Iatrogenic punctate chorioretinopathy after internal limiting membrane peeling

Area of Science:

• Ophthalmology
• Retinal Surgery
• Vitreoretinal Interface Pathology

Background:

• Macular hole repair often involves internal limiting membrane (ILM) peeling.
• Grasping the ILM with forceps can potentially cause iatrogenic injury.
• Understanding these injuries is crucial for surgical complication assessment.

Purpose of the Study:

• To define and characterize the chorioretinal lesions resulting from unintentional internal limiting membrane (ILM) grasping during macular hole surgery.
• To investigate the angiographic features and clinical significance of these iatrogenic lesions.

Main Methods:

• Interventional case series involving 15 patients undergoing pars plana vitrectomy for macular hole repair.
• Prospective review of patients undergoing ILM peeling with end-gripping forceps.
• Pre- and post-operative fundus photography, fluorescein angiography (FA), and indocyanine green angiography (ICGA) were utilized.

Main Results:

• Small, punctate chorioretinal lesions (100-400 micrometers) were consistently observed post-surgery at the ILM grasping site.
• FA showed early hypofluorescence with late margin staining; ICGA revealed early hypofluorescence with visible choroidal vessels in larger lesions due to RPE/choriocapillaris thinning.
• Lesions demonstrated stable angiographic findings without enlargement or neovascularization during follow-up.

Conclusions:

• Iatrogenic punctate chorioretinopathy is defined as the chorioretinal lesion from unintentional ILM grasping.
• This complication of ILM peeling appears to have no immediate adverse effect on surgical outcomes.
• Long-term follow-up is recommended to monitor for potential delayed complications like choroidal neovascularization.