Estudio experimental sobre técnica de disminución de incarceración vítrea en esclerotomías de vitrectomía microincisional. Comparación de distintos métodos de visualización

Abstract

BACKGROUND: Transconjunctival sutureless vitrectomy (TSV) has progressively been adopted as the first choice vitrectomy technique for an increasing number of vitreoretinal surgeons in the last years. Sclerotomy vitreous entrapment has been related to some postoperative complications such as the presence of peripheral retinal tears due to vitreous contraction, acute endophthalmitis favoured by the presence of incisional vitreous wick and recurring vitreous haemorrhage due to fibrovascular ingrowth in diabetic patiens, and thus, its study has been considered important. In our study, we evaluate the influence that the cannula removal technique exerts on the postoperative incisional vitreous incarceration using an experimental model of vitrectomized eye. Moreover, we compare the vitreous incarceration detection capacity of anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM) and direct visualization. MATERIAL AND METHODS: Prospective, randomized and observer-masked experimental study in which 23-gauge TSV was performed through oblique sclerotomies in 118 cadaveric pig eyes. Once the vitrectomy was finished, one of the superior cannulas was removed with the light probe introduced through it, and the other cannula was extracted with the cannula plug inserted. Postoperative incisional vitreous incarceration was evaluated by AS-OCT, UBM and direct visualization. CONCLUSION: Interposing the light probe through the cannula during its removal reduces the postoperative wound vitreous incarceration in our experimental model. On the other hand, direct visualization is the most effective method for detecting vitreous entrapment; however, this invasive technique should be used only in experimental research. In usual clinical practice, UBM is superior to AS-OCT for detecting vitreous incarceration.