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Janet Y. Tsui, Ryan M. Tarantola, Jordan M. Graff, Stephen R. Russell, H. Culver Boldt, James C. Folk, Vinit B. Mahajan; Sclerotomy-related Retinal Breaks During 23-Gauge Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6107.
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To study intraoperative sclerotomy-related retinal breaks in 23-gauge surgery.
A retrospective consecutive case series was assembled from the surgical logs and charts of patients undergoing 23-gauge vitrectomy over 28 months at the University of Iowa. Demographic data, preoperative, intraoperative, and postoperative exam records were reviewed. All cases were performed by creating pars plana, beveled scleral wounds using a single-step Alcon (Alcon Laboratories Inc., Fort Worth, Texas, USA) 23-gauge trocar/cannula microvitrectomy system. The retinal periphery was examined with scleral depression before and at the end of each case by two surgeons. A sclerotomy-related retinal break was defined as any break not present during a preoperative scleral depressed exam, within one clock-hour on either side of a sclerotomy site, anterior to the equator.
548 eyes met inclusion criteria. 145 of these cases involved the repair of a rhegmatogenous retinal detachment (RRD), and 403 were performed for indications including most commonly epiretinal membrane, vitreous hemorrhage, macular hole, and tractional retinal detachment. Follow up ranged from 8 to 20 weeks. Sclerotomy-associated retinal breaks were found in 9 of 548 (1.6%) cases. A break was found in 1/145 (0.7%) RRD cases and 8/403 (2.0%) non-RRD cases. All breaks occurred in the superior retina. Eight were discovered intraoperatively and 1 postoperatively. In non-RRD eyes, there was vitreomacular traction in 6/8 cases, phakia in 6/8 cases, and no posterior vitreous detachment in 6/8 cases. No eye with a sclerotomy-related break developed a new retinal detachment.
In our series, 23-gauge vitrectomy surgery was associated with a low rate of sclerotomy-associated retinal breaks. Further studies will determine whether phakic status, vitreomacular traction, and posterior vitreous detachment are important risk factors of this complication.
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