Postoperative

The most common postoperative complication of PR is new and/or missed retinal breaks (Table 4.6) [3,9,11-18]. Most of these are discovered during the first postoperative month, with between 61% and 86% being identified during this time period [19, 20]. Of new and/or missed breaks, 76% occur in the superior two-thirds of the retina. They almost invariably occur anterior to the equator and are more common in pseudophakic or aphakic eyes [20]. Missed breaks can be avoided by performing a very thorough preoperative retinal examination. The authors have found that a 78D or 90D exam of the peripheral retina is invaluable for discovering small breaks preoperatively. Additionally, cases with media opacities,

Table 4.6. Postoperative complications

New/missed breaks [3,9,11-18]

Break re-opened [13,15]

Epiretinal membrane [9,11-14,16,17]

Proliferative vitreoretinopathy [3,9,11-18]

Cataract [11,13-15,17,18]

Cystoid macular edema [14,18]

Delayed resorption of subretinal fluid [10,14,16]

Macular hole [13,14,15,17]

Anterior ischemic optical neuropathy [14,17]

Endophthalmitis [13]

such as sector or spoke cortical cataracts, peripheral capsular opacification, and vitreous hemorrhage, which preclude a clear view, may be less well suited to PR. The risk of new break formation is minimized using prophylactic treatment of at-risk lesions, such as lattice patches, cystic tufts, and meridional complexes,with laser prior to gas injection. Consideration should be given to prophylactic 360° laser at the vitreous base, which has been reported to lower the rate of new/missed breaks and increase surgical success [14]. Delayed resorption of SRF is encountered in between 0% and 6% of cases [10,14,16]. In most instances, the original detachment was subacute or chronic, and the SRF was shifted away from the original break, trapping it in the subretinal space.

Additional reported posterior segment complications included epiretinal membrane (ERM) formation in 0% to 11% of cases [9, 11-17], PVR in 3% to 13% [3,9,11-18], cystoid macular edema (CME) in 0% to 8% [14,18], macular hole in 0% to 3% [13-15,17], anterior ischemic optic neuropathy in four cases [14, 17], and endophthalmitis in one case [13].

Late anterior segment complications include cataract formation. Although lens injury during injection is rare, late cataract presumably due to gas-lens touch is much more common. Cataract is reported in 0% to 20% of cases [11,13-15,17,18], with rates depend ing on type and amount of gas used as well as duration of follow-up postoperatively.

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