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Comparative Study
. 2017 Oct;37(10):1948-1955.
doi: 10.1097/IAE.0000000000001445.

VITREOUS INCARCERATION IN SCLEROTOMIES AFTER VALVED 23-, 25-, OR 27-GAUGE AND NONVALVED 23- OR 25-GAUGE MACULAR SURGERY

Gian Marco Tosi  1 , Alex Malandrini, Gabriele Cevenini, Giovanni Neri, Davide Marigliani, Arianna Cerruto, Gianni Virgili
Affiliations
Comparative Study

VITREOUS INCARCERATION IN SCLEROTOMIES AFTER VALVED 23-, 25-, OR 27-GAUGE AND NONVALVED 23- OR 25-GAUGE MACULAR SURGERY

Gian Marco Tosi et al. Retina. 2017 Oct.

Abstract

Purpose: To study the patterns of vitreous incarceration at sclerotomy sites by ultrasound biomicroscopy in patients subjected to valved or nonvalved small-gauge pars plana vitrectomy.

Methods: A prospective comparative study of 88 eyes affected by epiretinal membrane and macular hole. Patients were divided into four groups: valved or nonvalved 23-gauge (16 eyes each) and valved or nonvalved 25-gauge (20 eyes each); their vitreal disposition was compared by ultrasound biomicroscopy. Vitreal disposition was also assessed in 16 eyes of 16 patients subjected to valved 27-gauge pars plana vitrectomy.

Results: Three vitreal patterns were identified: P0 (vitreous not visible or vitreous strand distant from the sclerotomy site), P1 (vitreous strand parallel to and in contact with the sclerotomy site), and P2 (vitreous strand entrapped in the sclerotomy site). The effect of valved trocar use on vitreous incarceration seemed to be somewhat beneficial, but no statistically significant effect could be shown (odds ratio: 0.85, 95% confidence interval: 0.42-1.74, P = 0.657). Similarly, no differences in vitreous incarceration were shown among vitrectomy gauges (23, 25, or 27) both in a model including valved trocars only (P = 0.858) and in a model with all available data (P = 0.935).

Conclusion: In 23- and 25-gauge macular surgeries, postoperative vitreous incarceration does not seem to be reduced using valved cannulas and was similar to that observed in 27-gauge surgery.

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Conflict of interest statement

None of the authors has any financial/conflicting interests to disclose.

Figures

Fig. 1.
Fig. 1.
Pattern 0. Radial scanning plane; 25-gauge surgery. A. The internal hole of the sclerotomy site (arrowhead) shows no vitreous. B. At the internal hole of the sclerotomy site (arrowhead), UBM shows a vitreous strand (white arrow) parallel to but distant from the sclera.
Fig. 2.
Fig. 2.
Pattern 1. Radial scanning plane; 25-gauge surgery. A and B. Vitreous strand (white arrow) parallel to and in contact with the sclera without incarceration. Arrowheads indicate the internal hole of the sclerotomy site.
Fig. 3.
Fig. 3.
Pattern 2. Radial scanning plane; 25-gauge surgery. Vitreous strand (white arrow) entrapped in the sclerotomy site. The internal hole of the sclerotomy site (arrowhead) shows two different modalities of scleral wound healing (A, increased amount of tissue on the internal surface of the sclerotomy site; B, loss of substance on the internal surface of the sclerotomy site).
Fig. 4.
Fig. 4.
Frequency of vitreous patterns for each subgroup of nonvalved (NV) (23- and 25-gauge) or valved (V) (23-, 25- and 27-gauge) trocars. Numbers within the figure are the absolute number of sclerotomies (total = 253) for each pattern and group, while the y-axis refers to the percentage for each group.
See this image and copyright information in PMC

References

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