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Pars plana incisions of four patients: histopathology and electron microscopy
F H Koch1, A E Kreiger, M Spitznas
1Department of Ophthalmology, University of Bonn, Alfried Krupp Laboratory, Germany.
Abstract:
The pathology of pars plana incisions of four patients is described: three with light microscopy and one with light and electron microscopy. Two eyes were removed because of choroidal melanoma, immediately and 8 days after vitrectomy and transvitreous retinal biopsy. Considerable disruption of tissues surrounding the pars plana incisions was observed. Vitreous was incarcerated in the wounds, which healed with granulation tissue. One eye was examined 4 months after vitrectomy for diabetic retinopathy and a failed pars plana filtering operation. It contained fibrovascular ingrowth from all the incisions, infiltrating the vitreous base with granulation tissue and causing vitreous haemorrhage and retinal detachment. One eye was removed 1 year after vitrectomy for anterior hyaloidal fibrovascular proliferation and early phthisis. The wound had fibrous ingrowth histologically and evidence of active fibroplasia.
Insights
Pars plana incisions in vitrectomy patients can lead to complications like vitreous incarceration and fibrovascular ingrowth. These issues can cause significant ocular pathology, including retinal detachment and hemorrhage.
Area of Science:
- Ophthalmology
- Surgical Pathology
Background:
- Pars plana vitrectomy is a common surgical procedure.
- Understanding the long-term effects of surgical incisions is crucial.
Observation:
- Histopathological examination of four patients' eyes post-vitrectomy was performed.
- Two eyes were examined immediately and 8 days after surgery due to choroidal melanoma.
- One eye was examined 4 months post-surgery for diabetic retinopathy and failed filtering surgery.
- Another eye was examined 1 year post-surgery for anterior hyaloidal fibrovascular proliferation.
Findings:
- Significant disruption of tissues around pars plana incisions was noted.
- Vitreous incarceration within wounds led to granulation tissue formation.
- Fibrovascular ingrowth from incisions infiltrated the vitreous base, causing vitreous hemorrhage and retinal detachment.
- Histological analysis revealed fibrous ingrowth and active fibroplasia in chronic wounds.
Implications:
- Pars plana incisions can be sites of significant pathological changes.
- These changes may lead to severe complications affecting visual outcomes.
- Further research into optimizing wound healing after pars plana vitrectomy is warranted.