Self sealing sclerotomies (SSK) reduce the operative
trauma also with 20 gauge instruments
Jörg C. Schmidt (Marburg)
Background: In order to reduce the periocular trauma during vitrectomy, it is mendatory to
use transconjunktival 25 Gauge or 23 Gauge trocaresystems, thus avoiding a scleral suturing.
An alternative are self sealing sclerotomies for convnetional 20 Gauge instruments.
Self sealing sclerotomies in pars-plana vitrectomy can easily be combined with a scleral tunnel
for phacoemulsification and thus enable a non-stitch surgical technique.
Material and methods: Self sealing sclerotomies were used on over 1000 patients at our
institution up to now. In 40% of the cases an additional phacoemulsification via a scleral
tunnel with subsequent implantation of a PMMA intraocular lens was performed. The conjunctiva
was readapted with tissuglu or a covered suture.
Results: At the end of the vitrectomy over 90% of the self sealing sclerotomies were tightly closed without additional sutures
but with air endotamponade. So in none of the case a subjonjunctival granuloma coused by sutures was seen. Due to the
nature of self sealing sclerotomies no intraocular pressure changes occured, even if surgical instruments had to be changed
and in cases of gas or air endotamponade, thus reducing the risk of choroidal or intraocular bleedings. In combination with
a scleral tunnel and phacoemulsification, self sealing sclerotomies do not lead to increased instability of the bulb. Post-op
hypotony was fund in two uveitis cases but no leckage.
Discussion: The simple handling of SSK, the good wound closure and the use all 20 Gauge instruments are excellent options
compaired to the 23 Gauge or 25 Gauge trocarsystem. Self sealing sclerotomies can be combined with phacoemulsification
as non-stitch surgical technique. This reduces both postoperative astigmatism and suture granulomas.