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Sebastien Bruneau, Alain Gaudric, Pascale Massin, Ramin Tadayoni; Contribution Of Technical Progress And Influence Of Surgical Factors On The Rate Of Iatrogenic Peripheral Retinal Breaks In Macular Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3775.
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© ARVO (1962-2015); The Authors (2016-present)
To report the rate of intraoperative retinal breaks in macular surgery during two separate periods of six years, and to study the influence of surgical techniques advances.
1065 eyes undergoing pars plana vitrectomy at the ophthalmology department of Lariboisiere Hospital during period 1 (January 2002 to December 2003) and period 2 (January 2008 to December 2009) for indications including idiopathic epiretinal membranes and idiopathic macular holes. Exclusion criteria were secondary macular holes and epiretinal membranes, preexisting retinal breaks or rhegmatogenous retinal detachment and previously vitrectomized eyes. Primary endpoint was frequency of iatrogenic peripheral retinal breaks. Secondary endpoints were risk factors associated with iatrogenic peripheral retinal breaks including experience of the surgeon and type of vitrectomy (transconjonctival or standard 20 G vitrectomy). Finally, the rate of postoperative rhegmatogenous retinal detachment was estimated.
Intraoperative iatrogenic peripheral retinal breaks occurred during period 1 in 16,67% (69/414 eyes) compare to 12,13% (79/651 eyes) during the period 2 (p=0,046). Postoperative rhegmatogenous retinal detachment due to undetected or new peripheral retinal breaks over the period 1 occurred in 1.69% (7/414 cases) versus 1,38% (9 of 651 eyes) over the period 2. Breaks were most common during macular holes surgery (24,72%) than epiretinal membranes surgery (8,46%). Overall, breaks were more frequent when the experience of the surgeon was inferior to 3 years (21,02%) than the surgical experience was superior to 3 years (10,09%). Surgical techniques influence the occurrence of iatrogenic peripheral retinal breaks; during period 2 there was 22,34% of retinal breaks with standard 20 G vitrectomies versus 10,41% with transconjonctival surgeries.
Iatrogenic peripheral retinal breaks induced by vitrectomy are more common than previously reported. In a few years, progress in vitrectomy techniques has reduced the rate of retinal breaks by about ¼. However, other factors such as surgical experience remain important. The control of peripheral retina at the end of intraocular procedures remains a major measure of safety to reduce the rate of postoperative retinal detachments, especially for less experienced surgeons.
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