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F. Seffo, L. Rao, M. Ward, K. Jamal, S. Huang; Smaller Incision Size Decreases the Risk of Post–Operative Complications in Intraocular Surgery . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5259.
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To investigate the role of surgical incision size on the incidence of post–operative complications in intraocular surgery.
A literature review of published and unpublished case series was performed to evaluate the incidence of post–operative complications following intraocular surgery as a function of scleral wound size. We reviewd the first 98 cases of 25 gauge posterior segment surgery performed by an experienced retina surgeon, SH, between September 2002 and November 2005. We looked at the incidence of endophthalmitis, hypotony, ocular hypertension, and vitreous hemorrhage.
We reviewed 98 consecutive small–incision surgeries for visual loss associated with non–clearing vitreous hemmorrhage (52), epiretinal membrane (13), traction retinal detachment (9), vitreous opacity (8), rhegmatogenous retinal detachment (6), CRVO (5), endophthalmitis (2), BRVO (1), retinopathy of prematurity (1), and BRAO (1). We found that the incidence of endophthalmitis was (0/98), retinal detachment (4/98), persistent vitreous hemorrhage (8/98), hypotony (9/98), and ocular hypertension (18/98). Post–operative ocular hypertension was defined as intraocular pressure > 22 and requiring the addition of a glaucoma medication(s). All cases of elevated intraocular pressure were well controlled with the use of medications. In previously published series the incidence of endophthalmitis after large–incision intraocular surgery was found to be 0.05%. In one study the incidence of endophthalmitis was found to be as follows: ICCE ± IOL 0.093%, ECCE ± IOL 0.072%, PE/CC IOL 0.040%, and IV injection 0.04%. In our study there were no cases of endophthalmitis noted.
Smaller incision size is associated with a decreased incidence of post–operative complications, especially endophthalmitis. Preoperative diagnosis and variations in surgical technique play a role in other complications. With the improvement in clinical experience, we expect the rate of post–operative complications to become even lower. Historical review and our small current series suggest that the trend towards microincisional surgery may be safer.
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