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The Induced Posterior Vitreous Detachment: A Risk-factor in Pars Plana Vitrectomy?
1Elsner H., 2Rudolf M., 1Laqua H.,
1Medizinische Universität zu Lübeck, Klinik für Augenheilkunde (Lübeck)
2 (Lübeck)
Purpose: It is a clinical impression that an induced posterior vitreous detachment during Pars plana vitrectomy leads a higher rate of intraoperative iatrogenic peripheral retinal tears than a vitrectomy does when the posterior vitreous is preoperatively already detached. We evaluated this suspected correlation in a retrospective study and documented the postoperative rate of retinal detachments.
Method: Two consecutive groups of patients, group A (n=58) presented with a preoperatively detached posterior vitreous in cases with macular hole stage 4 or macular pucker and group B (n=113) with a preoperatively atached posterior vitreous in cases with macular hole stage 2/3 were retrospectively evaluated considering the intraoperative rate of peripheral retinal tears and concerning the rate of postoperative retinal detachment during a follow-up period of 3-48 months.
Results: In group A 27,58% showed peripheral retinal tears at the end of vitrectomy. A postoperative retinal detachment occurred in 5,1%. In group B 34,5% revealed intraoperative peripheral retinal tears and 3,5% developed a postoperative retinal detachment. Statistical analysis showed no significant difference between Group A and B considering both parameters.
Conclusions: The induced posterior vitreous detachment during Pars plana vitrectomy did not prove to be a risk factor for higher rates of intraoperative iatrogenic peripheral retinal tears. A thorough retinal examination including scleral indentation at the end of vitrectomy with cryocoagulation of discovered retinal tears is essential for an acceptable low rate of postoperative retinal detachments.