Purpose: Transient ocular hypotony commonly occurs after 23-gauge (23G) vitrectomy. To assess possible causes, we visualized the sclerotomy site and pars plana by anterior segment optical coherence tomography (AS-OCT). Procedures: We prospectively analyzed the intraocular pressure (IOP) and findings related to clinical hypotony, assessed by AS-OCT, in 13 consecutive eyes of 13 patients receiving 23G vitrectomy. Five patients receiving a 20G vitrectomy served as controls. Results: The mean IOP after 23G vitrectomy was 11 mm Hg (range: 5–32 mm Hg; 13 eyes) at postoperative day 1. In contrast to controls, AS-OCT showed a scleral gap at the incision site in 22/39 sclerotomies (10/13 eyes), and subclinical choroidal detachment in 9/13 eyes. Conclusions: A scleral gap and choroidal detachment at the incision site are frequent findings following 23G vitrectomy. These subclinical features may account for postoperative hypotony as they are absent in 20G vitrectomy and scleral sutures. Hypotony following 23G vitrectomy is a self-limiting phenomenon and usually does not require therapeutic intervention.

Nagpal M, Wartikar S, Nagpal K: Comparison of clinical outcomes and wound dynamics of sclerotomy ports of 20-, 25-, and 23-gauge vitrectomy. Retina 2009;29:225–231.
Fujii GY, de Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C, Ng E, Barnes A, Wu SL, Sommerville DN: A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology 2002;109:1807–1812, discussion 1813.
Eckardt C: Transconjunctival sutureless 23-gauge vitrectomy. Retina 2005;25:208–211.
Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M: Incidence of endophthalmitis after 20- and 25-gauge vitrectomy causes and prevention. Ophthalmology 2008;115:2215–2220.
Kusuhara S, Ooto S, Kimura D, Itoi K, Mukuno H, Miyamoto N, Akimoto M, Kuriyama S, Takagi H: Outcomes of 23- and 25-gauge transconjunctival sutureless vitrecto- mies for idiopathic macular holes. Br J Ophthalmol 2008;92:1261–1264.
Scott IU, Flynn HW Jr, Dev S, Shaikh S, Mittra RA, Arevalo JF, Kychenthal A, Acar N: Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes. Retina 2008;28:138–142.
Lott MN, Manning MH, Singh J, Zhang H, Singh H, Marcus DM: 23-gauge vitrectomy in 100 eyes: short-term visual outcomes and complications. Retina 2008;28:1193–1200.
Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, Dugel PU, Gupta S, Pollack JS: Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol 2008;146:193–197.
Parolini B, Romanelli F, Prigione G, Pertile G: Incidence of endophthalmitis in a large series of 23- and 20-gauge transconjunctival pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2009;247:895–898.
Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H: Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy. Retina 2009;29:456–463.
Kim MJ, Park KH, Hwang JM, Yu HG, Yu YS, Chung H: The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy. Korean J Ophthalmol 2007;21:201–207.
Tewari A, Shah GK, Fang A: Visual outcomes with 23-gauge transconjunctival sutureless vitrectomy. Retina 2008;28:258–262.
Wimpissinger B, Kellner L, Brannath W, Krepler K, Stolba U, Mihalics C, Binder S: 23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial. Br J Ophthalmol 2008;92:1483–1487.
Tsang CW, Cheung BT, Lam RF, Lee GK, Yuen CY, Lai TY, Lam DS: Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment. Retina 2008;28:1075–1081.
Hikichi T, Matsumoto N, Ohtsuka H, Higuchi M, Matsushita T, Ariga H, Kosaka S, Matsushita R: Comparison of one-year outcomes between 23- and 20-gauge vitrectomy for preretinal membrane. Am J Ophthalmol 2009;147:639–643.e1.
Fine HF, Iranmanesh R, Iturralde D, Spaide RF: Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology 2007;114:1197–1200.
Taban M, Sharma S, Ventura AA, Kaiser PK: Evaluation of wound closure in oblique 23-gauge sutureless sclerotomies with Visante optical coherence tomography. Am J Ophthalmol 2009;147:101–107.e1.
Gupta OP, Maguire JI, Eagle RC Jr, Garg SJ, Gonye GE: The competency of pars plana vitrectomy incisions: a comparative histologic and spectrophotometric analysis. Am J Ophthalmol 2009;147:243–250.
Kunimoto DY, Kaiser RS: Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology 2007;114:2133–2137.
Venkatesh P, Verma L, Tewari H: Posterior vitreous wick syndrome: a potential cause of endophthalmitis following vitreo-retinal surgery. Med Hypotheses 2002;58:513–515.
Singh RP, Bando H, Brasil OF, Williams DR, Kaiser PK: Evaluation of wound closure using different incision techniques with 23- and 25-gauge microincision vitrectomy systems. Retina 2008;28:242–248.
Ezra E, Gregor ZJ: Surgery for idiopathic full-thickness macular hole: two-year results of a randomized clinical trial comparing natural history, vitrectomy, and vitrectomy plus autologous serum. Morfields Macular Hole Study Group Report No. 1. Arch Ophthalmol 2004;122:224–236.
Gupta OP, Weichel ED, Regillo CD, Fineman MS, Kaiser RS, Ho AC, McNamara JA, Vander JE: Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging 2007;38:270–275.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.