Benitez-Herreros Javier, Lopez-Guajardo Lorenzo, Vazquez-Blanco Miguel, Opazo-Toro Valeria, Silva-Mato Agustin
Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco s/n 28805 Alcalá de Henares, Madrid, Spain.
Department of Surgery, Medical and Social Sciences, Faculty of Medicine, Alcalá University, Madrid, Spain.
Graefes Arch Clin Exp Ophthalmol. 2016 Mar;254(3):489-95. doi: 10.1007/s00417-015-3243-4. Epub 2015 Dec 15.
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.
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.
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).
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.
缝合是经结膜无缝线玻璃体切除术（TSV）后封闭渗漏巩膜切口最常用的技术。然而，为了避免结膜缝线带来的弊端，已出现了其他封闭技术，如对切口上方的结膜进行烧灼。为了进一步了解结膜透热疗法实现的切口封闭效果，鉴于术后早期眼睛会承受压力应激，研究在眼压（IOP）变化情况下获得的伤口封闭阻力也会很有意思。在我们的研究中，我们比较了TSV后用双极透热疗法治疗的巩膜切口与未进行烧灼的切口所观察到的机械阻力。
这是一项实验性、随机且观察者盲法研究，对80只猪尸体眼进行了23G TSV。每次玻璃体切除完成后，用双极透热镊对上方其中一个巩膜切口部位上方的结膜进行烧灼；对另一个上方切口未进行任何操作。通过玻璃体切除系统（Accurus；爱尔康实验室，德克萨斯州）逐渐增加眼压，直到上方其中一个巩膜切口裂开，使眼内液体流出。
在35%的病例中（80只眼中的28只），接受透热疗法的巩膜切口首先出现眼内液体流出（p = 0.01）。比较开口压力值时，烧灼过的切口在显著更高的压力水平下渗漏，高于未应用透热疗法的切口（p < 0.001）。
在我们的实验模型中，对无缝线巩膜切口进行双极透热疗法已证明是增加巩膜切口封闭阻力的有效方法。尽管此前已有在玻璃体切除眼中使用该方法的描述，但我们的研究是首次分析烧灼后的巩膜切口对眼压升高的反应。
