Retinal Breaks Associated with the Induction of Posterior Vitreous Detachment

PURPOSE: To evaluate the correlation between the incidence of vitrectomy-related retinal breaks and the induction of a posterior vitreous detachment (PVD). DESIGN: Retrospective, nonrandomized comparative study. METHODS: Three hundred and eleven eyes of 311 patients who underwent pars plana vitrectomy for the treatment of epiretinal membrane (ERM) or macular hole (MH) were reviewed. We identified the incidence of retinal breaks, the number of eyes requiring induction of PVD during operation, and the possible associated factors for retinal break in the 2 groups. RESULTS: The incidence of retinal breaks related to the operation was 6.9% (12/174 eyes) in the ERM group and 14.6% (20/137 eyes) in the MH group (P=.02). Induction of PVD was carried out in 28 eyes (16.0%) of the ERM group and in 105 eyes (76.6%) of the MH group (P=.01). Intraoperative or postoperative retinal breaks, or both, in the ERM group were detected in 9 (32.1%) of 28 eyes with induction of PVD and in 3 (2.1%) of 146 eyes without induction of PVD (P=.006). A similar trend also was observed in the MH group; retinal breaks related to the operation were detected in 19 (12.7%) of 105 eyes with induction of PVD and in 1 (3.1%) of the 32 eyes without induction of PVD (P=.008). CONCLUSIONS: Induction of PVD during vitrectomy results in a significantly higher incidence of intraoperative or postoperative retinal breaks, or both. Caution should be exercised after the induction of PVD to identify all retinal breaks so they can be treated. (Am J Ophthalmol 2009; 147:1012-1016. (C) 2009 by Elsevier Inc. All rights reserved.)