Comparison of Intraocular Pressure Between Sutureless and Sutured 23-gauge Vitrectomy

Hyung Jung Kim; Sojin Hong; Young Sook Park; Joon Hong Sohn

doi:10.3341/jkos.2010.51.6.835

Journal List > J Korean Ophthalmol Soc > v.51(6) > 1008837

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Kim, Hong, Park, and Sohn: Comparison of Intraocular Pressure Between Sutureless and Sutured 23-gauge Vitrectomy

Original Article

J Korean Ophthalmol Soc 2010;51(6):835-841.

Published online: 3 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.6.835

Comparison of Intraocular Pressure Between Sutureless and Sutured 23-gauge Vitrectomy

Hyung Jung Kim, MD, PhD, Sojin Hong, MD, Young Sook Park, MD, PhD, Joon Hong Sohn, MD, PhD

HanGil Eye Hospital, Incheon, Korea

Address reprint requests to Joon Hong Sohn, MD, PhD HanGil Eye Hospital #543-36 Bupyung-dong, Bupyung-gu, Incheon 403-010, Korea Tel: 82-32-503-3322, Fax: 82-32-504-3322, E-mail: Jhsohn19@hanafos.com

Received 9 November 2009 Accepted 30 March 2010

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 compare 23-gauge transconjunctival sutureless vitrectomy (TSV) and sutured vitrectomy in the aspect of intraocular pressure (IOP) changes and complications.

Methods

Through a retrospective chart review, 45 sutureless patients (48 eyes) and 48 sutured patients (52 eyes) who had undergone 23-gauge transconjunctival vitrectomy by one surgeon (J.H. Sohn) were compared. IOP was measured routinely pre-operativley, at 1 day, 1 week, and 1 month post-operatively. Postoperative IOP, hypotony (IOP＜7 mmHg) rates and complications associated with hypotony were assessed respectively. In addition, the cases involving intraocular air or gas tamponade or cataract extraction were compared.

Results

One day after the surgery, 3 eyes of the sutureless group developed hypotony, which persisted in 2 eyes through post-operative 1 week. Two eyes of the sutureless group developed hypotony 1 week after the surgery. Most of the hypotony cases were transient, but choroidal detachment occurred in 2 cases, and retinal detachment occurred in 1 case. In contrast, none of the sutured group developed hypotony. Intraocular air or gas tamponade significantly raised IOP 1 day after the surgery. When the operation was combined with cataract extraction, IOP was reduced postoperative 1 week and 1 month.

Conclusions

The well-known risk factor of 23-gauge sutureless vitrectomy is postoperative hypotony. The present study showed postoperative hypotony can result in retinal detachment as a complication in contrast to previous studies. The authors conclude that suturing the wound for the prevention of hypotony is better, especially in cases with high risk of hypotony or defi-nite wound leakage.

Keywords: Complication, Hypotony, Transconjunctival sutureless vitrectomy, 23-gauge

References

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Figure 1.

Preoperative and postoperative IOP changes in 23-gauge vitrectomy. Post operative 1 day IOP is higher in sutured group than sutureless group (IOP: intraocular pressure, Op: operation, D: day, W: week, M: month).

Table 1.

Preoperative diagnosis

	No. of eyes (%)
	Sutureless (%)	Sutured (%)
Vitreous hemorrhage due to PDR^*, tractional retinal detachment	26 (54.2)	27 (51.9)
Diabetic macular edema	2 (4.2)	0 (0)
Vitreous hemorrhage due to RVO^†	3 (6.3)	4 (7.7)
Macular edema due to RVO^†	5 (10.4)	1 (1.9)
Macular hole	2 (4.2)	4 (7.7)
Epiretinal membrane	2 (4.2)	4 (7.7)
Vitreous opacity due to uveitis	1 (2.1)	3 (5.8)
IOL^‡ dislocation	4 (8.3)	3 (5.8)
Lens dislocation	3 (6.3)	1 (1.9)
Macular hole, Retinal detachment	0 (0)	2 (3.8)
Retinal detachment	0 (0)	2 (3.8)
Central RVO^† (RON^§)	0 (0)	1 (1.9)

^* PDR=proliferative diabetic retinopathy;

^† RVO=retinal vein occlusion;

^‡ IOL=intraocular lens;

^§ RON=radial optic neurotomy.

Table 2.

Comparison of intraocular pressure changes between sutured and sutureless group associated with cataract extraction and AFX or GFX

	Pre-operation	Postoperative 1 day	Postoperative 1 week	k Postoperative 1 month
All group
With cataract extraction	14.5	21.3	12.6	13.84
Without cataract extraction	15.7	18.9	16.9	16.17
P-value^*	0.106	0.152	<0.001	<0.001
With AFX^† or GFX^‡	14.9	21.9	15.5	15.2
Without AFX^† or GFX^‡	15.7	14.9	13.7	14.9
P-value^*	0.657	<0.001	0.319	0.746
Sutured group
With cataract extraction	14.3	24.1	13.6	14.1
Without cataract extraction	15.2	23.0	17.8	15.7
P-value^*	0.37	0.604	0.012	0.046
With AFX^† or GFX^‡	14.7	24.9	16.4	15.0
Without AFX^† or GFX^‡	14.9	19.1	13.8	14.8
P-value^*	0.861	0.027	0.248	0.818
Sutureless group
With cataract extraction	16.1	17.6	11.3	13.5
Without cataract extraction	14.6	15.1	16.1	16.6
P-value^*	0.189	0.205	0.006	0.002
With AFX^† or GFX^‡	15.1	18.2	14.4	15.4
Without AFX^† or GFX^‡	16.5	11.5	13.5	15.1
P-value^*	0.734	0.001	0.88	0.835

^* P-values by independent t-test;

^† AFX=air-fluid exchange;

^‡ GFX=gas-fluid exchange. The values in bold indicate statistical significance (P<0.05).

Table 3.

Comparison of intraocular pressure changes between sutured and sutureless group

	Intraocular pressure change (mmHg)
	Pre-operation	Postoperative 1 day	Postoperative 1 week	Postoperative 1 month
Without cataract extraction
Sutured group	15.2	23.0	17.8	15.7
Sutureless group	16.1	15.1	16.1	16.5
P-value^*	0.376	<0.001	0.329	0.405
With cataract extraction
Sutured group	14.3	24.1	13.7	14.1
Sutureless group	14.6	17.8	11.0	13.5
P-value^*	0.794	0.007	0.053	0.44
With AFX^† or GFX^‡
Sutured group	14.7	24.9	16.4	15.0
Sutureless group	15.1	18.2	14.4	15.4
P-value^*	0.595	<0.001	0.199	0.626
Without AFX^† or GFX^‡
Sutured group	14.9	19.1	13.8	14.8
Sutureless group	16.5	11.5	13.5	15.1
P-value^*	0.366	0.004	0.862	0.808

^* P-values by independent t-test;

^† AFX=air-fluid exchange;

^‡ GFX=gas-fluid exchange. The values in bold indicate statistical significance (P<0.05). The values in bold indicate statistical significance (P<0.05).

Table 4.

Hypotony and complications

	No. of eyes
	Sutureless	Sutured
Postop 1 day IOP^* <10	8^†	1^‡
Postop 1 day IOP^* <7	3^§	0
Postop 1day IOP^* ≥10 & Postop 1 week IOP^*<7 (without anti-glaucoma treatment)	2	0
Choroidal detachment	2	0
Post-operative RD^∏	1	0

^* IOP=intraocular pressure;

^† 6 cases persisted through postoperative 1 week;

^‡ Persisted through postoperative 1 week;

^§ All of the patients showed their IOPs below 10 till postoperative 1 week;

^∏ RD=retinal detachment.

Table 5.

Risk factors for hypotony

	P-value^*	Expectancy
Suture	0.064	0.126
Cataract extraction	0.249	0.380
AFX^† or GFX^‡	0.342	2.233

^* P-values by binomial regression analysis;

^† AFX=air-fluid exchange;

^‡ GFX=gas-fluid ex exchange.

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