Intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for stage 3 and stage 4 idiopathic macular holes

Abstract

AimsTo investigate characteristics of intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for idiopathic macular hole and classify the breaks based on their causes to analyse the risk factors.MethodsThis retrospective study enrolled patients with stage 3 or 4 idiopathic macular hole who underwent 23-gauge vitrectomy in Beijing Tongren Hospital from July 2015 to August 2018. The intraoperative iatrogenic retinal breaks were classified into three types: by induction of posterior vitreous detachment (type 1), by peripheral vitreous cutting (type 2) and by others (type 3). The types, incidence and distribution of the breaks were analysed, and all clinical features were compared between eyes with and without the breaks.ResultsA total of 364 eyes from 341 patients were recruited. Twenty-five breaks from 24 eyes (6.6%) were encountered, 52% (13/25) of which distributed in the superior region. Type 1 and type 2 breaks contributed 52% (13/25) and 44% (11/25) to all, respectively. Eyes with stage 3 and stage 4 holes showed no significant differences in incidence or distribution in type 2 breaks. No breaks occurred on the surface of lattice degenerations. All clinical features showed no significant differences between eyes with and without the breaks.ConclusionDistribution of intraoperative iatrogenic retinal breaks shows no preference for the superior or inferior region. Induction of posterior vitreous detachment and traction from peripheral vitreous cutting are major causes of the breaks, which classify them into two main types. The presence of lattice may not be one of the risk factors if treated properly.

Optimized design of surgical steps in pars plana vitrectomy for macular hole retinal detachment in pathological myopia decreases rate of iatrogenic retinal break and shortens length of operation

“…The fluttering of retina was much less than PFCL assisted vitrectomy alone. This allows much safer peripheral vitreous cutting, another main cause for iatrogenic break [ 13 ].…”

“…It was reported that induction of posterior vitreous detachment lead to 50% of all iatrogenic retinal tear [13] and risk of developing iatrogenic break seemed to be correlated to adhesion of the posterior vitreous hyaloid [14,15]. While in pathological myopic patients, the surgical induction of PVD was more difficult with residual vitreous cortex more often presented [16], possibly due to the adhesion caused by presence of proinflammatory and angiogenesis-related cytokines in their vitreous [17].…”

Vitreous Opacity Vitrectomy (VOV): Safest Possible Removal of “Floaters”

“…The iatrogenic retinal tear rate during vitrectomy has decreased from as high as 37% in the 1970ʹs, 34 to 2–7% today. 33 , 35 , 36 Using the technological innovations of small gauge, cannulated entry, 37 , 38 and the ultra-high-speed suction/cutters recently developed by outstanding corporate partners in the vitreoretinal surgery industry, my experience is that the iatrogenic tear rate can now be further reduced to less than 1%, using VOV techniques.…”

Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study

“…In our case series, scleral-depressed peripheral examinations were performed at the end of each surgery and no retinal break was identified in each case at the end of the procedure. As reported, the incidence of retinal breaks of macular diseases such as epiretinal membrane (ERM) and MH was low, ranging from 0 to 15.8% [23][24][25][26][27][28][29], but with an average of less than 2.0% [23][24][25][26][27]. The 0% rate of complications in our technique may be owing to the nonscleral-depressed shaving of the vitreous base, vitrectomy by only one experienced surgeon (P.X), and the relatively small sample size.…”