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Milad Hakimbashi, Payam Amini, Azadeh Khatibi, Michael H. Goldbaum; Retinal Detachment from Guttering also a Problem after Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5796.
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We describe the characteristics, diagnosis, and treatment of recurrent retinal detachment caused by guttering after vitrectomy for retinal detachment repair. After circumferential scleral buckle or encircling band, guttering can occur when subretinal fluid leaks from a superior break anterior to the buckle, tracks inferiorly between the buckle and the ora, and creates what looks like an inferior retinal detachment. Can the same principle apply to retinal detachments repaired by vitrectomy?
We present a retrospective case series of seven patients with recurrent retinal detachment due to guttering of subretinal fluid after vitrectomy.
The age ranged from 40 to 69 years. All recurrent detachments looked like inferior detachments. All eyes had previous treatments with vitrectomy and peripheral laser. However a gap between the equatorial laser and the ora permitted subretinal fluid to extend inferiorly from the superior break, causing guttering between the laser and the ora that fed the inferior detachment. Visualization of theguttering required scleral depression. Five out of seven eyes had encircling bands and circumferential tires in addition to vitrectomy and peripheral laser. Treatment was repeat vitrectomy, extension of laser to the ora, and tamponade. A single procedure sealed the break and reattached the retinas.
Guttering can occur in eyes treated with scleral buckle when there is leakage from a break anterior to the circumferential buckle. The same phenomenon can occur in eyes treated with vitrectomy and 360 degrees peripheral laser, if the laser does not fully extend to the ora. Leakage into the gap between laser and the ora tracks inferiorly to create inferior detachments. Recurrent detachments after vitrectomy merits examination for a gap between the ora and peripheral laser and fluid tracking inferiorly in the gap. The guttering is solved by extending the laser treatment in that space and sealing the break. Guttering can be prevented by ensuring that laser treatment extends out to the ora.
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