Wound morphologies of sclerotomies closed with scleral massage and scleral needling techniques: A comparative study

Abstract

Background: This prospective study aimed to compare scleral needling with the conventional scleral massage technique for sclerotomy closure, using anterior segment optical coherence tomography (AS-OCT) to assess postoperative wound morphology.

Methods: Thirty eyes of 30 patients undergoing pars plana vitrectomy with a 25G vitrectomy system (Constellation; Alcon Laboratories, Fort Worth, TX, USA) were included. In each eye, one superior sclerotomy site (superonasal or superotemporal) was closed with scleral needling (Group A), while the other was closed with scleral massage (Group B), eliminating the impact of individual variability.

Results: Most sclerotomies (80%) could be closed with a single attempt of needling (mean 1.2 ± 0.4). The mean outer and inner sclerotomy incision diameters on the postoperative first day were 119 ± 22 and 94 ± 17 µm, respectively, for group A, and 118 ± 19 and 94 ± 16 µm, respectively, for group B ( P = 0.658 and 0.871, respectively). Sclerotomy wound diameters of both groups A and B decreased significantly on postoperative day 14 ( P < 0.001 and P < 0.001, respectively). None of the patients developed postoperative hypotony or any severe complication. A conjunctival bleb in four Group A patients resolved by day 3.

Conclusion: The newly described scleral needling technique was as successful and safe as the conventional scleral massage technique. AS-OCT imaging also confirmed that scleral needling did not cause any disruption on wound morphology.

Keywords: AS-OCT; scleral massage; scleral needling; sclerotomy incisions; sutureless vitrectomy.

Figure 1

Closure steps for superior sclerotomies. The microcannula trocar was removed (a). The infusion line was temporarily closed, and a blunt tip applicator was massaged over the sclerotomy from the inside to the outside of the incision (b). The infusion line was reopened, and the sclerotomy port was inspected for leakage (c). Following removal of the other microcannula trocar, a 30-G needle was inserted full thickness and perpendicular into the scleral tunnel adjacent to the sclerotomy (d and e). The needle was removed, and a balanced salt solution was dropped over the sclerotomy to detect the presence of an air bubble to ensure that there is no leakage (f)

Figure 2

Anterior segment optical coherence tomography image samples of oblique sclerotomies on postoperative days 1, 3, 7, and 14. On postoperative day 1 (a), the length of the scleral gap (arrow 1) is visible as a hyporeflective area in the sclera. The external entry of the scleral gap (arrow 2) is the outer diameter of sclerotomy. The internal entry of the scleral gap (arrow 3) is the inner diameter of sclerotomy. Arrow 4 shows a thinner scleral gap thought to be created by scleral needling. The scleral gap is reduced as the follow-ups progress. Postoperative day 3 (b), postoperative day 7 (c), and postoperative day 14 (d)

Figure 3

Closure rate of sclerotomy gaps on different postoperative days (groups A and B). The closure rate was defined as the amount of scleral gap that remained open. Group A, scleral needling; Group B, scleral massage