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Correspondence747Sir,
Self-sealing sclerotomies in parsplana vitrectomy: aprospective evaluation of peroperative complicationsThe use of sutureless self-sealing sclerotomy sites in parsplana-vitrectomy was first described by Chen in 1996.1We present the results of 296 consecutive primaryvitrectomy cases over a period of 5 years (November1997 to November 2002) prospectively evaluated forcomplications.The same surgeon (RRG) carried out each procedure.The method used to create the sclerotomy sites was thatoriginally described by Chen.1 A proforma wascompleted by the surgeon at the end of each operation.Information recorded included the patients age,indication for surgery, additional instrumentation used,any peroperative complications, and sclerotomy sitesrequiring sutures. Each sclerotomy site was checked atthe end of the operation with a dry Visispear eye sponge(VISITEC) swab. If leakage of gas, air, oil, or balanced saltsolution (BSS) was seen, it was sutured with a 6/0 vicrylor 8/0 monofilament nylon suture.Inclusion criteria: All primary pars plana-vitrectomiesExclusion criteria: (1) Redo operations. (2) Surgicallyenlarged sclerotomy sites made to remove intraocularforeign bodies (IOFB). (3) One severely traumatised eye,too soft to make scleral tunnels.ResultsIn all, 296 eyes underwent primary vitrectomy throughself-sealing sclerotomies in the 5-year period. There were882 self-sealing sclerotomy sites.Indications for surgery are given in Table 1, togetherwith the suture rate.CommentThe goal of self-sealing sclerotomy sites is to avoid theuse of sutures to close sclerotomy sites at the end ofvitreoretinal surgery. There is no need to use plugsperoperatively as the sclerotomy seals spontaneouslyeach time an instrument is removed. It also allowsconstant running of the infusion with no turning on andoff as instruments are removed, and thus intraocularpressure remains stable. Other reported advantagesinclude a shortened operating time1,2 and prevention ofirritation related to nonabsorbable sutures.3 However, anumber of possible complications including woundleakage4,5 and vitreous and retinal incarceration5 havealso been highlighted.Our study found the 82.2% of sclerotomy sites wereself-sealing. Wound leakage from sclerotomy sites occursdue to stretching of the scleral pocket or due to radial
tearing of the scleral flap. A number of factors mayincrease this leakage and hence the suture...