J Korean Ophthalmol Soc.  2009 Mar;50(3):359-364. 10.3341/jkos.2009.50.3.359.

Partial Fluid-Air-Exchange at the End of 23 Gauge Sutureless Vitrectomy to Prevent Postoperative Hypotony

• Ku M
• Sohn HJ
• Lee DY
• Nam DH

• KMID: 2111245
• DOI: http://doi.org/10.3341/jkos.2009.50.3.359

Abstract

PURPOSE: To evaluate the efficacy and safety of partial fluid air exchange at the end of 23-gauge transconjunctival sutureless vitrectomy to prevent postoperative hypotony.
METHODS
Fifty-five eyes in 49 consecutive patients who underwent partial fluid air exchange at the end of 23-gauge sutureless vitrectomy by a single surgeon at Gil Hospital between August 2007 and February 2008 were recruited for this study. Intraocular pressure (IOP), visual acuity and post-operative complications were evaluated.
RESULTS
Surgical indications included proliferative diabetic retinopathy (n=31), epiretinal membrane (n=9), nondiabetic vitreous hemorrhage (n=5), vitreous opacities (n=3), and others (n=7). Two eyes showed hypotony (<6 mmHg) on postoperative day 1 and resolved within a week without any supplemental procedures. Other complications included choroidal detachment in 1 eye, hyphema in 1 eye, and transient IIOP in 2 eyes. In 38 eyes in which combined cataract surgery was performed, air bubble-related complications including iris capture by the IOL in 3 eyes (7.9%) and opacification of the posterior capsule in 11 eyes (28.9%) occurred. No case of retinal detachment or endophthalmitis was observed. The final best corrected visual acuity was 20/40 or better in 14 eyes (25.5%).
CONCLUSIONS
The partial fluid air exchange shows promise as an effective and safe procedure for prevention of postoperative hypotony after sutureless vitrectomy. Air bubble-related complications after combined cataract surgery can be avoided by several techniques.

Keyword

Complication; Hypotony; Sutureless vitrectomy; 23 Gauge

MeSH Terms

Cataract
Choroid
Diabetic Retinopathy
Endophthalmitis
Epiretinal Membrane
Eye
Humans
Hyphema
Intraocular Pressure
Iris
Retinal Detachment
Visual Acuity
Vitrectomy
Vitreous Hemorrhage

Figure

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  Figure 1. Partial fluid air exchange at the end of 23-gauge sutureless vitrectomy. (A) Schematic picture of the procedure. (B) Intraoperative photograph showing vitreous cavity being replaced by air. Air-bubbles are popping out through the cannula.

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  Figure 2. Preoperative and postoperative intraocular pressure (IOP) changes. There were no significant differences in IOP among the measurements. * Two cases of hypotony were observed at postoperative 1 day.

Reference

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