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Air Jet-Related Retinal Injury During Contemporary 25-Gauge Vitrectomy: Multimodal Imaging of 3 Cases
Sosuke Ishiyama1, Ryo Inoue, Hiroshi Nakashima
1Department of Ophthalmology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Retinal Cases & Brief Reports
|July 22, 2026
Summary
Air jet injury during 25-gauge pars plana vitrectomy can cause retinal damage. Careful surgical technique, particularly managing air pressure and flow, may prevent this complication.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Microsurgery
Background:
- Pars plana vitrectomy (PPV) is a common retinal surgery.
- Modern vitrectomy uses smaller gauge instruments, like 25-gauge.
- Retinal injury from surgical instruments is a known complication.
Purpose of the Study:
- To characterize retinal injury caused by air jets during 25-gauge PPV.
- To explore the mechanisms behind this injury.
- To suggest preventive measures.
Main Methods:
- Retrospective review of 3 eyes with retinal injury during 25-gauge PPV.
- Analysis of surgical videos.
- Evaluation of multimodal imaging findings.
Main Results:
- Retinal whitening or injury observed intraoperatively or postoperatively.
- Injury patterns varied from full-thickness macular loss to inner/outer retinal damage.
- Autofluorescence was superior to ultrawide-field photography for lesion delineation.
Conclusions:
- Air jet-related retinal injury is a risk even with 25-gauge PPV.
- Injury likely results from mechanical trauma to inner and outer retinal layers.
- Preventive strategies include managing decompression, aspiration, and infusion flow.
