title: Sutureless triplanar sclerotomy for 23-gauge vitrectomy.
abstract: OBJECTIVE
  To describe and test the intraoperative integrity of triplanar sclerotomies.
  
  
  METHODS
  A prospective consecutive case series of 180 sclerotomies in 60 eyes was studied. After conjunctival dissection, triplanar transscleral wounds were created with a 23-gauge trocar using a standardized technique. At the conclusion of surgery, an air-fluid exchange was performed, and cannulas were removed. Then, unsutured scleral wound integrity was tested for permeability to vitreous, gas, and fluid by application of a cellulose sponge, observation of gas escape, and examination by the Seidel method, respectively. Postoperative intraocular pressure was recorded. Laboratory studies with fresh human donor globes were conducted to evaluate the histologic characteristics of triplanar sclerotomies.
  
  
  RESULTS
  Unsutured triplanar wounds were closed to vitreous, gas, and fluid in 169 of 180 sclerotomies (93.9%). Eleven sclerotomies were open and showed positive results using only 1 testing method each. In these cases, vitreous was detected in 1 wound, gas escaped from 8 wounds, and Seidel test results were positive in 2 wounds. Complex retinal detachment repairs had a higher rate of wounds requiring suture placement. One patient had transient postoperative day 1 hypotony.
  
  
  CONCLUSIONS
  It is possible to achieve high rates of unsutured wound closure with triplanar transscleral sclerotomies. No single method of evaluating wound leakage appeared to be the most sensitive. More complex cases requiring longer surgical times, more instrument passes, and increased wound manipulation resulted in higher rates of wound leakage. Leakage can be subtle, and surgeons should use multiple methods to adequately assess sclerotomy closure.
authors.affiliation: Vitreoretinal Service, Department of Ophthalmology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA. vinit-mahajan@uiowa.edu
authors.forename: Vinit B
authors.initials: VB
authors.lastname: Mahajan
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Tarantola
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Graff
authors.forename: H Culver
authors.initials: HC
authors.lastname: Boldt
authors.forename: Michael D
authors.initials: MD
authors.lastname: Abramoff
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Russell
authors.forename: James C
authors.initials: JC
authors.lastname: Folk
mesh_terms: D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008866:Microsurgery / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012164:Retinal Diseases / Q000601:surgery; D012590:Sclera / Q000601:surgery*; D012599:Sclerostomy / Q000379:methods*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000175:diagnosis; D013536:Suture Techniques; D014065:Tonometry, Ocular; D014821:Vitrectomy / Q000379:methods*; D014945:Wound Healing / Q000502:physiology