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P-C Kuo, GA Peyman, G Men, F Ghahramani, C Livir-Rallatos, R Ratnakaram, PJ Lee; The Effect of Intraoperative Retinal Manipulation on the Underlying Retinal Pigment Epithelium . Invest. Ophthalmol. Vis. Sci. 2002;43(13):648.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Retinal pigment epithelial changes and visual field defects have been described after vitreoretinal surgery. Localized compression injury caused by either intentional or inadvertent contact of vitreoretinal instruments may explain these postoperative changes. This study was designed to evaluate the retinal and retinal pigment epithelial changes resulting from manipulation of the attached retina without frank retinal injury. Methods: One eye each of 6 pigmented rabbits underwent surgery during which the inner retinal surface was touched at several points without causing a retinal break or hemorrhage with a 20-gauge silicone-tipped subretinal fluid cannula introduced through a sclerotomy. The rabbits were followed with indirect ophthalmoscopy, fundus photography, and IVFA, and sacrificed at different intervals. The specimens were evaluated with light microscopy. Results: On IVFA, diffuse hyperfluorescence noted at the injury sites significantly decreased by the fourth day and almost completely disappeared by the second week. The initial leakage pattern evolved to an irregular staining pattern as a result of irregular pigment proliferation. Three types of changes were observed on light microscopy: disorganization and proliferation at the level of the outer retina without a significant inner retinal damage, inner retinal damage without a significant outer retinal damage, and disorganization of all retinal layers. No damage to the choriocapillaris was detected on light microscopy. Conclusion: Intraoperative manipulation of the attached retina may cause significant RPE displacement and proliferation and varying degree of disorganization of normal retinal architecture in the absence of retinal breaks and hemorrhages.
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