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Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony

Authors Horowitz S, Damasceno NA, Muralha F, Pereira MB, Maia M, Damasceno EF

Received 24 March 2019

Accepted for publication 19 August 2019

Published 4 September 2019 Volume 2019:13 Pages 1703—1710

DOI https://doi.org/10.2147/OPTH.S209813

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Soraya Horowitz1, Nadyr A Damasceno1, Felipe Muralha2, Maurício B Pereira3, Mauricio Maia2, Eduardo F Damasceno3

1Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil; 2Department of Ophthalmology, The Universidade Federal de São Paulo, Brazil; 3Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil

Correspondence: Eduardo F Damasceno
Marques do Paraná, 303 Niteroi, 20530050 Brazil
Tel +55 212 562 2343
Email e_damasceno@yahoo.com

Purpose: To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony.
Methods: This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony.
Results: Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening.
Conclusion: Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P<0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.

Keywords: vitreoretinal surgery, pars plana vitrectomy, 23-gauge sclerotomy, sclerotomy closure, sclerotomy diathermy, vitrectomy complications


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