Retinal Breaks Associated with the Induction of Posterior Vitreous Detachment

Chung, Song Ee; Kim, Kuk-Hyoe; Kang, Se Woong

doi:10.1016/j.ajo.2009.01.013

Cited by 72 publications

(65 citation statements)

References 16 publications

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“…Given the position and direction of the vitreous cutter in conventional vitrectomy, some degree of perpendicular traction to the vitreous base cannot be avoided (Figure 1-A3). Considering the similar propensity for the incidence of PVD-related retinal break in macular surgery despite the evolution of the vitrectomy machine, 1,3,4,6,[8][9][10][11][12] the effect of increasing cut velocity may be limited. Some degree of artificial vitreous traction seems to be inevitable during peripheral vitreous removal.…”

Section: Discussionmentioning

confidence: 99%

“…The induction of a posterior vitreous detachment (IPVD) during vitrectomy has been suggested as one of the etiologies of retinal breaks. [1][2][3][4] In particular, this is suspected to be the main cause when the break is located further away from the sclerotomy site.…”

Section: Introductionmentioning

confidence: 99%

“…1,[3][4][5] However, a fundamental strategy to prevent the development of iatrogenic retinal breaks related to an IPVD has not yet been established. Some investigators have recommended a careful intraoperative and postoperative peripheral examination at the end of each vitrectomy.…”

Section: Introductionmentioning

confidence: 99%

“…2,4 Thus, we hypothesized that this complication could be prevented by restricting the extent of the IPVD. We planned a modified vitrectomy procedure in which the extent of the IPVD and removal of vitreous cortex was restricted to an area slightly beyond the margin of the temporal major vascular arcade.…”

Section: Introductionmentioning

confidence: 99%

“…Some investigators have recommended a careful intraoperative and postoperative peripheral examination at the end of each vitrectomy. 1,3,4,6 More detailed techniques such as scleral depression 1,4 and use of a wide-angle viewing system 4 have been recommended to minimize the incidence of a missed break. However, these recommendations were focused mainly on early detection and treatment of breaks rather than preventing the development of the break itself.…”

Section: Introductionmentioning

confidence: 99%

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Partial posterior hyaloidectomy for macular disorders

Kim

Kang

Kim

et al. 2013

Eye

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Purpose To evaluate the effect of partial posterior hyaloidectomy (PPH) in preventing iatrogenic retinal breaks related to the induction of a posterior vitreous detachment (IPVD) Methods Fifty-nine patients who necessitated IPVD for an epiretinal membrane or macular hole were included in this prospective, interventional case series. Extensive removal of vitreous gel, close to the retina, was conducted before IPVD under 23 G (gauge)-vitrectomy system. The PPH involved the limited extent of IPVD and limited removal of the outermost vitreous cortex to an area slightly beyond the margin of the temporal major vascular arcade. The incidence of retinal breaks related to the surgery was compared with 57 eyes that had undergone conventional 23-G total vitrectomy accompanied by extensive IPVD using w 2 -test. Results Patients were followed-up for a mean of 14.3 months (6-30 months) after the surgery. The incidence of peripheral retinal breaks after the PPH was 3.4% (2/59 eyes), which was significantly lower than that in the eyes that underwent conventional 23 G vitrectomy (15.8%, 9/57 eyes, P ¼ 0.023) for the same disorders that required an IPVD. No patient complained of postoperative floaters, postoperatively. Conclusions PPH would be an efficient procedure to prevent iatrogenic peripheral retinal breaks related to an IPVD.

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