Comparison of Intraocular Pressure Between Sutureless and Sutured 23-gauge Vitrectomy

PURPOSE: To compare 23-gauge transconjunctival sutureless vitrectomy (TSV) and sutured vitrectomy in the aspect of intraocular pressure (IOP) changes and complications. METHODS: Through a retrospective chart review, 45 sutureless patients (48 eyes) and 48 sutured patients (52 eyes) who had undergone 23-gauge transconjunctival vitrectomy by one surgeon (J.H. Sohn) were compared. IOP was measured routinely pre-operativley, at 1 day, 1 week, and 1 month post-operatively. Postoperative IOP, hypotony (IOP<7 mmHg) rates and complications associated with hypotony were assessed respectively. In addition, the cases involving intraocular air or gas tamponade or cataract extraction were compared. RESULTS: One day after the surgery, 3 eyes of the sutureless group developed hypotony,which persisted in 2 eyes through postoperative 1 week. Two eyes of the sutureless group developed hypotony 1 week after the surgery. Most of the hypotony cases were transient, but choroidal detachment occurred in 2 cases, and retinal detachment occurred in 1 case. In contrast, none of the sutured group developed hypotony. Intraocular air or gas tamponade significantly raised IOP 1 day after the surgery. When the operation was combined with cataract extraction, IOP was reduced postoperative 1 week and 1 month. CONCLUSIONS: The well-known risk factor of 23-gauge sutureless vitrectomy is postoperative hypotony. The present study showed postoperative hypotony can result in retinal detachment as a complication in contrast to previous studies. The authors conclude that suturing the wound for the prevention of hypotony is better, especially in cases with high risk of hypotony or definite wound leakage.

Fibrous Encapsulation of Biodegradable Collagen Matrix After Trabeculectomy: A Case Report

PURPOSE: Recently, biodegradable collagen matrix has been used as a possible substitute for anti-metabolite in trabeculectomy in order to control the responsiveness of the wound healing process. This paper reports a case of encapsulation of the biodegradable collagen matrix after trabeculectomy. CASE SUMMARY: We conducted a fornix-based trabeculectomy on a 58-year-old man with medically uncontrollable steroid-induced glaucoma. We implanted biodegradable collagen matrix onto the sclera flap beneath the conjunctiva. Immediately after the surgery, we observed a localized bleb with high elevation. In the three months of follow-up, the bleb became encapsulated, and an increase in intraocular pressure was noted. During the wound revision, encapsulated material surrounded by thick fibrous membrane was found and removed from the subconjunctival space, followed by biopsy. Biopsy results demonstrated that amorphous collagenous material was surrounded by spindle and inflammatory cells. CONCLUSIONS: It is important to note that the fibrous encapsulation of collagen material is a possible complication of biodegradable collagen matrix-augmented trabeculectomy.

Pigment Deposition of Cosmetic Contact Lenses on the Cornea after Intense Pulsed-Light Treatment

We report a case of corneal deposition of pigments from cosmetic contact lenses after intense pulsed-light (IPL) therapy. A 30-year-old female visited our outpatient clinic with ocular pain and epiphora in both eyes; these symptoms developed soon after she had undergone facial IPL treatment. She was wearing cosmetic contact lenses throughout the IPL procedure. At presentation, her uncorrected visual acuity was 2/20 in both eyes, and the slit-lamp examination revealed deposition of the color pigment of the cosmetic contact lens onto the corneal epithelium. We scraped the corneal epithelium along with the deposited pigments using a no. 15 blade; seven days after the procedure, the corneal epithelium had healed without any complications. This case highlights the importance of considering the possibility of ocular complications during IPL treatment, particularly in individuals using contact lenses. To prevent ocular damage, IPL procedures should be performed only after removing the lenses and applying eyeshields.

Trabeculectomy With Biodegradable Collagen Material: A Report of Two Cases

PURPOSE: To report two cases of trabeculectomy with biodegradable collagen material conducted on two post-vitrectomy patients. CASE SUMMARY: The first patient was a 43-year-old woman with uncontrolled increased intraocular pressure (IOP) after pars plana vitrectomy with scleral buckling for diabetic retinopathy and vitreous hemorrhage. Another patient, a 28-year-old woman with aphakia, also had uncontrolled increased IOP after pars plana vitrectomy with encircling scleral buckling for retinal detachment. For both of these patients, we performed trabeculectomy using mitomycin C and recently developed biodegradable collagen matrix. In the first case, the IOP was increased three months after the surgery, for which needling was done. After needling, the IOP was well controlled in the range of 16 to 19 mmHg up to eight months postoperatively with stilling anti-glaucomatous eyedrops (Cosopt(R), Xalatan(R)). In the second case, IOPwas increased one week after the surgery, but it was well controlled between 14 to 21 mmHg up to nine months postoperatively with anti-glaucomatous eye drops (Combigan(R)). CONCLUSIONS: Biodegradable collagen matrix can possibly reduce the surgical failure of trabeculectomy and it is especially suitable for high risk patients when combined with anti-metabolic agents like MMC.