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Published on: September 13, 2016
Assessment of the transscleral removal technique for subretinal proliferative tissues during vitrectomy for
Tomoyuki Ishibashi1, Ryo Inoue2, Hiroshi Nakashima1
1Department of Ophthalmology, Osaka Rosai Hospital Clinical Research Center for Optical Sensory Organ Disability, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
Purpose:
To provide insights into the transscleral removal technique for subretinal proliferative tissues (SRP).
Study Design:
Retrospective, single-center case series.
Methods:
Patients who underwent transscleral removal of SRP during vitrectomy for rhegmatogenous retinal detachment (RRD) were included. The preoperative RRD extent, SRP distribution, intraoperative maneuvers, complications, and surgical outcomes were assessed.
Results:
Seven eyes of seven patients were enrolled for surgery. The RRD extent involved four quadrants in two eyes, three quadrants in three eyes, and two quadrants in the remaining two eyes. SRP were widely distributed beneath the detached retina in all the cases, with submacular SRP present in six cases. In these six cases, all the SRP, including the submacular SRP, could be removed without creating retinotomies via 1 or 2 subretinal trocars. However, peripheral SRP with extensive and strong adhesion to the retina required multiple retinotomies and conventional bimanual removal in one case. Surgical failure, attributable to the transscleral technique, occurred in one case due to a missed retinal puncture that occurred during subretinal trocar insertion, resulting in recurrent RRD. This patient had RRD within two quadrants, and the subretinal space could not be adequately dilated before insertion. All the patients had achieved retinal reattachment without deterioration of visual acuity at the final follow-up visit.
Conclusion:
The transscleral removal technique was suitable for the removal of SRP, including the posterior pole area, with minimal retinal damage. However, this technique may not be appropriate for SRP removal with extensive and strong adhesions or for cases with relatively nonextensive RRD.
