A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM:To introduce and evaluate the clinical efficacy of a new technique,the use of viscoelastic substances(VS)to close leaking sclerotomy in 23G microincision vitrectomy,and to observe its effect on the visual acuity and intraocular pressure(IOP)of patients.METHODS:Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique(June 2019 to September 2020)and after the use of VS technique(October 2020 to December 2021)were selected as the subjects of this study.The above cases underwent operation by the same surgeon and were retrospectively analyzed.VS technique was used as the alternative to suturing,in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure.RESULTS:A total of 174 eyes were covered in the study,including 84 eyes in the control group(before the use of VS technique)and 90 eyes in the VS technique group.The number of eyes that needed to be sutured decreased considerably from 42.9%in the control group to 3.3%in the VS technique group,and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7%in the control group to 2.2%in the VS technique group.No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group.No major complications associated with VS technique were identified during the study.CONCLUSION:In 23G microincision vitrectomy,VS technique is a safe,simple,and effective method to close leaking sclerotomy.

Functional evaluation of the filtering bleb by ultrasound biomicroscopy after trabeculectomy with mitomycin C

AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3 min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure（IOP） was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mmHg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36 mo after trabeculectomy（13.6±9.7 m o）. RESULTS： This study included 33 trabeculectomy filtering blebs of 25 patients（9 males and 16 females）. The mean age of patients was 53.2±14.2 y（range 25-71y）. We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs（IOP ≤18 mmHg without antiglaucoma medications）, others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings（intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts） and cases with different grades of clinical functional success（P〈0.01）.CONCLUSION： UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.