Preliminary evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm behind the limbus_Chinese Journal of Ocular Fundus Diseases

Authors：

 Xie Zhenggao , Chen Fang , Xia Ying , Du Wei , Zhu Jun , Tong Jun , Gan Chunlan , Chen Xi

Department of Ophthalmology, Clinical Medicine School of Yangzhou University, Yangzhou 225001, China; Department of Ophthalmology, Subei People’s Hospital, Yangzhou 225001, China;

Corresponding author：

Xie Zhenggao, Email: zgxie87@163.com

Keywords：

Lens, crystalline/injuries; Retinal perforations; Vitrectomy/adverse effects

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.014

Video：

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ObjectiveTo evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.MethodsThis is a prospective uncontrolled case study. The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study. There were 56 males (59 eyes) and 84 females (86 eyes), with the mean age of (56.34±9.98) years and axial length of (23.99±2.57) mm. There were 139 phakic eye and 6 aphakic eyes. All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus. To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex, the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries. Pearson correlation analysis was used to analyze the relationship between age, anteroposterior axis of eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.ResultsSurgical related complications included retinal tears close to the scleral incision sites (3/145 eyes, 2.1%) and lens injury (3/121 eyes, 2.5%). No other surgical complications occurred, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Based on CT images, the average scleral distance from limbus to the plane passing through the lens posterior apex, anteroposterior axis of eyeball and lens thickness was (6.72±0.81), (24.39±0.97), (4.22±0.47) mm, respectively. The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9, P=0.000 6).ConclusionPrimary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.

Citation： Xie Zhenggao, Chen Fang, Xia Ying, Du Wei, Zhu Jun, Tong Jun, Gan Chunlan, Chen Xi. Preliminary evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm behind the limbus. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 387-390. doi: 10.3760/cma.j.issn.1005-1015.2017.04.014 Copy

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2.	Kumar A, Duraipandi K, Gogia V, et al. Comparative evaluation of 23- and 25-gauge microincision vitrectomysurgery in management of diabetic macular traction retinal detachment[J]. Eur J Ophthalmol, 2014, 24(1): 107-113. DOI: 10.5301/ejo.5000305.
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4.	Oshima Y, Wakabayashi T, Sato T, et al. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery[J]. Ophthalmology, 2010, 117(1): 93-102. DOI: 10.1016/j.ophtha.2009.06.043.
5.	Ramkissoon YD, Aslam SA, Shah SP, et al. Risk of iatrogenic peripheral retinal breaks in 20-G pars plana vitrectomy[J]. Ophthalmology, 2010, 117(9): 1825-1830. DOI: 10.1016/j.ophtha.2010.01.029.
6.	Cha DM, Woo SJ, Park KH, et al. Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(6): 1469-1474. DOI: 10.1007/s00417-013-2302-y.
7.	Kwon OW, Song JH, Roh MI. Retinal detachment and proliferative vitreoretinopathy[J]. Dev Ophthalmol, 2016, 55: 154-162. DOI: 10.1159/000438972.
8.	Nadal J, Carreras E, Canut MI. Endodiathermy plus photocoagulation as treatment of sclerotomy site vascularization secondary to pars plana vitrectomy for proliferative diabetic retinopathy[J]. Retina, 2012, 32(7): 1310-1315. DOI: 10.1097/IAE.0b013e318236e7ef.
9.	Zaninetti M, Petropoulos IK, Pournaras CJ. Proliferative diabetic retinopathy: vitreo-retinal complications are often related to insufficient retinal photocoagulation[J]. J Fr Ophtalmol, 2005, 28(4): 381-384.
10.	Neuhann IM, Hilgers RD, Bartz-Schmidt KU. Intraoperative retinal break formation in 23-/25-gauge vitrectomy versus 20-gauge vitrectomy[J]. Ophthalmologica, 2013, 229(1): 50-53. DOI: 10.1159/000343710.
11.	Scartozzi R, Bessa AS, Gupta OP, et al. Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems[J]. Am J Ophthalmol, 2007, 143(1): 155-156. DOI: 10.1016/j.ajo.2006.07.038.
12.	Agrawal R, Ho SW, Teoh S. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone Ⅲ) injury[J]. Indian J Ophthalmol, 2013, 61(10): 541-545. DOI: 10.4103/0301-4738.121066.

1. Elhousseini Z, Lee E, Williamson TH. Incidence of lens touch during pars plana vitrectomy and outcomes from subsequent cataract surgery[J]. Retina, 2016, 36(4): 825-829. DOI: 10.1097/IAE.0000000000000779.
2. Kumar A, Duraipandi K, Gogia V, et al. Comparative evaluation of 23- and 25-gauge microincision vitrectomysurgery in management of diabetic macular traction retinal detachment[J]. Eur J Ophthalmol, 2014, 24(1): 107-113. DOI: 10.5301/ejo.5000305.
3. Neuhann IM, Hilgers RD, Bartz-Schmidt KU. Intraoperative retinal break formation in 23-/25-gauge vitrectomy versus 20-gauge vitrectomy[J]. Ophthalmologica, 2013, 229(1): 50-53. DOI: 10.1159/000343710.
4. Oshima Y, Wakabayashi T, Sato T, et al. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery[J]. Ophthalmology, 2010, 117(1): 93-102. DOI: 10.1016/j.ophtha.2009.06.043.
5. Ramkissoon YD, Aslam SA, Shah SP, et al. Risk of iatrogenic peripheral retinal breaks in 20-G pars plana vitrectomy[J]. Ophthalmology, 2010, 117(9): 1825-1830. DOI: 10.1016/j.ophtha.2010.01.029.
6. Cha DM, Woo SJ, Park KH, et al. Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(6): 1469-1474. DOI: 10.1007/s00417-013-2302-y.
7. Kwon OW, Song JH, Roh MI. Retinal detachment and proliferative vitreoretinopathy[J]. Dev Ophthalmol, 2016, 55: 154-162. DOI: 10.1159/000438972.
8. Nadal J, Carreras E, Canut MI. Endodiathermy plus photocoagulation as treatment of sclerotomy site vascularization secondary to pars plana vitrectomy for proliferative diabetic retinopathy[J]. Retina, 2012, 32(7): 1310-1315. DOI: 10.1097/IAE.0b013e318236e7ef.
9. Zaninetti M, Petropoulos IK, Pournaras CJ. Proliferative diabetic retinopathy: vitreo-retinal complications are often related to insufficient retinal photocoagulation[J]. J Fr Ophtalmol, 2005, 28(4): 381-384.
10. Neuhann IM, Hilgers RD, Bartz-Schmidt KU. Intraoperative retinal break formation in 23-/25-gauge vitrectomy versus 20-gauge vitrectomy[J]. Ophthalmologica, 2013, 229(1): 50-53. DOI: 10.1159/000343710.
11. Scartozzi R, Bessa AS, Gupta OP, et al. Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems[J]. Am J Ophthalmol, 2007, 143(1): 155-156. DOI: 10.1016/j.ajo.2006.07.038.
12. Agrawal R, Ho SW, Teoh S. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone Ⅲ) injury[J]. Indian J Ophthalmol, 2013, 61(10): 541-545. DOI: 10.4103/0301-4738.121066.

Chinese Journal of Ocular Fundus Diseases

Preliminary evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm behind the limbus

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