title: Evaluation of mechanical closure resistance of sutureless vitrectomy sclerotomies after conjunctival cauterization with bipolar diathermy forceps.
abstract: BACKGROUND
  Suturing is the most widely used technique to close leaking sclerotomies after transconjunctival sutureless vitrectomy (TSV). However, with the aim of avoiding the disadvantages caused by conjunctival stitches, there have been described other closure techniques, such as the cauterization of the conjunctiva placed over the incisions. To continue advancing knowledge of the incisional occlusion effect achieved by conjunctival diathermy, it would be also interesting to study the wound closure resistance obtained under intraocular pressure (IOP) changes, given that in the early postoperative period eyes are subjected to pressure stress. In our study, we compare the mechanical resistance observed in sclerotomies treated with bipolar diathermy after TSV compared to that found in incisions in which cauterization was not performed.
  
  
  METHODS
  This was an experimental, randomized, and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, cauterization was performed with bipolar diathermy forceps on the conjunctiva placed over one of the superior sclerotomy sites; no maneuver was performed over the other superior incision. IOP was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape.
  
  
  RESULTS
  In 35 % of cases (28 of 80 eyes), sclerotomies subjected to diathermy allowed intraocular fluid escape first (p = 0.01). When comparing opening pressure values, cauterized incisions leaked at significantly higher pressure levels than those in which diathermy was not applied (p < 0.001).
  
  
  CONCLUSIONS
  Bipolar diathermy on sutureless sclerotomies has demonstrated to be, in our experimental model, an effective method for increasing the sclerotomy closure resistance. Although its use in vitrectomized eyes has previously been described, our study is the first to analyze the response of cauterized sclerotomies to IOP increases.
authors.affiliation: Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco s/n 28805 Alcalá de Henares, Madrid, Spain. jbenitezherreros@hotmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Benitez-Herreros
authors.affiliation: Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco s/n 28805 Alcalá de Henares, Madrid, Spain. llguajardo@icam.es.|Department of Surgery, Medical and Social Sciences, Faculty of Medicine, Alcalá University, Madrid, Spain. llguajardo@icam.es.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lopez-Guajardo
authors.affiliation: Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco s/n 28805 Alcalá de Henares, Madrid, Spain. vazquez567@hotmail.com.
authors.forename: Miguel
authors.initials: M
authors.lastname: Vazquez-Blanco
authors.affiliation: Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco s/n 28805 Alcalá de Henares, Madrid, Spain. cony134@hotmail.com.
authors.forename: Valeria
authors.initials: V
authors.lastname: Opazo-Toro
authors.affiliation: Department of Surgery, Medical and Social Sciences, Faculty of Medicine, Alcalá University, Madrid, Spain. agustin.silva@uah.es.
authors.forename: Agustin
authors.initials: A
authors.lastname: Silva-Mato
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D002425:Cautery; D003228:Conjunctiva / Q000601:surgery*; D004195:Disease Models, Animal; D004548:Elasticity / Q000502:physiology; D004564:Electrocoagulation; D007429:Intraocular Pressure; D008866:Microsurgery; D012599:Sclerostomy; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D034421:Sus scrofa; D013536:Suture Techniques; D041623:Tomography, Optical Coherence; D014821:Vitrectomy / Q000379:methods*; D014945:Wound Healing / Q000502:physiology*
keywords: Cauterization; Closure competency; Diathermy; Sclerotomy; Vitrectomy