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      Presumed sclerotomy site bleeding inflowing into the anterior chamber after the removal of a 23-gauge microcannula in 23-gauge sutureless vitrectomy

      case-report

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          Abstract

          We experienced two cases of the influx of the sclerotomy site bleeding into the anterior chamber during 23-gauge sutureless vitrectomy for pseudophakic rhegmatogenous retinal detachment. Soon after the removal of a 23-gauge microcannula at the end of the surgery, presumed sclerotomy site hemorrhage was rapidly fluxed into the anterior chamber. The anterior chamber bleeding might come from the sclerotomies rather than from episcleral vessels. The posterior pressure in the gas-filled pseudophakic eye might have pushed the sclerotomy site bleeding into the anterior chamber. We could not find any vitreous hemorrhages. The hemorrhage within the anterior chamber spontaneously absorbed within 14 days.

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          Intraoperative breakage of a 25-gauge vitreous cutter.

          Kousuke Noda, Norihiro Nagai, Susumu Ishida … (2004)
          To report breakage of a 25-gauge vitreous cutter during vitreous surgery. Interventional case report. A 60-year-old woman was referred for management of an epiretinal membrane at the macula. Visual acuity was 20/100 in the affected left eye. Vitreous surgery using a 25-gauge vitrectomy system was carried out with a combination of conventional cataract surgery. The vitreous cutter was lodged within the sclerotomy cannula after peripheral vitrectomy and was pulled together with the cannula. The cannula was reinserted by trocar, but as the floating peeled epiretinal membrane was dissected with the vitreous cutter, the tip of the cutter was broken and was aspirated with the membrane. Stereoscopic microscopy and scanning electron microscopy demonstrated that the edge that had broken at the cutter port was smooth. Although 25-gauge instruments remain useful, care should be taken against rare surgical complications related to their fragility.
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            Sutureless vitrectomy

            Sunil K Warrier, Rajeev Jain, Jagjit Gilhotra … (2008)
            Sutureless vitrectomy has rapidly been accepted as an essential part of a vitreoretinal surgical setup. The size and structure of the wound along with near intact conjunctival covering makes the incision self-sealing and safe. This allows the vitrectomy instruments to be used without creating an initial limited peritomy to expose bare sclera, and obviates the need for sutures at the end of the procedure. Wound construction is the essential step in ensuring postoperative wound stability. Both one-step and two-step wound constructions have been described. Key points include an oblique, tunneled approach to ensure a valve-like effect as well as misalignment of conjunctival and scleral wounds by displacing conjunctiva during construction. Advantages include decreased operative times in certain cases and decreased postoperative inflammation, early postoperative rehabilitation, improved patient comfort, and minimal conjunctival damage. Complications are based around wound competence, hypotony, and its relationship to endophthalmitis rates. Early reports highlighted an increase in endophthalmitis though further studies are required to accurately assess the incidence. Endophthalmitis has not been reported in cases that underwent fluid/air exchange. This review focuses on techniques, benefits, complications, personal experiences, and the safety profiles of sutureless vitrectomy systems. A literature review was undertaken using ′Medline′ and ′Pubmed′. Search terms included sutureless vitrectomy, 20 gauge, 23 gauge, 25 gauge, and transconjunctival and small gauge vitrectomy.
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              Suprachoroidal fluid as a complication of 23-gauge vitreous surgery.

              M Akimoto, S Ooto, H Takagi … (2008)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Medknow Publications (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): Nov-Dec 2010
                Volume: 58
                Issue: 6
                Pages: 543-545
                Affiliations
                Department of Ophthalmology, Gachon University Gil Hospital, Incheon, South Korea
                Author notes
                Correspondence to: Dr. Hee Jin Sohn, Department of Ophthalmology, Gachon University Gil Hospital, 1198, Kuwol-dong, Namdong-ku, Incheon - 405 760, South Korea. E-mail: ahh2@ 123456gilhospital.com
                Article
                Publisher ID: IJO-58-543
                DOI: 10.4103/0301-4738.71709
                PMC ID: 2993992
                PubMed ID: 20952846
                SO-VID: 82891a20-74c2-401e-a10b-8b02ec24559f
                Copyright © © Indian Journal of Ophthalmology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 June 2009
                Date accepted : 30 June 2010
                Categories
                Subject: Brief Communications

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: sutureless vitrectomy,bleeding,sclerotomy site
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: sutureless vitrectomy, bleeding, sclerotomy site

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