Modified Scleral Needling Technique to Achieve Scleral Wound Closure in Microincision Vitrectomy Surgery

The study aimed to evaluate the effectiveness of the modified scleral needling (SN) technique for unclosed scleral wounds in 25-gauge vitrectomy.

This retrospective study examined 50 scleral wounds that failed to self-close at the end of vitrectomy surgery performed by the same surgeon using a three-port 25-gauge vitrectomy system (Constellation® Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA) at Nihon University Hospital between February and August 2023. In all cases, scleral wounds were created by oblique puncture, and sufficient peripheral vitrectomy was performed. After the removal of the cannula, wound closure was assessed under air perfusion. The modified SN technique was implemented if the scleral wounds, excluding the infusion port, did not self-close. If self-closure was not achieved after three attempts of the modified SN technique, the scleral wound was sutured.

The modified SN technique closed 98% (49 of 50) of the leaking scleral wounds, and the average number of punctures was 1.36. Cochran's Q test revealed a statistically significant difference in the rate at which air leaks were sealed across the four stages (Q = 117.97; p = 2.11 × 10⁻²⁵). Subsequent pairwise comparisons using McNemar's test showed a significant improvement between the zero (no treatment) and first applications (p = 0.0005), as well as between the first and second applications (p = 0.0156). However, there was no statistically significant difference between the second and third applications (p = 0.125).

The modified SN technique is safe and effective for promoting scleral wound closure in microincision vitrectomy surgery.