Evaluation of Wound Closure in Oblique 23-gauge Sutureless Sclerotomies With Visante Optical Coherence Tomography

PURPOSE: To investigate the in vivo real-time wound morphology of fresh 23-gauge sutureless oblique sclerotomy wounds with anterior segment optical coherence tomography (OCT). DESIGN: Prospective, observational case series. METHODS: Subjects underwent three-port pars plana vitrectomy with a 23-gauge trocar/cannula microincision surgical system at the Cole Eye Institute. All incisions were created in an oblique (aka beveled or angled) fashion. The incisions were imaged with the Visante OCT (Carl Zeiss Meditec, Dublin, California, USA) device on postoperative days 1 and 8. The main outcome measure was wound structure (eg, presence of gaping) as evaluated with OCT. Surgical and ocular parameters were also recorded. RESULTS: Fourteen patients were investigated. Gross clinical examination revealed no evidence of leakage. OCT demonstrated closed wounds in all eyes on postoperative days 1 and 8. The external (entry) site of the incision was occasionally seen as a gape; however the rest of the wound was closed. One patient with closed wounds had transient hypotony along with shallow peripheral choroidals noted on postoperative day 1, which resolved on their own. CONCLUSIONS: Oblique incisions have been proposed for microincision sutureless vitrectomy to prevent wound leakage, hypotony, and the secondary risk of endophthalmitis. This study demonstrates that oblique incisions provide adequate wound apposition as shown by OCT even on postoperative day 1. (Am J Ophthalmol 2009;147101-107. (c) 2009 by Elsevier Inc. All rights reserved.)