Sclerotomy port suturing in microincisional vitrectomy surgery

Abstract

Despite the advantages of self-sealing wounds in microincisional vitrectomy surgery (MIVS), wound leak can occur, leading to hypotony and increased risk of choroidal detachment and endophthalmitis. Inappropriate wound construction is the major cause of wound leaks, apart from failure to detect and manage wound leaks. Few techniques of wound construction have been described to prevent wound leaks and enhance appropriate closure, but wound leaks can still happen. It is challenging to address it due to compromised visibility because of the oozing of blood or vitreous substitute and swelling of the conjunctiva and tenons. The use of an inverted surgical contact lens to detect port leakage has been documented. Still, it fails to address the issue of passing the suture to close the sclerotomy. Our approach addresses both issues. It has been reported that more than one-third of ports in MIVS require suturing. In our technique, we start suturing the port at the conclusion of surgery while withdrawing the cannula itself. We did 30 consecutive cases of MIVS for various indications where suturing the ports was done with this new technique. The mean postoperative intraocular pressure on day one was 18.82 ± 12.24 mmHg. Our technique ensures proper identification of the port and facilitation of suturing of the port, especially in cases where we decide to suture the sclerotomy in anticipation of a leak.

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