Distacco di Retina dopo Vitrectomia per problemi maculari e floaters
Abstract inviato alla società italiana di Vitreoretina per il congresso GIVRE 2016.
su 597 casi di chirurgia maculare (408) e per Floaters (189) dal 2012 al 2015 si sono verificati 2 distacchi di retina post-operatori (0,3%), uno in un caso di pucekr e uno in un caso di foro maculare.
Iatrogenic Retinal breaks in 25-gauge vitrectomy with trans-scleral illumination shaving technique.
To evaluate the incidence of intraoperative retinal breaks and post-operative retinal detachment after 25-gauge vitrectomy for elective macular cases using a trans-scleral illumination technique to perform vitreous-base shaving. METHODS: A consecutive series of 597 eyes undergoing surgery for idiopathic epiretinal membrane (221 cases), floaters (189), macular hole (119) and vitreous macular traction syndrome (66) was retrospectively evaluated. All vitrectomies (surgeon GB) are performed using 25-gauge+ instruments and valved trocars. After core vitrectomy (and induction of vitreous detachment if not already present) and the necessary additional procedures (e.g. macular peeling), triamcinolone acetonide (Kenacort) is injected in the vitreous cavity. Then, the standard 25-gauge light pipe is covered with a sleeve obtained from a 20-gauge venflon cannula. The light brightness is increased to 100%, and the light probe used to indent the sclera and trans-illuminate the vitreous base. Complete vitreous base shaving is carried out for 360°. Patients were followed up for a minimum of 6 months. RESULTS: There were 597 eyes involved in this study. Iatrogenic retinal breaks were found in 99 eyes (16.5%) during surgery. The majority were detected in cases where posterior vitreous detachment (PVD) was induced during surgery (52 eyes; 22.5% of the eyes where a PVD was induced), and in 47 eyes (12.8%) with an already detached vitreous (p-value= 0.002 Fisher´s Exact Test). Rhegmatogenous retinal detachment developed in only 2 cases (0,3%) during the follow-up. Other complications during the follow-up included two cases of post-operative hypotony (0.3%), one case of endophthalmitis (0.15%), and 4 cases of intraoperative cristalline lens touch (0.6%) CONCLUSIONS: 25-gauge transconjunctival sutureless vitrectomy is a safe procedure for treatment of elective vitreous-retina cases. Inducing a PVD and performing vitreous base shaving is essential to ensure thorough removal of the vitreous. Performing vitreous base shaving with a trans-scleral illumination technique carries a risk of intraoperative retinal breaks which is relatively higher than previously reported. However, this does not translate in a higher risk of post-operative retinal detachment. Other complications were similar to previous reports.