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A. Singh, M. Hosseini, S. M. Hariprasad; Hydrogel Bandage for Vitrectomy Surgery: A Histopathologic India Ink Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3602.
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Microincisional vitrectomy surgery (MIVS) has been increasingly accepted in the vitreoretinal surgical community.Postoperative complications related to this sutureless procedure such as endophthalmitis and hypotony have been reported. Standard 20G vitrectomy incisions are routinely sutured. This study tested an in situ forming polyethylene glycol (PEG) hydrogel (I-ZIP® Ocular Bandage, Ocular Therapeutix Inc, Bedford, MA) to secure sutureless 23G and 20G vitrectomy incisions in fresh human cadaveric eyes.
Six fresh intact whole human globes received incisions 4 mm posterior to the limbus in each quadrant of each eye. Two in each eye were standard, straight 20G vitrectomy incisions (MVR blade), of which one was sutured with 7-0 Vicryl and one was covered with hydrogel. The other two incisions were beveled 23G incisions of which one was left bare (no sutures or hydrogel) and the other was covered with hydrogel.Sponges soaked in India ink were placed over the incision sites. The IOP was then cycled between 0 and 30mmHg ten times (5 sec duration at each pressure point). In addition, manual pressure was applied around each incision when the pressure was at zero. The ink was rinsed from all outer surfaces, incisions were histologically processed and light microscopy was used to visualize ink particle ingression into the incisions.
Ink ingression rates: 20G Suture: 0/5 (0% of incisions with ink); 20G Hydrogel: 0/6 (0%); 23G Bare: 4/6 (67%); and 23G Hydrogel: 0/5 (0%). One 20G suture track showed ink ingress. The Figure shows the protection provided by the gel over a 20G incision (left) compared to an unprotected 23G incision (right).
The hydrogel was shown to protect both 20G and 23G incisions from infiltration by India ink after aggressive manipulation. In 20G incisions the gel worked at least as well as sutures, both 0%. Applying the gel to 23G sutureless tracks decreased the ink ingress rate from 66% (4/6) to 0% (0/5).
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