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Ocular surface fluid contamination of sutureless 25-gauge vitrectomy incisions
Ajay Singh1, Julie A Chen, Jay M Stewart
1Department of Ophthalmology, University of California, San Francisco, CA 94143-0730, USA.
Purpose:
To determine whether 25-gauge transconjunctival sutureless vitrectomy incisions are more likely to allow the inflow of ocular surface fluid than sutured vitrectomy incisions.
Methods:
Four groups of cadaver eyes underwent three-port vitrectomy in a laboratory setup. Groups A and B had 25-gauge vitrectomy, with and without conjunctival displacement, respectively, and were left unsutured. Group C had 25-gauge vitrectomy with suturing of the sclerotomies. Group D had 20-gauge sutured vitrectomy. In all groups, India ink was applied to the ocular surface after the procedure, and the intraocular pressure (IOP) was varied to simulate postoperative IOP changes. Histology of the incisions was performed.
Results:
Ink particles were identified in the wound in over two-thirds of eyes that underwent 25-gauge sutureless vitrectomy. Conjunctival displacement had no effect on ink ingress. Sutured 25- and 20-gauge incisions did not demonstrate ink particles in the wound.
Conclusions:
Twenty-five-gauge transconjunctival sutureless vitrectomy incisions, with or without conjunctival displacement, allowed the entry of ocular surface fluid into the eye in this laboratory model. Based on the limited number of eyes examined in this study, sutureless vitrectomy techniques may carry an increased risk of bacterial contamination that could predispose to endophthalmitis. Suturing may protect against ocular surface fluid ingress.
