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Pioneer of vitreoretinal surgery gives pearls on retinal detachment surgery complications

Issue: April 2016

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BASSANO DEL GRAPPA, Italy — Retinal detachment surgery is successful nowadays in more than 90% of cases, but complications that involve the macula may still occur and jeopardize functional outcomes.

“The anatomic result is perfect, but the patient complains of vision loss, blurred, distorted or double vision. This is often due to complications of unknown etiology or to well-known complications that are very difficult to treat,” Vito De Molfetta, MD, said here at the Bassano Ophthalmology Meeting.

Vito De Molfetta

Persistent subfoveal fluid or edema may be present for unknown reasons, leading to permanent vision loss even after spontaneous reabsorption.

“We fumble around with therapies such as corticosteroids, diuretics, anti-inflammatory drugs, using them off label with uncertain, often poor results,” De Molfetta said.

Macular folds are another complication, quite common in cases of detachment of the upper part of the retina when patients are not kept face down after surgery, according to De Molfetta.

“The fluid collects under the macula and forms folds, very difficult to flatten back. Reintervention in these cases is extremely complicated,” he said.

De Molfetta was against internal limiting membrane peeling, which is currently common as a prophylaxis for epiretinal membrane formation, as this increases the incidence of macular hole even at a later stage. Subretinal hemorrhages, on the other hand, are often overlooked but require immediate treatment because of the toxic effects of blood on photoreceptors.

Delayed surgery is the cause of other severe events, such as retinal pigment epithelium atrophy and alterations of the photoreceptor outer segments, due to the permanence of fluid in the posterior pole.

“Treating without delay is mandatory, particularly in case of macula-off detachment,” he said. – by Michela Cimberle

Reference: De Molfetta V. Complications of vitreoretinal surgery. Presented at: Bassano Ophthalmology Meeting; April 9; Bassano del Grappa, Italy.

Disclosure: De Molfetta reports no relevant financial disclosures.