Abstract
Purpose :
Pars plana vitrectomy incisions can be self-sealing, sutured, or sealed with ocular adhesives. Complications such as leaks, hypotony, endophthalmitis, inflammation, astigmatism, and suture breakage raise questions regarding what technique and material modifications can improve scleral wound closure. The purpose of this study is to evaluate the effectiveness of combining the patient’s own tissues with products that are already FDA approved in a novel technique for scleral wound closure in pars plana vitrectomy.
Methods :
Cadaveric Yorkshire porcine eyes (n=3) were manually vitrectomized and a 23-gauge trocar was used to create a scleral wound which leaked saline infusion fluid at baseline. 200μL of platelet rich plasma (PRP) was mixed with 100μl of thrombin for PRP clot formation. In one trial, A 2mm dermatological hole punch was used to mold the clotted plasma. A pair of 23-gauge Grieshaber MAXGrip Forceps delivered the clot through the 23-gauge trocar into the scleral wound. In another trial, the 23-gauge trocar was removed and a 2-20μl pipette delivered the clotted plasma into the wound. The MAXGrip Forceps were used as a plunger to push the clot through the micropipette tip and into the wound. A mixture of whole blood and thrombin were aspirated into 16-,18-, and 20-gauge angiocath tips creating clotted whole blood. The IV angiocath tips were then cut into 6-8mm pieces, creating cylindrical clots. The clots were delivered through the 23-gauge trocar into the scleral wound. This methodology of clot delivery was also used for polymerized ReSure Sealant.
Results :
A PRP clot was delivered through a 2-20μl pipette tip using the MAXGrip Forceps, preventing ocular wound leakage up to a pressure of 60 mmHg. A clot of whole blood molded from the 20G IV angiocath tip was successfully delivered through the 23G trocar with no ocular wound leakage at baseline. However, it was dislodged during the Seidel test.
Conclusions :
This study provided preliminary evidence that clotted PRP and clotted whole blood could be feasible options for scleral wound closure. Further well controlled, randomized, and live animal studies will be required to determine the efficacy and long-term stability of the outlined materials and methodology of clot formation and delivery, but further studies have the potential to shape the approach to sclerotomy closure.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.