Iatrogenic punctate chorioretinopathy after internal limiting membrane peeling

Abstract

Purpose To define the chorioretinal lesions created unintentionally during grasping the internal limiting membrane (ILM) with end-gripping forceps. Design Interventional case series. Methods A prospective review of a consecutive series of 15 patients (15 eyes) who underwent macular hole repair was performed. All patients underwent a three-port pars plana vitrectomy with ILM peeling. Fundus photographs, fluorescein angiography, and indocyanine green angiography were performed in all patients before and after surgery. Results In all eyes, small punctate barely seen chorioretinal lesions in the macular region were detected after surgery. These punctate lesions corresponded to the area where ILM was grasped with forceps. The lesions ranged from 100 to 400 μm in diameter. Their number ranged between 8 and 15 (mean, 12.6). In the early phase of fluorescein angiography, the lesions appeared hypofluorescent; in the late phase, there was slight staining of the margin of the lesions extending from the adjacent choriocapillaris, causing indistinct borders. In the early phase of indocyanine green angiogram, the lesions were hypofluorescent and in some larger lesions choroidal vessels were visible due to the thinning and atrophy of the retinal pigment epithelium and choriocapillaris. In the late phase, the homogenous hypofluorescent areas had well-delineated margins and were usually round or oval. This angiographic finding was independent of the age of the lesion, and neither enlargement of the lesions nor development of choroidal neovascularization were noted during follow-up. Conclusions Iatrogenic punctate chorioretinopathy is the chorioretinal lesion created unintentionally during grasping the ILM with end-gripping forceps. It must be reported as one of the complications of ILM peeling. These small punctate lesions did not appear to affect the surgical outcome. However, the lesions should be followed to detect any long-term complication such as choroidal neovascularization.