Oblique parallel incisions in 25G surgery improves healing

Performing 25-gauge pars plana vitrectomy with oblique parallel incisions rather than with standard straight incisions, may allow for more complete postoperative wound sealing, according to a report published in the September issue of Graefe's Archive for Clinical and Experimental Ophthalmology.

Stanislao Rizzo and colleagues from the Santa Chiara Hospital, Pisa, Italy enrolled 45 patients with macular holes. In 15 eyes, operations were carried out using oblique parallel insertion, in a further 15, oblique perpendicular insertions were used, and the remaining 15 received straight incisions (SI). Each patient underwent ultrasound biomicroscopy (UBM) examinations, one day, one week and one month postoperatively.

Oblique parallel insertions healed immediately following removal of the 25-gauge cannula. At one day postoperatively, all sclerotomies were well-healed with the internal wound lips showing excellent apposition. In addition, 39 sclerotomies were undetectable by UBM and six were only just observable.

In the oblique perpendicular insertion group, the incisions also healed immediately and all sclerotomies were well-healed by one day postoperatively. However, minimal gape was visible on UBM. Three eyes also showed peripheral cilio-choroidal detachment at one day postoperatively — this was resolved in all cases by seven days follow-up.

In the straight incision group, 10 cases of conjunctival blebs developed. Of these, seven required air-gas refilling and three required suturing of the sclerotomies. By one day postoperatively, five subjects developed hypotony and UBM demonstrated significant gaps in all sites.

The authors concluded that oblique parallel incisions allow for better postoperative wound sealing.