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

Myun Ku; Hee Jin Sohn; Dae Yeong Lee; Dong Heun Nam

doi:10.3341/jkos.2009.50.3.359

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Ku, Sohn, Lee, and Nam: Partial Fluid-Air-Exchange at the End of 23 Gauge Sutureless Vitrectomy to Prevent Postoperative Hypotony

Original Article

J Korean Ophthalmol Soc 2009;50(3):359-364.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.3.359

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

Myun Ku, MD, Hee Jin Sohn, MD, Dae Yeong Lee, MD, Dong Heun Nam, MD, PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

Address reprint requests to Dong Heun Nam, MD, PhD, Department of Ophthalmology, Gachon University Gil Medical Center #1198, Guwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: eyedawns@gilhospital.com

Received 21 July 2008 Accepted 20 October 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Complication, Hypotony, Sutureless vitrectomy, 23 Gauge

References

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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.

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.

Table 1.

Indications for surgery

Indication	No. of Eyes	%
Proliferative diabetic retinopathy	31	56.4
Epiretinal membrane	9	16.4
Nondiabetic vitreous hemorrhage	5	9.0
Vitreous opacities	3	5.5
Panuveitis	2	3.6
Retinal tear	2	3.6
Endophthalmitis	1	1.8
Combined hamartoma of retina & RPE	1	1.8
Decompression retinopathy	1	1.8
Total	55	100

Table 2.

Summary of preoperative and postoperative visual acuity by surgical indication

Indication (n)	Preop^† VA^§ (logMAR^П± SD^#)	Final Postop^‡ VA (logMAR± SD)	p value^*
PDR^** (n=31)^††	1.06±0.2	0.82±0.3	0.02
ERM^†† (n=9)	0.7±0.3	0.3±0.2	<0.01
Non-clearing vitreous hemorrhage (n=5)	1.4±0.5	0.3±0.2	<0.01
Other^§§ (n=10)	0.54±0.4	0.31±0.3	0.03
Total (n=55)	1.1±0.5	0.5±0.3	<0.01

^*paired Student's t-test

^†Preop=preoperative

^‡Postop=postoperative

^§VA=visual acuity

^ПlogMAR=logarithm of the minimum angle of resolution

^#SD= standard deviation

^**PDR=proliferative diabetic retinopathy

^††ERM=epiretinal membrane

^§§vitreous opacity (3), panuveitis (2), retinal tear (2), endophthalmitis (1), combined hamartoma of retina & RPE (1), decompression retinopathy (1)

Table 3.

Postoperative complications

Complication	No. of Eyes	%
Leakage-related complication
Hypotony^*	2/55	3.6
Choroidal detachment	1/55	1.8
Combined surgery-related complication^†
Opacification of posterior capsule	11/38	28.9
Iris capture by intraocular lens optic	3/38	7.9
Fibrinous anterior chamber inflammation	6/38	15.8
Hyphema	1/38	2.6

^*Intraocular pressure <6 mmHg

^†Among thirty-eight eyes that underwent combined cataract surgery.

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