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P.E. Stanga, M. Gorbatov, L. Perez Belmonte, S. Charles, M. Lavin, G. Turner, P. Carlin, D. McLeod; Optical Coherence Tomography (OCT3) Imaging of the Conjunctiva and Sclerostomies After 25–Gauge Transconjunctival Sutureless Pars Plana Vitrectomy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4643.
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© ARVO (1962-2015); The Authors (2016-present)
To image the anatomic location of fluid and the timing of 25–gauge sclerostomy closure with optical coherence tomography (OCT3).
Uncontrolled, consecutive, interventional study. Ten patients. Mean age of 72.3 years (range 62–83). All patients completed follow–up. Examinations were scheduled on postoperative days 1 and 8 (average day 9, range 6 – 15) and one month after that (average day 53, range 37 – 88). Patients who underwent 25–Gauge transconjunctival sutureless pars plana vitrectomy surgery also underwent pre– and postoperative optical coherence tomography and biomicroscopy. Clinical records and anterior segment photographs were used to determine whether sclerostomies appeared closed, open, or widely open. Main Outcome Measures: Fluid immediately above the sclerostomy was classified based on its OCT3 appearance as predominantly subconjunctival (SC–OCT), predominantly sub–Tenon (ST–OCT) or mixed (MX–OCT).
The anatomic location of fluid was as follows: SC–OCT (22%), ST–OCT 37%) or MX–OCT (42%) counting over all time points. The proportion of sclerostomies with SC–OCT fluid increases from 4% at the first, to 20% at the second and 47% at the final examination. This is statistically significant (Chi square = 10.6, p = 0.005). The relative proportion of ST–OCT and MX–OCT sclerostomies did not change significantly. Traces of fluid were seen in 63% of sclerostomies at the final examination. Of 37 examinations where the sclerostomy was closed on biomicroscopy, 62%showed a discontinuity in the sclera on OCT3. Of 25 examinations where the sclerostomy appeared open, a discontinuity was visible in all but one. At 13 examinations the sclerostomy was not clinically detectable and imaged on OCT3 in 4 cases.
OCT3 shows the evolution of sclerostomies over time after 25–gauge transconjunctival sutureless pars plana vitrectomy. OCT3 demonstrates the postoperative patency of sclerostomies that appear closed on biomicroscopy. OCT3 appears to be a valuable tool for understanding why there seems to be a higher risk of hypotony and endophthalmitis in 25G vitrectomy compared to 20G.
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