Sclerotomy site leakage according to wound shape in 23-gauge microincisional vitrectomy surgery.
OBJECTIVE
To compare the shape and self-sealing nature of scleral incision sites according to bevel shape and trocar blade direction in 23-gauge microincisional vitrectomy surgery.


METHODS
Twenty-three-gauge microincisional vitrectomies were performed in 60 eyes using a single-step entry system (Alcon Surgical, USA) and a 23-gauge two-step Eckardt vitrectomy system (DORC, the Netherlands). Trocar cannula were inserted using trocar blades bevel-up (20 eyes) or bevel-down (20 eyes). In 20 eyes, trocars were inserted after sclerotomies were performed using a microvitreoretinal (MVR) blade. After removing the cannula, we compared the scleral wound shapes and looked for leakage.


RESULTS
A total of 180 sclerotomies were done: 60 in the bevel-up direction (group 1), 60 in the bevel-down direction (group 2), and 60 using an MVR blade (group 3). Bevel-up insertion produced a V-shaped sclerotomy wound, whereas bevel-down insertion produced a reverse V-shaped wound. The MVR blade produced a slit-shaped wound. Wound leakage was identified in 21 V-shaped wounds, seven reverse V-shaped wounds, and four slit-shaped wounds. We observed no cases of hypotony, vitreous incarceration, or endophthalmitis.


CONCLUSIONS
The self-sealing effect of slit-shaped wounds and reverse V-shaped wounds was superior to that of V-shaped wounds.
Choi
Kyung Seek
KS
Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea. ckseek@hosp.sch.ac.kr
Kim
Hoon Dong
HD
Lee
Sung Jin
SJ
D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D012590:Sclera / Q000473:pathology* / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D014821:Vitrectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*