Sclerotomy is a specialized surgical procedure performed on the eye. It involves creating a precise opening in the sclera, the tough, white outer layer of the eyeball. This intervention is undertaken to address various ocular conditions, aiming to restore or improve eye health.
What Sclerotomy Is
Sclerotomy refers to a surgical incision made into the sclera, commonly known as the white part of the eye. Its primary purpose is to gain access to the inner structures of the eye or to relieve pressure. For instance, it can facilitate procedures like vitrectomy. The word “sclerotomy” combines “skleros,” Greek for “hard” (referring to the sclera), and “-tomy,” meaning “cutting” or “incision.”
When Sclerotomy Is Needed
Sclerotomy manages various ocular conditions, especially those involving fluid imbalance or requiring internal eye access. A common reason is to treat glaucoma, diseases that damage the optic nerve. In these cases, sclerotomy helps create drainage pathways to reduce fluid buildup and lower intraocular pressure.
The procedure is also part of a vitrectomy, which removes vitreous humor, the gel-like substance filling the eye. This allows surgeons to access the retina and other internal structures to address conditions such as retinal detachment or to remove foreign bodies. Sclerotomy may also be considered when other medical treatments, including systemic osmotic therapy and topical drops, have not successfully lowered intraocular pressure, particularly if it remains above 40 mmHg.
How Sclerotomy is Performed
The general surgical approach for a sclerotomy involves making precise incisions into the sclera. The specific technique varies depending on the condition being treated and the surgeon’s preference. Some procedures involve a “self-sealing” incision, where the wound’s design helps it close without sutures.
Transconjunctival Sutureless Vitrectomy (TSV)
One type is transconjunctival sutureless vitrectomy (TSV), where small incisions are made through the conjunctiva and sclera to remove vitreous humor. Instruments are inserted through these angled incisions to perform the vitrectomy. This technique aims for faster healing, reduced conjunctival scarring, and improved patient comfort.
High-Frequency Deep Sclerotomy (HFDS)
Another method is high-frequency deep sclerotomy (HFDS), a minimally invasive procedure often used for primary open-angle glaucoma. This technique utilizes a high-frequency diathermic probe to create small pockets in the sclera, penetrating the trabecular meshwork and Schlemm’s canal. These pockets reduce outflow resistance for aqueous humor and lower intraocular pressure.
Full-Thickness Sclerotomy
Full-thickness sclerotomy involves making a complete incision through the sclera. This procedure can be used to treat conditions like uveal effusion syndrome, characterized by fluid buildup from compromised choriocapillaries due to a thickened sclera. It facilitates fluid drainage and can indirectly decompress vortex veins by relaxing scleral tension.
Recovery and Considerations After Sclerotomy
Following a sclerotomy, patients experience a recovery period with common discomfort, blurred vision, and light sensitivity. Most individuals can resume normal activities within two to four weeks. Post-operative care includes a plan for eye drops multiple times daily to prevent infection and reduce inflammation.
Patients will have follow-up appointments with their doctor to monitor healing and ensure the desired outcome. While complications are uncommon, potential risks include infection, bleeding, and retinal detachment. Temporary low intraocular pressure (hypotony) or leakage from the incision site can also occur. These issues are manageable with prompt medical attention.