Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

Abstract

Purpose:: The purpose of this article is to discuss the early- and late-onset corneal complications that can occur following vitreoretinal surgery.

Methods:: A systematic review of the literature was conducted using PubMed and Google Scholar databases. Articles detailing the clinical findings and the associations between surgical techniques, irrigating solutions, and microsurgical instruments used for vitreoretinal surgery and postoperative corneal complications were included in this review.

Results:: Vitreoretinal surgery can be associated with corneal complications such as persistent corneal epithelial defects, neurotrophic keratopathy, band keratopathy, ocular surface disruption, and endothelial cell damage. Risk factors for the development of cornea complications after posterior segment surgery include history of uncontrolled diabetes mellitus, aphakia or pseudophakia, disrupted anterior lens capsule integrity, use of irrigating solutions without appropriate buffers, use of contact viewing lenses intraoperatively, intraocular gases or silicone oil after vitrectomy, and prolonged duration of surgery.

Conclusions:: Corneal complications secondary to vitreoretinal surgery are multifactorial, but more commonly arise in diabetic patients, those with preexisting ocular comorbidities, and under certain surgical-related conditions. Special pre-, peri-, and postoperative considerations, with a focus on early identification and management of risk factors, are required to help decrease the incidence of corneal complications.

Figure 1.. Individual with persistent corneal epithelial defect secondary to complex retinal detachment repair, silicone oil placement, and removal.

Slit lamp examination showing a central epithelial defect.

Figure 2.. Individual with development of band keratopathy three months after undergoing PPV with placement of silicone oil and lensectomy with endolaser.

A. Slit lamp evaluation demonstrating band keratopathy. B. Anterior segment OCT with presence of thin hyperreflective bands with underlying shadowing around Bowman’s layer (yellow arrows), corresponding to corneal calcium deposits.