Incidence of retinal detachment after macular surgery: a retrospective study of 634 cases

Abstract

Aims: To evaluate the rate of retinal detachment after macular surgery. Methods: A retrospective non-randomised study of 634 macular surgery procedures was undertaken in two academic centres. Idiopathic macular hole (IMH) surgery (n = 272) and epiretinal membrane (ERM) surgery (n = 362) were performed between 2000 and 2003. We noted the anatomical and functional results of these procedures and we studied serious complications excluding cataract. Results: Minimum follow up was 1 year. No retinal detachment (RD) occurred in patients presenting with an intraoperative or preoperative successfully treated retinal break (RB). The rate of RD occurring after IMH surgery was higher than after the ERM surgical procedure (6.6% vs 2.5%, p = 0.02). The rate of RD was higher in patients presenting with stage 2 and 3 IMH than with stage 4 IMH. However, lens status as well as preoperatively treated RD did not influence the rate of RD after macular surgery. Conclusion: Retinal detachment remains the most common serious complication of macular surgery. Surgical detachment of the posterior vitreous face and associated peripheral retina anomaly seem to increase the rate of this complication. Careful examination of the peripheral retina is a key issue in preventing retinal detachment occurring after macular surgery.T he most frequently reported complications of macular surgery are cataract, high intraocular pressure (IOP), retinal vascular occlusion, intraocular inflammation, endophthalmitis, cystoid macular oedema, phototoxicity, macular holes, retinal breaks (RBs), retinal detachment (RD) and surgery failures. 1-5The number of operations on the macula has increased over the last 10 years and many authors have reported different procedures for the treatment of idiopathic macular hole (IMH) and epiretinal membrane (ERM). [6][7][8][9][10][11][12] For the most part, these studies aimed to specify the anatomical and functional results in order to determine the best procedure. The complications of these procedures were mentioned but few attempts have been made to discuss their risk factors.

Visual acuity outcomes following surgery for idiopathic epiretinal membrane: an analysis of data from 2001 to 2011

“…Rates of complications in this study were similar to those of previously published articles. 5 It would therefore be of economic and symptomatic benefit to the patient if a combined procedure was undertaken as the rates of cataract progression are high following PPV. 19,20 In conclusion, this study shows improvement in VA after PPV and ERM removal.…”

“…Surgery can lead to complications, which can worsen vision and in some cases cause complete visual loss in the operated eye. 5 In addition, many ERMs are asymptomatic and non-progressive. Population studies have shown the rate of progression of ERMs to be between 16 and 33%.…”

Partial posterior hyaloidectomy for macular disorders

“…The breaks located in the superior quadrants, particularly in the quadrant near the surgeon's dominant hand, are considered sclerotomy-related breaks. 1,3,6,12,13 On the other hand, an IPVD is thought to be an important etiology when the breaks are located in the inferior quadrants. 2,3,5 Two of three (66.7%) retinal breaks in the PPH group were identified in the superior quadrants, near the sclerotomy sites, suggesting the etiology of these breaks could be sclerotomy-related rather than IPVD-related.…”

“…Given the position and direction of the vitreous cutter in conventional vitrectomy, some degree of perpendicular traction to the vitreous base cannot be avoided (Figure 1-A3). Considering the similar propensity for the incidence of PVD-related retinal break in macular surgery despite the evolution of the vitrectomy machine, 1,3,4,6,[8][9][10][11][12] the effect of increasing cut velocity may be limited. Some degree of artificial vitreous traction seems to be inevitable during peripheral vitreous removal.…”

“…Some investigators have recommended a careful intraoperative and postoperative peripheral examination at the end of each vitrectomy. 1,3,4,6 More detailed techniques such as scleral depression 1,4 and use of a wide-angle viewing system 4 have been recommended to minimize the incidence of a missed break. However, these recommendations were focused mainly on early detection and treatment of breaks rather than preventing the development of the break itself.…”