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L.F. Hagemann, L.E. A. Marques, B.D. Kuppermann; Comparision Of Wound Leakage Between Straight And Tunnel Scleral Incisions After 25 Gauge Vitrectomy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4661.
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To compare wound leakage between tunnel and straight scleral incisions after 25 gauge vitrectomy under progressive intraocular pressure elevation testing.
Ten enucleated New Zealand White rabbit eyes were used. A three–port vitrectomy was performed using the Alcon 25 gauge vitrectomy system and the Accurus® machine, with one superior sclerotomy performed using a tunnel incision and the second superior sclerotomy performed using a straight incision for comparative purposes.. First, the infusion cannula was placed 3 mm from the limbus at the 6 o’clock position. A scleral tunnel incision was then created and the cannula was placed at the 10 o’clock position. Central core vitrectomy was performed and continued until free flow of fluid through the cannula was noticed. The cannula was removed with intraocular pressure at 0 mmHg. Balanced Saline Solution (BSS) was stained with ICG (200mg/l) to help observation of wound leak. Intraocular pressure was then increased progressively until leakage was noticed at the incision site and the pressure at which leakage from the sclerotomy site was noted was recorded.. The straight scleral incision was then created at the 2 o’clock position and the same method of vitrectomy, cannula removal, progressive pressure increase and observation of leakage was performed. Intraocular pressured of 120 mmHg was the maximum pressure possible in the system utilized.
One eye was excluded due to damage to the eye from high pressure during surgery. Of the remaining nine eyes, the average intraocular pressure when leakage was observed was 110 mm Hg (range 30–120, SD= 30) in the tunnel incision group and 12,8 mmHg (range 5–20, SD = 5,89) in the straight incision group (p<0.001). Eight of the nine tunnel sclerotomy incisions withstood the maximum pressure of 120 mm Hg without any sign of leakage, whereas none of the straight sclerotomy incisions withstood pressures greater than 20 mm Hg before leakage was seen. The one tunnel incision sclerotomy which did not withstand the maximum pressure appeared to have only minimal tunneling during cannula placement.
Scleral tunnel incisions showed significantly increased resistence to leakage when compared with straight incisions under progressive intraocular pressure increase testing using the 25 gauge vitrectomy system in rabbit eyes. Performing scleral tunnel incisions may prevent leakage and improve the outcomes of 25 gauge vitrectomy surgeries.
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