SELF SEALING SCLEROTOMIES IN SIMPLE PARS PLANA VITRECTOMIES
J. Schmidt, A. Pineyro-Garza, G.W. Nietgen, R. Jalilzadeh
Background: Besides conventional sealing of sclerotomies by various suture techniques we present here a technique of self sealing and atraumatic sclerotomy closure. Since 1997 we perform more frequently sutureless self-sealing sclerotomies in primary vitrectomies and now present procedure and outcome.
Methods: During the above time span we have operated 65 eyes (out of 258 eyes in total) with this technique undergoing primary and uncomplicated vitrectomy procedures like macula pucker, subretinal coroidal neovascularization and diabetic intravitreal bleeding. In the planed area of sclerotomy a scleral pocket is being created, similar to one seen in cataract surgery, but in 3.5 mm distance to limbal structures. In the depth of this pocket a sclerotomy is performed. A valve-like occlusion of the sclerotomy results. Control parameters for the long term postoperative functioning of this technique were intraoperative problems, IOP, conjunctival reactions and subjective patient responses.
Results: In five eyes sclerotomy wounds (in 3 eyes) needed to be closed with a suture at the end surgery. In all but the above mentioned surgeries sclerotomies were tight during the operative and postoperative phase. No patient had postoperative hypotony. In one eye with postoperative severe bleeding a wash-out vitrectomy five days after primary surgery using the same sclerotomies without complications was performed. Here we also closed sclerotomies and conjunctiva sutureless.
Conclusions: The advantages of this technique are minimal changes in eye pressure while changing instruments because a valve function of the sclerotomy tunnel exists. Probably a lower astigmatism rate will result from this procedure. Since we used no suture material creating foreign bodies, less need to suture at the end surgery exists and no granuloma formation from the non-absorbable suture material will develop. A subjectively felt lower foreign body sensation by patient leads to an overall better healing with faster rehabilitation.
Department of Ophthalmology, Philipps University, 35037 Marburg, Germany