The frequency with which retinectomy is performed has increased dramatically. Major management factors involve instruments, lensectomy and scleral buckling, the anterior retina, and complications.
Boston-Retinectomy, excision of retinal tissue, is performed to varying degrees based on the pathology. This may range from simple removal of an anterior flap of a retinal tear in a primary retinal detachment to removal of retinal incarceration in a traumatic or surgical wound removal or removal of fibrotic contracted retina proliferative vitreoretinopathy (PVR).
Dean Eliott, MD, associate director, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, discussed the best approaches to retinectomy.
The frequency with which retinectomy is performed has increased dramatically, and recent studies have indicated that it is performed in up to 64% of cases of PVR. Three types of retinectomy are performed: inferior 180°, 360°, and focal posterior, of which the first is most common.
“The major management factors concerning retinectomy involve use of the appropriate instruments, the roles of lensectomy and scleral buckling, dealing with the anterior retina, and preventing postoperative complications such as subretinal perfluorocarbon liquid, hypotony, and recurrent proliferation and retinal detachment, Dr. Eliott pointed out.
Some pearls when performing retinectomy, he said, include completely removing the membrane before retinectomy and performing the retinectomy posterior to the vitreous base, most often with the edges at the 3 and 9 o’clock positions to avoid possible reproliferation and traction at 6 o’clock.
In addition, hemostasis is “critical,” and diathermy is used to delineate the intended edge and prevent bleeding. Because reproliferation is associated with hemorrhage, intraoperatively and postoperatively there should be no hemorrhage at the retinectomy edge.
Other important points are that a vitrectomy probe is used most often to cut the retina. Most surgeons completely excise the anterior retina to prevent postoperative proliferation and traction. Silicone oil or gas can be used as a tamponade, but silicone oil is preferred.
Performing a lensectomy is recommended because aphakia is correlated with a normal IOP. Dr. Eliott does not recommend preserving the anterior capsule because of complications such as opacification, wrinkling, and iris adhesions, among others. A scleral buckle should be placed at the retinectomy edges at the 3 and 9 o’clock sites. Retention of subretinal perfluorocarbon can be avoided by using lower infusion pressure, valved cannulas, or a saline rinse after fluid-air exchange.
Numerous studies have demonstrated the retinectomy with use of silicone oil performed in eyes with recurrent retinal detachment or PVR had good results with lower risks of recurrence.
This article was adapted from Dr. Elliott’s presentation during Retina Subspecialty Day at the 2012 American Academy of Ophthalmology annual meeting.
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