INTRAOPERATIVE ASSESSMENT OF VITREOSCHISIS IN RETINAL DETACHMENT

Abstract

Purpose : to investigate if Posterior Vitreous Detachment (PVD) as assessed using B-scan Ultrasonography (B-scan US) and Optical Coherence Tomography (OCT) preoperatively is confirmed during surgery.

Methods : fifty patients with primary rhegmatogenous retinal detachment not complicated by PVR C were assessed using 10 and 20 MHz B-scan US (Quantel Medical Aviso Ultrasound) and OCT (Heidelberg Engineering, Heidelberg, Germany) to evaluate the presence of vitreous detachment before undergoing vitrectomy. Injection of triamcinolone acetonide in order to better visualize the posterior hyaloid and brushing of the retinal surface using a finesse^TM flex loop was carried out in all cases intraoperatively. If still attached, the posterior hyaloid was then removed using the loop, serrated forceps and the vitrectome. All vitrectomies were filmed and re-evaluated comparing intraoperative with B-scan and OCT features.

Results : in 16% of cases the hyaloid appeared attacched to the retina on B-scan US, OCT and during surgical manouvers. Conversely, B-scan US, OCT and surgical observation showed a detached hyaloid in twenty-eight cases out of fifty (56%). In 28% of cases, posterior hyaloid seemed to be detached with B-scan US and OCT, but a vitreoschisis was found intraoperatively (Fig. 1).

Conclusions : when performing vitrectomy to repair primary rhegmatogenous retinal detachment it could be advisable to always stain the vitreous and brush the retinal surface in order to ascertain if a posterior vitreoschis is present. Our findings show that in more than one case out of four US and OCT fail to detect vitreoschisis. Further studies are needed to assess whether this maneuver improves the long-term outcome of vitrectomies.

This is a 2020 ARVO Annual Meeting abstract.

 

A) B-scan Ultrasonography and B) Optical Coherence Tomography showing a detached posterior hyaloid C) intraoperative: hyaloid is still attached to the retina and removed using finesse^TM flex loop and serrated forceps.