Authors: Enrico Bertelli, Stefano Coser, Paolo Pelanda, Veronika Rogger, Bolzano, Italy

Advantages:

Post-surgical hypotony is a rare but potentially dangerous complication of mini-invasive sutureless vitrectomy. Individual characteristics of the sclera or variables in dynamic and extension of performed vitrectomy may lead to unpredictable selfsealing features of transconjunctival sclerotomies under balanced salt solution tamponade. Even apparent optimal self-sealing conditions at the end of surgery may in fact lead to severe hypotony the following day. Air tamponade seems in principle to guarantee better self-sealing of transconjunctival sclerotomies, thank to the higher surface tension of air.

Methods:

We performed a retrospective study upon 23 eyes of 23 patients (15M, 8F, mean age 69), who underwent transconjunctival 23 G vitrectomy with 2-step microcannula insertion. Treated pathologies included diabetic macular edema with traction (17 cases) and macular pucker (6 cases). In all cases a DORC vitrectomy valved microcannula system was used. Vitrectomy exceeded the standard “core vitrectomy” and was extended more to the periphery, with particular attention devoted to retrolental vitreous. At the end of surgery a complete fluid-air exchange was performed in all cases, in order to obtain a complete closure also of the inferotemporal sclerotomy.

Effectiveness / Safety:

None of the cases required transconjunctival sutures at the end of surgery. In 4 cases an injection of air through the pars plana with a 30 G needle was performed at the end of surgery. In no case hypotony was observed, with postoperative IOP ranging from 9 to 20 mm Hg. Complications observed encompassed postoperative hemorrhage in the vitreous chamber from a superior sclerotomy in 1 case, with spontaneous resolution, cataract in 2 out of 8 phakic eyes. Mean follow-up has reached 11 months.

Take home message:

Internal air tamponade at the end of 23 G transconjunctival vitrectomy has prevented post-surgical hypotony in the 23 examined cases, without inducing significant complications.