Purchase this article with an account.
P.-Y. Boey, K. Sandhanam, S.-Y. Lee, S.-G. Ong; A Novel Technique to Evaluate 20-Gauge and 23-Gauge Pars Plana Sclerostomy Wounds Using Spectral-Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3603.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate 20-gauge and 23-gauge pars plana sclerostomy wounds using spectral-domain optical coherence tomography (SDOCT)
Patients who had undergone standard three-port pars plana vitrectomy using either a 20-gauge or 23-gauge trocar surgical incision system were recruited. Imaging of the sclerostomy wounds was performed using the SDOCT (Topcon 3DOCT-1000, Topcon Medical Systems, Paramus, NJ, USA). The images were taken on three consecutive visits which comprised post-operative day 1, week 1 and month 1. Wound integrity including closure and presence of any gape was assessed. Clinical data including visual acuity, intraocular pressure (IOP) and presence of any wound leak were recorded.
Seventeen eyes of 16 patients were imaged with the SDOCT. Four eyes had 20-gauge sclerostomy incisions while 13 eyes had 23-gauge incisions. The 20-gauge incisions were perpendicular to the scleral surface and closed with sutures, while the self-sealing 23-gauge incisions were oblique and sutureless. SDOCT imaging demonstrated that sclerostomy wounds in both groups were closed at all post-operative visits, and were well-apposed as early as the first post-operative day. There were no differences in wound structure between the 20-gauge and 23-gauge groups, in terms of wound apposition or gape. Clinically, there were no cases of wound leak at any time in both groups. There was no difference in mean IOP (mmHg) between the 20-gauge vs 23-gauge group pre-operatively (14.7±4.2 vs 13.7±2.9, p=0.73), or post-operatively (day 1 [19.0±9.8 vs 12.0±4.7, p=0.25], week 1 [16.3±5.9 vs 12.0±3.8, p=0.25] and month 1 [13.7±7.5 vs 11.1±3.1, p=0.54]). One case in the 20-gauge group had transient hypotony at month 1, with no wound leak or choroidal detachment, and this subsequently resolved spontaneously.
This study describing the novel use of SDOCT demonstrates good wound apposition in both 20-gauge and 23-gauge sclerostomy wounds, even as early as post-operative day 1. There was no difference between the two incision systems in terms of post-operative IOP and wound structure.
This PDF is available to Subscribers Only