Iatrogenic Retinal Tears Research Articles

Membrane delaminating wedge.

Iatrogenic retinal tears may complicate procedures to treat proliferative vitreoretinal diseases. To decrease the risk of this complication, we developed a new instrument, the membrane delamination wedge, that allows the surgeon to separate the proliferative membranes from the retina effectively and safely.

Vitrectomy for Nondiabetic Vitreous Hemorrhage

Fifty cases (fifty-three eyes) of nondiabetic vitreous hemorrhage underwent vitrectomy. The visual acuity improved in 39 eyes (73.6%) postoperatively. Twenty seven eyes obtained a visual acuity of 0.05 or better. The postoperative vision was related to the etiology and macular function. Vitreous hemorrhage due to blunt trauma responded best. All of them had vision improved. Eales's disease also had a good result. 77% was improved in vision postoperatively. The main complications of surgery were recurrent vitreous hemorrhage and secondary glaucoma, especially hemolytic glaucoma (4/6). The timing for vitrectomy, degree of cutting and hemolytic glaucoma were briefly discussed.

Results of Conventional Vitreous Surgery for Proliferative Vitreoretinopathy

During a five-year period (1978 through 1982), we used conventional vitreous surgery techniques to treat patients who had recurrent retinal detachment as the result of proliferative vitreoretinopathy. At a six-month follow-up, 24 (33%) of 72 patients achieved total retinal reattachment; 14 patients regained ambulatory vision (5/200 or better) after one operation. Only 12 patients were reoperated on; four achieved retinal reattachment. Anatomic success correlated with a lesser grade of proliferative vitreoretinopathy and an absence of detectable retinal breaks. Creation of iatrogenic retinal tears and broad scleral buckling and an extended interval between the initial detachment and vitreous surgery did not improve the prognosis.

Complications of Vitreous Surgery for Diabetic Retinopathy: I. Intraoperative Complications

One hundred seventy-nine eyes were analyzed to determine the incidence of intraoperative complications during vitrectomy for proliferative diabetic retinopathy. Inadvertent corneal epithelial defects occurred in 51 eyes (28%). The lens was removed in 42 (25%) of 170 phakic eyes. This was done through a pars plana approach. Accidental mechanical lens damage occurred in one eye, and mild pharmacologic lens damage occurred in two eyes. Some bleeding from fibrovascular tissue occurred in nearly every case, but this was controlled with diathermy except in seven eyes (4%) in which severe bleeding required premature termination of the operation. Iatrogenic retinal tears occurred in 36 (20%) of the 179 eyes. Fifteen (34%) of the total of 44 retinal tears were anterior to the equator, and 11 (73%) of the 15 anterior tears were located posterior to the sclerotomy through which the vitrectomy probe was introduced. Twenty-nine (66%) of the 44 retinal tears were posterior to the equator, and 19 of the 29 occurred within 15° radius of the fovea.

Diabetic Traction Retinal Detachment: Factors Influencing Final Visual Acuity

A group of eyes with clear media and diabetic traction retinal detachments treated with vitreous surgery were statistically analyzed to identify those parameters that would allow us to improve case selection. The configuration of the retinal detachment proved to be important, with hammock and flat diffuse central detachments having a good prognosis, and highly elevated, atrophic detachments such as table-top and tent-shaped demonstrating a poor prognosis. Eyes with florid diabetic retinopathy did less well than those with more inactive forms of retinopathy. Preretinal membranectomy, although accompanied by an increased rate of iatrogenic retinal tears, has a definite role in the treatment of more complex traction detachments and increases the number of eyes that may benefit from surgery. Eyes with preoperative vision better than 5/200 did significantly better than eyes with poorer preoperative vision.

Surgical Management of Macular Pucker After Retinal Reattachment Surgery

We used vitrectomy techniques to remove epiretinal membranes that caused reduced visual acuity in 13 consecutive eyes with macular pucker after otherwise successful retinal reattachment surgery. A technically successful result with visual improvement was achieved in each case. An iatrogenic retinal tear (successfully repaired) occurred in one eye, and recurrent retinal detachment requiring an additional operation occurred postoperatively in two eyes. Despite such risks, and that the best postoperative visual acuity achieved was 6/9 (20/30), the use of vitrectomy methods in removal of epiretinal membranes in selected cases of macular pucker can provide significant improvement in vision.

Complicated retinal detachment and its management with pars plana vitrectomy.

Fifty patients with retinal detachment accompanied by vitreous haemorrhage, perforating eye injuries, intraocular foreign bodies, massive preretinal retraction,.giant tears greater than 180 degrees, and proliferative retinopathies underwent pars plana vitrectomy, cryocoagulation, scleral buckling, and intravitreal gas injection. Intraoperative complications included minimal to moderate bleeding and iatrogenic retinal tears, but no retinal dialysis was produced at the pars plana sclerotomy site. Postoperative complications included recurrent vitreous haemorrhage, rubeosis, haemolytic, erythroclastic, or neovascular glaucoma, transient increase of intraocular pressure, uveitis, and macular pucker. Phthisis bulbi occurred in 6 eyes; in 3 of these eyes enucleation was required. Successful reattachment was accomplished in 56% of these complicated retinal detachments, most of which had been considered inoperable by conventional techniques. Visual improvement was achieved in 46% of eyes. Follow-up ranged from 6 to 29 months.