The effect of intraoperative retinal manipulation on the underlying retinal pigment epithelium: an experimental study.
OBJECTIVE
Retinal pigment epithelial changes described after vitreoretinal surgery may result from localized compression injury caused by intentional or inadvertent contact with vitreoretinal instruments. The authors evaluated these changes resulting from manipulation of the retina without frank retinal injury.


METHODS
One eye each of six pigmented rabbits underwent surgery during which the inner retinal surface was touched at several points with a 20-gauge silicone-tipped subretinal fluid cannula without causing a retinal break or subretinal hemorrhage. The rabbits were followed-up with indirect ophthalmoscopy, fundus photography, and fluorescein angiography, and were killed at 1 hour, 1 week, or 2 weeks. Light microscopy was used for histopathologic evaluation.


RESULTS
On fluorescein angiography, diffuse leakage noted at the injury sites significantly decreased by the fourth day and almost completely disappeared by the second week. Disruption of photoreceptor outer segments and retinal pigment epithelium in the early specimens, and irregular pigmentation, proliferation, and migration of the retinal pigment epithelium at 1 and 2 weeks were the prominent features on histopathologic examination.


CONCLUSIONS
Intraoperative manipulation of the attached retina may cause significant pigment epithelium displacement and proliferation and varying degrees of disorganization of normal retinal architecture in the absence of clinically evident retinal breaks and subretinal hemorrhages.
Men
Gamze
G
Department of Ophthalmology, Tulane University Health Sciences Center, 1430 Tulane Avenue SL-69, New Orleans, LA 70112-2699, USA.
Peyman
Gholam A
GA
Kuo
Po-Cheng
PC
Ghahramani
Fatemah
F
Canakis
Christina
C
Ratnakaram
Ramakrishna
R
Bezerra
Yanno
Y
D000818:Animals; D001813:Blood-Retinal Barrier; D002199:Capillary Permeability; D004195:Disease Models, Animal; D005131:Eye Injuries / Q000150:complications*; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D007431:Intraoperative Complications; D009887:Ophthalmoscopy; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D011817:Rabbits; D012160:Retina / Q000293:injuries*; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology*; D012171:Retinal Vessels / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000150:complications*