Sutureless biplanar closure of leaking wounds in micro-incision vitreous surgery: A novel technique.

Aim:: To describe a novel technique for sutureless hermetic closure of leaking scleral wounds in micro-incision vitreous surgery.

Methods:: This study is a two-centre, non-comparative, interventional case series. We studied 1240 scleral incisions on 870 eyes using different gauges (20, 23, 25) to evaluate the effectiveness of a new technique to seal scleral wounds without sutures. If wounds were found leaking after removing the trocar, we used the same trocar (or microvitreoretinal) blade to make an adjacent trans-scleral entry in the same direction as the main incision to access its internal flap supporting it from inside. Simultaneously, we applied a blunt smooth-surface instrument to massage the scleral wound from outside to close it hermetically. We treated 870 eyes using three types of tamponading agents, namely, silicone oil in 654 (75%) eyes, non-expansible gas in 128 (15%) eyes, and air in 88 (10%) eyes. We performed optical coherence tomography in the first 100 sclerotomies on the post-operative Day 1.

Results:: We closed leaking incisions at the first attempt in 1231 (99.3%) cases; in 9 (0.7%) cases of 20-gauge incisions, we closed the wounds at the second attempt. We observed no hypotony at the end of surgery. The mean intraocular pressure was 16 mmHg (8-51 mmHg) on the post-operative Day 1.

Conclusion:: Our results show the biplanar closure technique may be used as an effective, quick, sutureless approach to close leaking wounds hermetically in micro-incision vitreous surgery procedures. It is safe, less traumatic, cost-effective, and easy-to-perform typical surgical settings.