Sclerotomy site leakage according to wound shape in 23-gauge microincisional vitrectomy surgery

Abstract

PURPOSE: 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.