Bioptic significance of incarcerated contents at sclerotomy sites during vitrectomy

Abstract

Purpose: To study the clinical significance of incarcerated materials at sclerotomy sites during vitrectomy.

Methods: Fifty samples prolapsed from the entries to standard three-port pars plana vitrectomies were collected along the scleral surface. Samples from rhegmatogenous retinal detachments (RD) (n = 28), traumatic RD (n = 4), miscellaneous vitreous hemorrhages (n = 12), and intraocular foreign bodies (n = 6) were stained with hematoxylineosin and examined under light microscopy after being fixed in paraffin sections or smeared on slides.

Results: The specimens collected after sclerotomy contained vitreous tissue mixed with dispersive and sheet nonpigmented ciliary epithelia, scattered pigment granules, and small pigment gobbets. Specimens collected during vitrectomy contained pigment granules and various cells with a jellylike appearance. Fibrous tissue and remnants of ciliary body and retina were found in some specimens. The incarcerated tissues caused 12 cases of iatrogenic retinal breaks, among which RD recurred in six cases postoperatively due to anterior proliferative vitreoretinopathy. In the noniatrogenic retinal break group, only 4 RD recurred (6/12 versus 4/38, chi2 = 6.586, P = 0.01).

Conclusion: The incarcerated contents at sclerotomy sites were mainly adjacent tissues and cells. Prolapsed and incarcerated ciliary body and retina fragments were common and might cause iatrogenic retinal breaks. Attention should be paid to this material intraoperatively.