DISTRIBUTION OF IATROGENIC RETINAL BREAKS IN MACULAR HOLE SURGERY

Background: Intraoperative peripheral iatrogenic retinal breaks can be a serious complication of vitreous surgery. This study was undertaken to determine whether vitreous surgical techniques used for macular ho le surgery were associated with a different incidence or distribution of retinal breaks. Methods: The authors prospectively evaluated a seri es of 181 consecutive eyes undergoing macular hole surgery. Contempora neous reporting of intraoperative and postoperative retinal breaks and postoperative retinal detachments was performed. Comparison was made to historic controls of two case series of patients undergoing vitreou s surgery for other indications. Results: Of 181 eyes, 10 (5.5%) had 1 5 intraoperative retinal breaks. Of the 15 breaks, 3 (20%) were in the quadrant near the surgeon's right-hand sclerotomy, 9 (60%) were in th e two inferior quadrants, and 11 (73%) were in the two temporal quadra nts. By comparison to previously reported case series, tears in our se ries were less likely to be near the right-hand sclerotomy (P = 0.0005 5) and more likely to occur in the two inferior retinal quadrants (P = 0.00015) and two temporal retinal quadrants (P = 0.0042). Two patient s (1.1%) of 181 had postoperative retinal detachments. Conclusions: Pa tients undergoing vitreous surgery for macular hole have a similar inc idence but different location of iatrogenic retinal breaks when compar ed with patients undergoing pars plana vitrectomy for other indication s. These breaks are not distributed near sclerotomy sites and tend to be in the inferior and temporal retina. This establishes the need for greater intraoperative surveillance in these areas.