Abstract
Purpose. To observe and classify vitreous incarcerations in patients undergoing second 20-gauge pars plana vitrectomy (PPV) for recurrent retinal detachment. Methods. Retrospective noncomparative consecutive case series. Eighty-two consecutive patients with recurrent retinal detachment were included. The previous sclerotomy sites were examined by our sclera depression method and the vitreous incarceration were classified into Grade 0–IV by their severity under surgical microscope before second surgery. The relationship of vitreous incarceration and different ports was statistically investigated in our included patients. Results. Vitreous incarceration in the previous sclerotomy sites were found frequently. Vitreous cutter sites were most involved, but the infusion pipe sites were the least. According to our classification and definition, Grade III and IV of vitreous incarceration in all the three different sclerotomy sites accounted for 32.5%. Grade II of vitreous incarceration consisted of 12.6%. Grade 0 and I in all the three different sclerotomy sites were 54.8%. The frequency of all grades of vitreous incarceration in light port or vitreous cutter port was significant higher than that in infusion port. Conclusions. Vitreous incarceration in light port and vitreous cutter port are found more common than in infusion port for 20-gauge PPV with our new method.
Highlights
The causes of vitreous surgery failure have been a controversial issue for the century [1,2,3]
There were 246 previous sclerotomy sites observed in the 82 included recurrent retinal detachment patients (82 eyes), of which 164 (66.7%) previous sclerotomy sites were found with different degrees of vitreous incarceration
We could see that the least sclerotomy-related complications occurred in infusion port, but the retinal breaks caused by sclerotomyrelated complications were the most frequency in vitreous cutter port
Summary
The causes of vitreous surgery failure have been a controversial issue for the century [1,2,3]. It was considered that anterior proliferative vitreoretinopathy (APVR) is the main reason of the initial or repeated vitreous surgeries [1, 2]. APVR was significantly associated with residual basal vitreous and could be prevented effectively by its complete removal during PPV [3]. Many pathological studies have demonstrated that APVR was related to vitreous incarceration of sclerotomy sites [4,5,6]. We developed a practical sclera depression method to examine the previous sclerotomy sites under surgical microscope before second 20-gauge PPV and defined a new method for classification of vitreous incarcerations in sclerotomy sites. We investigated the relationship of severity of vitreous incarcerations and different 20-gauge sclera port in our study group
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