Complications
May arise as a postoperative complication of any intraocular procedure, including vitrectomy, pneumatic retinopexy, and scleral buckling.
Patients should be made aware of signs indicative of endophthalmitis, such as pain, decreased vision, light sensitivity, and increasing redness.
Prompt treatment of acute endophthalmitis after eye surgery involves treatment with intravitreal antibiotics. No evidence has clarified whether the addition of steroids helps to resolve endophthalmitis or causes harm.[70]
Untreated rhegmatogenous RD may lead to permanent visual loss in affected eye.
Fellow eyes have several times the risk of developing rhegmatogenous RD, especially if peripheral retinal lesions are present.[25]
May arise as a consequence of scleral buckling surgery.
May arise as a consequence of vitrectomy or pneumatic retinopexy.
Eyes undergoing vitrectomy often develop cataracts, typically after about 2 years.
Recurrence or treatment failure (defined as lack of retinal reattachment or retinal redetachment) may occur due to a missed retinal break, postoperative development, or PVR.[63][64]
A missed retinal break usually presents within days or weeks, whereas PVR usually presents 4-8 weeks after surgery.
Persistent RD or redetachment requires surgery. The choice of procedure depends on the cause, although repeat surgery typically favors vitrectomy.
Characterized by seeding of the vitreous/retinal surfaces by cells that produce collagen and then membrane contraction with consequent tractional RD.[65] Scar formation is visible on clinical exam.
PVR is a natural consequence of untreated rhegmatogenous RD and occurs in 5% to 10% of eyes after surgery, although the incidence is operator and technique dependent. The least PVR-prone operation is pneumatic retinopexy.
Once PVR occurs, vitrectomy with or without silicone oil implantation has the highest success rate.[66][67][68]
A type of "mini" or "in situ" PVR, cellophane maculopathy/epimacular proliferation (epiretinal membrane, macular pucker) develops in up to 20% of eyes undergoing surgery for rhegmatogenous RD. This complication may be prevented in eyes undergoing vitrectomy by removing the internal limiting membrane or prescribing systemic corticosteroid therapy.[69]
Important intraoperative complications include subretinal hemorrhage from transscleral drainage and retinal pigment epithelium damage from over freezing.
Important postoperative complications include myopia, diplopia, strabismus, astigmatism, subretinal gas/air injection, anterior segment ischemia, macular pucker, and PVR.[71][72] Buckle-related complications include misplaced buckle, early (≤1 week) or delayed (>1 week) buckle exposure or migration, and buckle infection.[71]
More people experience cataract development, cataract progression, and new/iatrogenic breaks with vitrectomy than with scleral buckling; however, fewer people experience choroidal detachment with vitrectomy.
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Important intraoperative complications include lens touch and retinal injury.
Important postoperative complications include cataract, macular pucker, PVR, new RD, maculopathy (e.g., dye or light toxicity), and postsurgical endophthalmitis.[71][73]
Macular pucker can be prevented by prophylactic peeling of the internal limiting membrane during vitrectomy.
More people experience cataract development, cataract progression, and new/iatrogenic breaks with vitrectomy than with scleral buckling; however, fewer people experience choroidal detachment with vitrectomy.
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Important intraoperative complications include subretinal hemorrhage from transscleral drainage and retinal pigment epithelium damage from over freezing. Both of these are rare but potentially severe.
Important postoperative complications include cataract and recurrent rhegmatogenous RD from a new or missed break.[55][71][74] Other potential complications include fish-egg gas bubbles (can effect view of the retina) and gas injection behind the lens.[71]
While the retina can tolerate exudate/serous fluid for surprisingly long periods of time, blood, especially if thick, can inflict early and permanent damage.
An end-stage ocular response to severe eye injury or disease (e.g., scarring, inflammation, and atrophy).[71]
This rare, bilateral, granulomatous uveitis usually becomes apparent within 3 months after injury to one eye.[71]
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