“Pinch and Stretch” technique to overcome ocular hypotony during scleral suturing of recti muscles

During extraocular muscle surgery, an uneventful scleral suture pass is very essential. In presence of normal intraocular tension, the surgery is quite predictable and safe. However, in the presence of significant hypotony, it becomes challenging. Therefore, to mitigate complication rate in these cases, we have adopted a simple technique, that is, the “pinch and stretch” technique. The surgical steps of this technique are as follows: In eyes with significant ocular hypotony, the surgery is initiated with a routine forniceal/limbal peritomy, following which the muscle is sutured and dis-inserted. Using three tissue fixation forceps, the scleral surface is stabilized. Using first forceps, the surgeon rotates the globe toward themself from the muscle stump, and with the remaining two forceps, the assistant pinches and stretches the episcleral tissue in an outward and upward direction just beneath the intended marks. This creates a flat scleral surface with significant firmness. Sutures are passed over this rigid sclera and the surgery is completed without any complications.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

Efficacy of two kinds of posterior chamber intraocular lens fixation in the treatment of lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS: Retrospective case-control study. A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected, among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture, and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens. The patients in both groups were followed up until 3mo after surgery to observe the operative time, best corrected visual acuity(BCVA), corneal endothelial cell count(CECC), central corneal thickness(CCT)and postoperative complications.RESULTS: The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs. 45.38±8.04min, P&#x003C;0.001). BCVA in both groups was significantly improved after surgery(all P&#x003C;0.05), and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs. 0.57±0.25, P&#x003C;0.001). At 3mo after surgery, CECC in both groups was lower than that before surgery(all P&#x003C;0.01). The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P&#x003C;0.01), and there was no significant change in CCT before and after surgery in the sutureless group. During follow-up period, the total complication rate in the sutureless group was lower than that in the suture group(26% vs. 38%, P&#x003E;0.05).CONCLUSION: 25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time, faster postoperative visual acuity improvement and fewer postoperative complications.

The Effects of the Scleral Suture in 23-Gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To evaluate the effects of scleral suture for the sclerotomy wound leakage and the clinical outcomes in 23-gauge transconjunctival sutureless vitrectomy with fluid-air exchange. METHODS: A retrospective, comparative chart review of 75 eyes of 75 patients who underwent 23-gauge transconjunctival vitrecomy with fluid air exchange was performed. The patients were divided into 2 groups according to the scleral suture used at the end of the operation, sclera-sutured group and sutureless group. The amount of intraocular gas remnants was measured to compare the degree of sclerotomy wound leakage and the postoperative intraocular pressure (IOP) and reoperation rate were analyzed. RESULTS: The mean IOP on postoperative day 1, 7 and 14 was 15.5 +/- 4.0 mm Hg in the sclera-sutured group and 15.8 +/- 6.2 mm Hg in the sutureless group, without statistical difference (p = 0.874). The percentage of intraocular gas remnants in eyes on postoperative day 1 was significantly higher in the sclera-sutured group (92.9 +/- 9.7%) than in the sutureless group (82.4 +/- 16.2%; p = 0.002) as well as on postoperative days 7 and 14. The reoperation rate was not statistically significantly different between the sclera-sutured group (6.5%) and sutureless group (9.1%; p = 0.683) CONCLUSIONS: In the cases of 23-gauge sutureless vitrectomy with fluid-air exchange, the scleral suture may be effective to prevent the sclerotomy wound leakage and maintain the intraocular gas longer, but there was no statistically significant difference in the final success rate between the 2 groups. However, as more intraocular gas remained in the sclera-sutured group than in the sutureless group statistically, the scleral suture should be considered in cases that require long-term gas tamponade.

The Resection of Extraocular Muscle without Scleral Suture in the Rabbit

PURPOSE: The purpose of this study was to find stability and histological change after resection of extraocular muscle by suturing the proximal and distal muscle segments end to end for elimination of the risk of scleral perforation in the rabbit. METHODS: After dividing rabbits into two groups, we performed the resection of superior rectus muscle. The control group (18 eyes) was treated with conventional operation method in which we placed sutures directly into sclera after resection of muscle, whereas in the experimental group (18 eyes) sutures were placed between proximal and distal muscle segments end to end, without scleral suture, after resection of muscle 3 mm behind the original insertion. We measured the maximum adhesion power at 1day, 1-, 4-, and 8-week postoperative intervals and observed the histopathologic findings at 4- and 8-week postoperative intervals in both groups. RESULTS: In both groups, the maximal adhesion power increased gradually with time at muscle-to-sclera and muscle-to-muscle adhesion site and reached its highest at 8th week. According to histopathologic findings, chronic inflammatory reaction and foreign body reaction were more severe in the experimental group at 4th week, but disappeared at 8th week in both groups. Fibrosis was slightly more severe in the experimental group. CONCLUSIONS: In resection of extraocular muscle for correction of strabismus, muscle-to-muscle suture is thought to be stable and effective way to avoid scleral perforation for the patient whose sclera is thin or abnormal.