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Iatrogenic retinal breaks caused by infusion fluid during pars plana vitrectomy
Ahmet Burak Bilgin1, Elif Betül Türkoğlu1, Hatice Deniz İlhan1
1Ophthalmology Department, Akdeniz University School of Medicine, Antalya, Turkey.
Objective:
To describe a series of cases of iatrogenic retinal breaks (IRBs) caused by the infusion fluid flow of a 25-gauge pars plana vitrectomy (PPV) system.
Design:
Retrospective case series.
Methods:
During 25-gauge PPV, 4 cases had IRBs caused by infusion fluid flow. The IRBs rapidly progressed to localized retinal detachment.
Results:
The first 3 cases had IRBs on the nasal quadrant midperiphery of the retina. The IRBs were treated with laser retinopexy and tamponade during surgery. Case 4 had a macular hole and macular detachment during scleral indentation. The IRBs seemed to be caused by intraocular pressure (IOP) control mechanisms of the vitrectomy device.
Conclusions:
To prevent IRBs caused by infusion fluid flow, we recommend using an IOP control limit of 4 mL/min for 25-gauge vitrectomy, with valved cannulas. In addition, the surgeon must be cautious during scleral indentation and air-fluid exchange not to cause a rebound hypotonia.
