Risk factors for iatrogenic retinal breaks during induction of posterior vitreous detachment in macula surgery

To determine risk factors for retinal breaks (RB) during the surgical induction of posterior vitreous detachment (IPVD) in macula surgery.

We retrospectively reviewed electronic records for all adult patients undergoing 25-G or 27-G vitrectomy for macula pathology between November 2019 and January 2024 requiring intraoperative IPVD. We excluded eyes with pre-existing PVD, panretinal photocoagulation, trauma, age < 18 years or missing information. The outcome measure was non-sclerotomy-related iatrogenic RB. We assessed the effect of age, gauge size (25-G vs 27-G), surgical indication (epiretinal membrane [ERM] vs macular hole[MH]/vitreomacular traction syndrome[VMTS]), lens status (Phakic vs Aphakic/Pseudophakic) and surgeon (Consultant vs Fellow) on the odds of RB.

Among 185 eyes included in our study, 15.1% experienced a RB during IPVD. Breaks were predominantly located in the inferior retina (69%). Multivariable analysis revealed gauge size significantly impacted RB rate (27-G OR 0.13 95%CI 0.03-0.60, p = 0.008). Other factors including age (OR 0.98 95%CI 0.96-1.01, p = 0.18), lens status (Phakic OR 0.36 95%CI 0.13-1.01, p = 0.053), surgeon grade (Fellow OR 1.8 95%CI 0.18-18.9, p = 0.61) and surgical indication (MH OR 0.70 95%CI 0.30-1.7, p = 0.42) were not significantly associated with odds of RB.

There is a high rate of iatrogenic RB in eyes requiring IPVD undergoing macula surgery. Smaller instrument gauge size was associated with lower odds of RB during IPVD, however causal inferences cannot be drawn from these findings. Neither age, surgical indication nor lens status were associated with odds of RB.