Iatrogenic retinal breaks in 25-gauge macular surgery.
OBJECTIVE
To describe the incidence and characteristics of iatrogenic retinal breaks in 25-gauge macular surgery.


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
We included 177 consecutive operations in 171 patients who underwent 25-gauge vitrectomy for idiopathic macular pucker or idiopathic macular hole. Main outcome measures were the incidence of breaks related to the sclerotomies, the incidence of breaks occurring elsewhere, the incidence of lesions suspicious for traction, the location of identified breaks, and intraoperative induction of posterior vitreous detachment (PVD).


RESULTS
Retinal breaks occurred in 15.8% of operations. In 6.2%, breaks were related to the sclerotomies, and in 10.7%, breaks were found elsewhere. In 8.5% of eyes, only lesions suspicious for traction were detected. Breaks or suspicious lesions were treated with external cryocoagulation in a total of 24.3% of cases. A statistically significant relation between PVD induction and presence of breaks elsewhere was identified. No correlation with lens status, initial diagnosis, or preoperative refraction was found. Retinal detachment occurred in 1.7% of cases.


CONCLUSIONS
We report an incidence of retinal breaks that is higher than previously found for 20- or 25-gauge surgery. Despite the high incidence of breaks, the incidence of postoperative retinal detachment was low. A specific characteristic was the relatively high incidence of breaks elsewhere and their relation to PVD induction. Our findings underscore the importance of scrupulous full 360-degree internal search at the end of each procedure to identify and treat all breaks and suspicious lesions optimally.
Tan
H Stevie
HS
Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. h.tan@amc.uva.nl
Mura
Marco
M
de Smet
Marc D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D012163:Retinal Detachment / Q000209:etiology; D012167:Retinal Perforations / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D012599:Sclerostomy / Q000009:adverse effects; D014821:Vitrectomy / Q000009:adverse effects*; D020255:Vitreous Detachment / Q000209:etiology