J Korean Ophthalmol Soc.  2021 Jun;62(6):806-811. 10.3341/jkos.2021.62.6.806.

Iatrogenic Retinal Breaks in Macular Hole and Epiretinal Membrane Using 25-gauge Vitrectomy

• Park SH
• Kwon HJ
• Park SW
• Byon IS
• Lee SM

• KMID: 2516808
• DOI: http://doi.org/10.3341/jkos.2021.62.6.806

Abstract

Purpose
To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings.
Methods
The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined.
Results
Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images.
Conclusions
It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.

Keyword

Epiretinal membrane; Iatrogenic retinal break; Macular hole; Vitrectomy; Wide fundus photography