Vitreous incarceration in patients undergoing second 20-gauge pars plana vitrectomy for recurrent retinal detachment

Abstract

Purpose. To observe and classify vitreous incarcerations in patients undergoing second 20-gauge pars plana vitrectomy (PPV) for recurrent retinal detachment. Methods. Retrospective noncomparative consecutive case series. Eighty-two consecutive patients with recurrent retinal detachment were included. The previous sclerotomy sites were examined by our sclera depression method and the vitreous incarceration were classified into Grade 0-IV by their severity under surgical microscope before second surgery. The relationship of vitreous incarceration and different ports was statistically investigated in our included patients. Results. Vitreous incarceration in the previous sclerotomy sites were found frequently. Vitreous cutter sites were most involved, but the infusion pipe sites were the least. According to our classification and definition, Grade III and IV of vitreous incarceration in all the three different sclerotomy sites accounted for 32.5%. Grade II of vitreous incarceration consisted of 12.6%. Grade 0 and I in all the three different sclerotomy sites were 54.8%. The frequency of all grades of vitreous incarceration in light port or vitreous cutter port was significant higher than that in infusion port. Conclusions. Vitreous incarceration in light port and vitreous cutter port are found more common than in infusion port for 20-gauge PPV with our new method.

Figure 1

Photograph of inner aspect of sclerotomy under sclera depression. At 10 o'clock, the pars plicate can be seen (arrow head) and the sclerotomy appeared white injury without vitreous incarceration (arrow), which is classified as Grade 0.

Figure 2

Photograph of inner aspect of sclerotomy under sclera depression. At 2 o'clock, the inner aspect of the sclerotomy presents a round white gap (arrow). The white vitreous fibers are incarcerated in the incision (arrow head) which is classified as Grade I.

Figure 3

Photograph of sclerotomy-related complication. An amount of vitreous (open arrow head) is incarcerated in the inner incision at 10 o'clock (arrow), which pulls retina leading atrophic retinal hole (arrow head). It is classified as Grade II.

Figure 4

A total avulsion of the vitreous base occurred in the ora serrata posterior to the previous incision at 2 o'clock, which exposed the radial red and white lines like zebrine striations (black arrow head). The avulsed ciliary epithelium curled on pars plana (white arrow head). The incarcerated vitreous in the sclerotomy has been fibrosis (black arrow). It is classified as Grade III.

Figure 5

The patient underwent an unsuccessful vitrectomy 13 days before. When he was examined, the retina was incarcerated in both superior sclerotomies. This figure represents Grade IV of retinal incarceration in sclerotomy site.