TY - JOUR
T1 - Factors affecting wound leakage in 23-gauge sutureless pars plana vitrectomy
AU - Lin, Albert L.
AU - Ghate, Deepta A.
AU - Robertson, Zachary M.
AU - O'Sullivan, Patrick Sean
AU - May, Warren L.
AU - Chen, Ching Jygh
PY - 2011/6
Y1 - 2011/6
N2 - Purpose: To evaluate risk factors for sclerotomy leakage in 23-gauge sutureless pars plana vitrectomy in 219 patients. Methods: Nested case-control study involving 48 patients with wound leaks (visible on-table sclerotomy leakage requiring sutures) and 171 control subjects without wound leaks. Patients received either a conventional sclerotomy incision at 45°, which was then changed to 90° midincision, or an extremely oblique sclerotomy incision (OSI) at 10°, which was then changed to 30° midincision. Risk factors studied included age, gender, laterality, surgical duration, sclerotomy incision (OSI vs. conventional sclerotomy incision), preoperative diagnosis (macular vs. nonmacular), history of vitrectomy, and primary surgeon (attending vs. supervised resident). Results: Multivariate logistic regression analysis found significant (P ≤ 0.05) protective factors for wound leakage including OSI, macular preoperative diagnosis, no previous vitrectomy, and female gender. Surgical duration at least 45 minutes was considered a borderline risk factor. Conclusion: Using an extremely OSI versus a conventional sclerotomy incision reduces the incidence of wound leakage postoperatively because of its self-sealing effect. Other factors that contribute to wound leakage, such as increased surgical duration and nonmacular diagnosis, may be indirect measurements of extensive trocar rotation, causing wound leakage despite the use of an OSI.
AB - Purpose: To evaluate risk factors for sclerotomy leakage in 23-gauge sutureless pars plana vitrectomy in 219 patients. Methods: Nested case-control study involving 48 patients with wound leaks (visible on-table sclerotomy leakage requiring sutures) and 171 control subjects without wound leaks. Patients received either a conventional sclerotomy incision at 45°, which was then changed to 90° midincision, or an extremely oblique sclerotomy incision (OSI) at 10°, which was then changed to 30° midincision. Risk factors studied included age, gender, laterality, surgical duration, sclerotomy incision (OSI vs. conventional sclerotomy incision), preoperative diagnosis (macular vs. nonmacular), history of vitrectomy, and primary surgeon (attending vs. supervised resident). Results: Multivariate logistic regression analysis found significant (P ≤ 0.05) protective factors for wound leakage including OSI, macular preoperative diagnosis, no previous vitrectomy, and female gender. Surgical duration at least 45 minutes was considered a borderline risk factor. Conclusion: Using an extremely OSI versus a conventional sclerotomy incision reduces the incidence of wound leakage postoperatively because of its self-sealing effect. Other factors that contribute to wound leakage, such as increased surgical duration and nonmacular diagnosis, may be indirect measurements of extensive trocar rotation, causing wound leakage despite the use of an OSI.
KW - 23-gauge
KW - oblique incision
KW - risk factors
KW - sutureless
KW - vitrectomy
KW - wound leakage
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U2 - 10.1097/IAE.0b013e3181ff0d77
DO - 10.1097/IAE.0b013e3181ff0d77
M3 - Article
C2 - 21386764
AN - SCOPUS:79958289094
SN - 0275-004X
VL - 31
SP - 1101
EP - 1108
JO - Retina
JF - Retina
IS - 6
ER -