Retinal Breaks Observed During Pars Plana Vitrectomy

Moore, Jeffrey K.; Kitchens, John W.; Smiddy, William E.; Mavrofrides, Elias C.; Gregorio, G. De

doi:10.1016/j.ajo.2007.03.048

Cited by 48 publications

(40 citation statements)

References 9 publications

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“…Over half of all such breaks were located inferiorly around the 6 o'clock position. Data regarding the distribution of iatrogenic breaks in the literature is variable with some authors either reporting that breaks are most commonly located inferiorly 8 or superiorly, 9 whereas others have found no significant predilection for a particular location. 10 The incidence of breaks did not appear to be higher in patients undergoing combined phacovitrectomy compared with vitrectomy alone, a finding supported by similar studies in the literature.…”

Section: Discussionmentioning

confidence: 95%

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

Gosse

Newsom

Lochhead

2011

Eye

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Purpose The development of 23-gauge vitrectomy surgery has many benefits including a reduction in surgical time and faster postoperative rehabilitation; however, some have suggested that the complication rate is higher. To assess this we compared the incidence and distribution of iatrogenic retinal tears in 20-and 23-gauge surgery. Methods Fifty consecutive 23-gauge and 50 consecutive 20-gauge vitrectomy cases were selected; eyes with a history of previous vitreoretinal surgery were excluded. All surgery was performed by two surgeons (JL and RN). Entry-site breaks (ESB) were defined as any new vitreoretinal abnormality occurring within 1 clock hour of an entry site for which treatment with cryotherapy was deemed necessary. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher's exact and v 2 -tests. Results ESB occurred in 24% (12/50) of cases in the 20-gauge group compared with 8% (4/50) in the 23-gauge group (P ¼ 0.03); 88% (14/16) occurred superiorly on the same side as the surgeons' dominant hand. Iatrogenic breaks recorded elsewhere indicated an increased incidence in the 20-gauge group (9/50 compared with 6/50 in 23-gauge) but this did not achieve significance; the most common position was at 6 o'clock. Conclusions 23-Gauge vitrectomy is associated with significantly fewer ESB when compared with conventional 20-gauge vitrectomy. The incidence of other iatrogenic breaks did not appear to be significantly different between the two groups.

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Section: Discussionmentioning

confidence: 95%

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

Gosse

Newsom

Lochhead

2011

Eye

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“…[1][2][3][4] Moore et al found no statistically significant association between posterior vitreous detachment (PVD) induction and retinal breaks in a retrospective observational series. 1 Tan et al 5 reported a 15.8% incidence of intraoperative breaks in a series of 177 consecutive cases undergoing 25-gauge transconjunctival sutureless vitrectomy (TSV). In this series, a statistically significant relationship between PVD induction and the presence of breaks elsewhere was identified.…”

Section: Introductionmentioning

confidence: 99%

“…Intraoperative recognition and treatment of these breaks reduces the postoperative risk of retinal detachment to that among eyes without observed intraoperative breaks. 1 The surgeon must perform with full understanding and knowledge of the limitations of instrumentation and machinery used in his or her hands. Equipped with this approach, iatrogenic retinal breaks can both be anticipated and promptly treated to the satisfaction of surgeon and patient.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Rahman

Murray

Stephenson

2013

Eye

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Purpse To describe the incidence and features of intraoperative retinal breaks caused by induction of posterior hyaloid face (PHF) separation during 23-gauge pars plana vitrectomy (PPV). Methods A prospective, consecutive, single surgeon, observational study of patients undergoing 23-gauge transconjunctival sutureless vitrectomy for macular pathology or floaters, was carried out between 2009 and 2011 at Calderdale Royal Hospital, UK. PHF separations were categorised as either suction induced or requiring membrane blue (DORC Limited) with suction (adherent). The outcome measure was dichotomised into retinal break or tear and no retinal break or tear. Forced entry and parsimonious multiple logistic regression analyses were conducted, using statistical software, to test for significance of association of the set of recorded factors and covariates with the dichotomised outcome measure. Results Data were collected and analysed from 137 patients. The incidence of iatrogenic retinal breaks associated with PHF separation during 23-gauge PPV was 18.2%. Under both forced entry and parsimonious multiple logistic regression models, the odds of a retinal break or tear reduce by about 3-4% for each increasing year of age. Findings also showed some substantive association in the forced entry model, with the odds of a retinal break or tear for adherent cases being around 3.8 times those for suctiononly cases.Conclusions Mechanical detachment of the PHF represents an important risk factor in the formation of retinal breaks. Particular care should be taken to examine intraoperatively for iatrogenic breaks in order to prevent missed breaks and subsequent rhegmatogenous retinal detachments.

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“…The breaks located in the superior quadrants, particularly in the quadrant near the surgeon's dominant hand, are considered sclerotomy-related breaks. 1,3,6,12,13 On the other hand, an IPVD is thought to be an important etiology when the breaks are located in the inferior quadrants. 2,3,5 Two of three (66.7%) retinal breaks in the PPH group were identified in the superior quadrants, near the sclerotomy sites, suggesting the etiology of these breaks could be sclerotomy-related rather than IPVD-related.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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Retinal Breaks Observed During Pars Plana Vitrectomy

Cited by 48 publications

References 9 publications

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Partial posterior hyaloidectomy for macular disorders

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