light pipe; Group N: cannulae simply pulled out). The primary outcome was the incidence of sclerotomy leaks in the two groups.
Twenty-four eyes (72 sclerotomies) were included in the study. Twelve of 16 sclerotomies (75%) leaked upon conclusion of surgery in Group L (inferior sclerotomies were not included) compared to 10 of 32 sclerotomies (31%) in Group N (p=0.005). This led to 5 of 8 eyes being soft at the end of surgery in group L compared to 2 of 16 eyes being soft in group N (p=0.02).Of all 24 eyes, 16 eyes (67%) had some leakage from at least one sclerotomy and 26 of 72 sclerotomies (37%) had some leak. Only one sclerotomy (1.4%) required suturing due to brisk wound leak and hypotony whereas the remaining leaks were self-limiting or were controlled by double-patching overnight.Superior sclerotomies were more likely to have wound leaks (16.7% at the inferotemporal sclerotomy vs. 46% at the superior sclerotomies; p=0.02). There was no significant difference in wound leak between dominant vs. non-dominant sclerotomy sites (p=0.38).Fluid air exchange also had no effect on sclerotomy leak (33% sclerotomy leak in air/gas filled eyes, vs 35% sclerotomy leak in fluid filled eyes; p=0.56) or the incidence of hypotony at the conclusion of the surgery (28.6 % of air/gas filled eyes and 29.4% of eyes with fluid were soft by digital palpation at the conclusion of surgery; p=0.56).
In our series the rate of sclerotomy leak was approximately 36% at the conclusion of 25-GA TCSV. Most of the leaks were self limited with only one sclerotomy site requiring suture placement. The inferotemporal sclerotomy site of infusion cannula was the least likely place for wound leak. Fluid air exchange had no statistically significant effect on sclerotomy leaks. Attempts to prevent vitreous wick by removing the cannular over the light pipe led to an increase in wound leak and a lower IOP in our series.
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