Barbara Wimpissinger1, Susanne Binder. 1. Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Rudolf Foundation Clinic, Vienna, Austria.
Abstract
PURPOSE: Today, pars plana vitrectomy represents a standard surgical procedure for a number of retinal diseases that were previously considered inoperable. The aim of the present study is to investigate the entry site of pars plana vitrectomy as a possible source of retinal detachment. METHODS: We reviewed retrospectively all cases of uncomplicated pars plana vitectomies because of macular hole, macular pucker and diabetic macular oedema performed in our department between 1 January 2001 and 7 July 2004. RESULTS: Over 3.5 years, 244 pars plana vitrectomies because of macular disease were performed. Sclerotomy-related retinal detachment was observed in 11 (4.5%) cases. These retinal detachments occurred at a mean of 37 (2-100) days after surgery. They appeared within the first 4 weeks in 55% of the cases. CONCLUSION: Iatrogenic retinal breaks and detachment continue to be a severe complication of pars plana vitrectomy, despite improvements in instrumentation and surgical techniques. A 4.5% incidence of sclerotomy-related retinal detachment after simple vitrectomy calls for action. Current approaches to reduce this complication - such as circular peripheral cryoretinopexy, scleral buckling or 360 degrees laser treatment - are invasive. We recommend extended vitreous base cleaning with scleral indentation and examination of the entry sites, performed with a three-mirror lens or via careful indirect ophthalmoscopy into the periphery, 4 weeks after surgery.
PURPOSE: Today, pars plana vitrectomy represents a standard surgical procedure for a number of retinal diseases that were previously considered inoperable. The aim of the present study is to investigate the entry site of pars plana vitrectomy as a possible source of retinal detachment. METHODS: We reviewed retrospectively all cases of uncomplicated pars plana vitectomies because of macular hole, macular pucker and diabetic macular oedema performed in our department between 1 January 2001 and 7 July 2004. RESULTS: Over 3.5 years, 244 pars plana vitrectomies because of macular disease were performed. Sclerotomy-related retinal detachment was observed in 11 (4.5%) cases. These retinal detachments occurred at a mean of 37 (2-100) days after surgery. They appeared within the first 4 weeks in 55% of the cases. CONCLUSION: Iatrogenic retinal breaks and detachment continue to be a severe complication of pars plana vitrectomy, despite improvements in instrumentation and surgical techniques. A 4.5% incidence of sclerotomy-related retinal detachment after simple vitrectomy calls for action. Current approaches to reduce this complication - such as circular peripheral cryoretinopexy, scleral buckling or 360 degrees laser treatment - are invasive. We recommend extended vitreous base cleaning with scleral indentation and examination of the entry sites, performed with a three-mirror lens or via careful indirect ophthalmoscopy into the periphery, 4 weeks after surgery.
Authors: M Dimitri Bouwens; Floris de Jong; Paul Mulder; Jan C van Meurs Journal: Graefes Arch Clin Exp Ophthalmol Date: 2008-08-16 Impact factor: 3.117