Vitreoretinal Services, Aravind Eye Hospital, Pondicherry, Tamil Nadu, India.
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Indian J Ophthalmol. 2018 Dec;66(12):1809-1814. doi: 10.4103/ijo.IJO_458_18.
To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS).
A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed.
Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ≥5 when circumferential sclerotomies were used.
Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.
评估套管针外部线性切口的方向和相关因素对 25G 经结膜玻璃体切除手术（25G TVS）巩膜切开闭合的影响。
共纳入 46 例（46 只眼）接受 25G TVS 治疗的患者，其中 23 只眼行环形切口，23 只眼行放射状切口。对自行封闭和缝合巩膜切开进行临床和前节光学相干断层扫描（AS-OCT）比较。分析年龄、眼部手术和注射、眼轴长度、套管类型、巩膜切开象限、手术时间、玻璃体基底部切除和眼内填充物对缝合率的影响。
46 只眼中有 23 只眼需要缝合（环形：17 只眼[74%]和放射状：6 只眼[26%]；P=0.003）。与上颞象限相比，超鼻上象限和下颞象限的巩膜切开需要缝合的比例明显较低[9 只眼（24%）和 12 只眼（27%）]。与术者右侧相比，术者左侧的巩膜切开和灌注口需要缝合的比例明显较低[10 只眼（25%）和 13 只眼（28%）]。与无眼内填充物相比，使用气体或硅油眼内填充物时，缝合的比例明显较低[5 只眼（36%）和 2 只眼（20%）]。在无眼内填充物的眼中，放射状巩膜切开的缝合比例较低（P=0.003）。当使用环形巩膜切开时，AS-OCT 上存在开放性巩膜切开的可能性≥5。
放射状外切口的自封闭更为常见。眼内填充物的使用与缝合减少相关。朝向术者优势手的上颞象限巩膜切开常需缝合。在本研究中，其他因素对巩膜切开闭合无影响。
