Incarcerated tissue at sclerotomy sites can cause retinal breaks

Prolapsed and trapped tissue at sclerotomy sites may cause iatrogenic retinal breaks, a study found. Surgeons should be aware of incarcerated ciliary body and retina fragments during surgery, the study authors advised.

Wen Liu, MD, PhD, and colleagues collected and studied 50 samples of tissue prolapsed from the entries to standard three-port pars plana vitrectomies. Samples from rhegmatogenous retinal detachments (RD) (n = 28), traumatic RD (n = 4), miscellaneous vitreous hemorrhage (n = 12) and intraocular foreign bodies (n = 6) were stained with hematoxylin-eosin and examined under light microscopy after being fixed in paraffin sections or smeared on slides.

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 jelly-like cells. Fibrous tissue and remnants of ciliary body were also found in some samples.

The tissues caused 12 cases of iatrogenic retinal breaks. Of these cases, RD recurred postoperatively in six cases due to anterior proliferative vitreoretinopathy. Only four cases of RD recurred in the noniatrogenic retinal break group (P = 0.01).

The study is published in the June issue of Retina.