Estudio experimental de la resistencia mecánica de las esclerotomías sin sutura en vitrectomía mircroincisional

Abstract

Background: Transconjunctival sutureless vitrectomy (TSV) has progressively been adopted as the first choice vitrectomy technique for an increasing number of vitreoretinal surgeons due to a series of advantages such as increased patient comfort with less postoperative inflammation, decreased operative times and reduction in surgery-induced astigmatism. Some studies have found that oblique architecture of the incisions associates better closure capacity than direct (perpendicular) sclerotomies. In our study, we compare the mechanical resistance to intraocular pressure rise of 23 and 25-gauge TSV oblique sclerotomies, used by the vitreous cutter and the endoillumination probe, in the immediate postoperative period, using an experimental model of vitrectomized eye. Material and methods: Prospective, experimental, randomized and observer-masked experimental study in which TSV 23 and 25-gauge oblique sclerotomies, performed in same cadaveric pig eye, are subject to an increase in intraocular pressure. Mechanical resistance is determined by the resistance to intraocular fluid leak through the sclerotomy. The simultaneous use of the different sclerotomy diameters in the same eye avoids interindividual scleral resistance differences. Conclusions: Oblique 23-gauge sutureless sclerotomies offer less mechanical resistance to intraocular pressure rise than 25-gauge in our experimental model. Thus, surgeons should assume performing more sclerotomy suturing in 23-gauge cases to obtain similar closure standards. The different use of the sclerotomies does not seem to cause differences in the incisional closure capacity at the end of the surgery.