A Study of Surgical Methodology to Reduce Vitreous Incarceration to Sclerotomies

Abstract

Purpose: : 20 gauge sutured sclerotomies have been shown to have vitreous incarceration to the wound. 25 gauge sutureless sclerotomies are thought to have less vitreous incarceration. Our study is to evaluate different methods to minimize the amount of vitreous incarceration..

Methods: : Fresh porcine eyes were obtained. A 19 gauge incision was made with an MVR blade 180 degrees opposite from the expected sclerotomy site for the vitreous cutter trochar. A 19 gauge widefield endoscope (Insight Instruments, Inc. Stuart, FL) was inserted for visualization of the trochar insertions. A 25 gauge infusion canula was placed to maintain intraocular pressure in the eye. The vitreous cutter was inserted in the other canula.. Triamcinolone (Triamcinolone Acetonide 40 mg/ml Kenalog Bristol–Myes Squibb, CO) was used to aid in visualization of the vitreous. A 2 port 25 gauge vitrectomy (Bausch and Lomb, St. Louis, MO) was completed. The trochar canulas were removed under different surgical conditions: (1) with the eye filled with air, (2) without air, (3) under a low pressure with (4) an angled incision and also (5) an angled incision with insertion of the lightpipe and then simultaneous withdrawal of the trochar and lightpipe.

Results: : Vitreous was observed tracking to the sclerotomy wound during removal of the trochars. There was no difference in the behavior of the vitreous with any of the surgical methods used. Vitreous incarceration was seen under all circumstances..

Conclusions: : Vitreous incarceration was observed under all surgical situations tested. The behavior of the vitreous was not altered by the different surgical techniques tested. Further clinical correlation is needed to determine if vitreous incarceration is a benefit or problem for 25 gauge vitrectomy.

Keywords: vitreoretinal surgery • vitreous • retina