F Matonti1, F Meyer2, H Rouhette3, S Guigou4, S Dumas5, E Parrat6, P-Y Mérité2, S Pommier7. 1. Service d'ophtalmologie, université Aix-Marseille, hôpital Nord, chemin de Bourrely, 13915 Marseille cedex 20, France; Équipe InViBe, institut de neurosciences de la Timone, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille, France. Electronic address: frederic.matonti@ap-hm.fr. 2. Centre d'ophtalmologie, 44, avenue Maréchal-de-Lattre-de-Tassigny, 13090 Aix-en-Provence, France. 3. Clinique Espérance, 122, avenue Dr-Maurice-Donat, 06250 Mougins, France. 4. Service d'ophtalmologie, hôpital Henri-Duffaut, 305, rue Raoul-Follereau, 84902 Avignon, France. 5. Centre d'ophtalmologie, 20, rue Ballon, 59000 Lille, France. 6. Centre d'ophtalmologie, 44, rue Henry-Becquerel-Jarry, immeuble SCI Futur, 97122 Baie-Mahault, Guadeloupe. 7. Centre d'ophtalmologie, 1 bis, quartier Lices-Berthelot, 84800 Isle-sur-la-Sorgue, France.
Abstract
PURPOSE: To evaluate the incidence, characteristics and risk factors for rhegmatogenous complications of transconjunctival sutureless 23-gauge vitrectomy (TSV) in macular surgery. The results were correlated with those reported in the literature. METHODS: Multicentric retrospective study of a cohort of patients undergoing macular surgery by 23-gauge TSV between January 2009 and June 2010. RESULTS: Four hundred and seventy-four patients divided into: epiretinal membrane (MEM) (n=279), vitreomacular traction (n=65) and idiopathic macular hole n=130. Forty-three percent of patients were pseudophakic. Posterior vitreous detachment (PVD) was absent in 60% of cases and was therefore systematically performed intraoperatively. It was seen that 1.7% of patients developed retinal tears and 2.7% retinal detachment with a higher incidence in the vitreomacular traction (VMT) group and the group in which the PVD was performed intraoperatively. Rhegmatogenous lesions were localized mainly in the inferior retina in the macular hole group. DISCUSSION: Results are consistent with the TSV literature. Their location does not appear to be related to the sclerotomies or handedness as in 20-gauge surgery, probably due to sclerotomy trocars. Localization of rhegmatogenous lesions in the inferior retina in macular hole surgery suggests a role of gas in this subgroup. In addition to instrument-retinal touch, the performance of a surgical PVD represents a major independent risk factor for retinal detachment (RD). CONCLUSION: Even with limited macular surgery, it is essential to check the retinal periphery for 360 degrees, especially for VMT and intraoperative PVD, and especially inferiorly in the case of gas tamponnade.
PURPOSE: To evaluate the incidence, characteristics and risk factors for rhegmatogenous complications of transconjunctival sutureless 23-gauge vitrectomy (TSV) in macular surgery. The results were correlated with those reported in the literature. METHODS: Multicentric retrospective study of a cohort of patients undergoing macular surgery by 23-gauge TSV between January 2009 and June 2010. RESULTS: Four hundred and seventy-four patients divided into: epiretinal membrane (MEM) (n=279), vitreomacular traction (n=65) and idiopathic macular hole n=130. Forty-three percent of patients were pseudophakic. Posterior vitreous detachment (PVD) was absent in 60% of cases and was therefore systematically performed intraoperatively. It was seen that 1.7% of patients developed retinal tears and 2.7% retinal detachment with a higher incidence in the vitreomacular traction (VMT) group and the group in which the PVD was performed intraoperatively. Rhegmatogenous lesions were localized mainly in the inferior retina in the macular hole group. DISCUSSION: Results are consistent with the TSV literature. Their location does not appear to be related to the sclerotomies or handedness as in 20-gauge surgery, probably due to sclerotomy trocars. Localization of rhegmatogenous lesions in the inferior retina in macular hole surgery suggests a role of gas in this subgroup. In addition to instrument-retinal touch, the performance of a surgical PVD represents a major independent risk factor for retinal detachment (RD). CONCLUSION: Even with limited macular surgery, it is essential to check the retinal periphery for 360 degrees, especially for VMT and intraoperative PVD, and especially inferiorly in the case of gas tamponnade.