Abstract
Purpose :
Small-gauge sutureless vitrectomy has become a preferred vitreoretinal surgical technique. Postoperative clinical assessment showed that 60% of 25-gauge sclerotomy wounds remain anatomically open 1 week after surgery. Wound closure can be facilitated by the use of external diathermy. The purpose of this study was to use iOCT for in-vivo validation of immediate closure of 25-gauge sclerotomy wounds in humans after the application external diathermy.
Methods :
This was a prospective study of 7 eyes of 7 consecutive patients who underwent 25-gauge vitrectomy using the Lumera 700 and RESCAN 700 iOCT platform (Carl Zeiss Meditec, Germany). Following completion of surgical procedures, trocars were removed and wounds were clinically assessed for evidence of leakage. Real-time iOCT was used to image the sites of sclerotomy wounds in all cases before and after the application of external diathermy using a power of 30 Watts for 5 seconds. Anatomical characteristics of sclerotomy wounds were carefully assessed and documented.
Results :
14 sclerotomy wounds from 7 eyes were imaged using iOCT. At the end of surgeries, a clinically apparent wound leak was present in 2 of 14 sclerotomies; 14%. However, iOCT demonstrated that, in-fact, all 14 sclerotomy wounds were anatomically wide open following removal of trocars (Fig 1). After the application of external diathermy, all wounds were anatomically sealed (Fig 2). The 2 clinically leaking sclerotomies were also sealed following the application of external diathermy. None of the patients developed hypotony or any other post-operative complications.
Conclusions :
iOCT demonstrated that despite no obvious wound leak, all 25-gauge sclerotomy wounds were anatomically open at the end of surgery. This promotes using a brief application of external diathermy on sutureless sclerotomy wounds to ensure their anatomical closure.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.