Original articleThe Competency of Pars Plana Vitrectomy Incisions: A Comparative Histologic and Spectrophotometric Analysis
Section snippets
Tissue Preparation
Two- to four-day-postmortem human cadaveric eyes were obtained from the Florida Lions Eye Bank (Miami, Florida, USA). All globes were transported and stored in a moist chamber at 4 C prior to use. Only globes with adequate conjunctiva and the Tenon capsule without scleral thinning were included in the study. Each globe was injected near the optic nerve with balanced salt solution [BSS] (Akorn Inc, Buffalo Grove, Illinois, USA) in order to achieve an intraocular pressure (IOP) between 10 and 20
Results
A total of nine eyes were studied. PPV was performed in a control eye and two eyes each using standard 20 G, standard 23 G, perpendicular 25 G, and beveled 25 G incisions.
The sclerotomy incision was identified grossly in all eyes (Figure 3). The external lip of the 20 G incision was identified by the location of the suture. After dissection through conjunctiva and Tenon capsule, the 23 G and 25 G incisions were identified. Grossly, the external lip of the 23 G incision was a very thin scleral
Discussion
Postoperative endophthalmitis is a devastating complication of intraocular surgery. Historically, the endophthalmitis risk following 20 G PPV has been lower than cataract surgery, with recent reported rates between 0.018 and 0.04%.9, 17, 18 Recent case reports, and two cohort studies, have highlighted a possible increased endophthalmitis risk following sutureless 25 G PPV.6, 7, 8, 9, 15, 19 A similar trend has been noted with the transition to CCI in cataract surgery. Studies have suggested an
Omesh P. Gupta, MD, MBA, is currently a Heed vitreoretinal fellow at Wills Eye Institute, Philadelphia, Pennsylvania. He graduated AOA from a 5-year program with a MD with Distinction in Research and a MBA with a concentration in Health Sciences Management from the University of Rochester School of Medicine and the William E. Simon Graduate School of Business Administration. Dr Gupta was then a resident and Co-chief Resident at Wills Eye Institute. He has contributed in over 35 articles, book
References (33)
- et al.
Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery
Ophthalmology
(2002) - et al.
Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease
Ophthalmology
(2005) - et al.
Corneal topographic changes after transconjunctival 25-gauge sutureless vitrectomy
Am J Ophthalmol
(2005) - et al.
Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems
Am J Ophthalmol
(2007) - et al.
Incidence of endophthalmitis after 20- and 25-gauge vitrectomy
Ophthalmology
(2007) - et al.
Bacterial endophthalmitis after small-incision cataract surgery: effect of incision placement and intraocular lens type
J Cataract Refract Surg
(2003) - et al.
Oblique sclerotomy technique for prevention of incompetent wound closure in transconjunctival 25-gauge vitrectomy
Am J Ophthalmol
(2006) - et al.
Endophthalmitis after pars plana vitrectomy: Incidence, causative organisms, and visual acuity outcomes
Am J Ophthalmol
(2004) - et al.
Relative stability of clear corneal incisions in a cadaver eye model
J Cataract Refract Surg
(1995) - et al.
Dynamic morphology of sutureless cataract wounds—effect of incision angle and location
Surv Ophthalmol
(2004)
Ultrasound biomicroscopy study of direct and oblique 25-gauge vitrectomy sclerotomies
Am J Ophthalmol
25-gauge scleral tunnel transconjunctival vitrectomy
Am J Ophthalmol
Dynamic morphology of clear corneal cataract incisions
Ophthalmology
Mechanism for development of endophthalmitis
J Cataract Refract Surg
Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy
Am J Ophthalmol
Postoperative complications associated with 25-gauge pars plana vitrectomy
Ophthalmic Surg Lasers Imaging
Cited by (0)
Omesh P. Gupta, MD, MBA, is currently a Heed vitreoretinal fellow at Wills Eye Institute, Philadelphia, Pennsylvania. He graduated AOA from a 5-year program with a MD with Distinction in Research and a MBA with a concentration in Health Sciences Management from the University of Rochester School of Medicine and the William E. Simon Graduate School of Business Administration. Dr Gupta was then a resident and Co-chief Resident at Wills Eye Institute. He has contributed in over 35 articles, book chapters, and presentations. Dr Gupta serves on the Editorial Board of Retina Today and Evidence-Based Ophthalmology.