Complications
May arise as a post-operative 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 retinal detachment may lead to permanent visual loss in affected eye.
Fellow eyes have several times the risk of developing rhegmatogenous retinal detachment, 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 re-detachment) may occur due to a missed retinal break, post-operative development, or proliferative vitreoretinopathy (PVR).[63][64]
A missed retinal break usually presents within days or weeks, whereas PVR usually presents 4-8 weeks after surgery.
Persistent retinal detachment or re-detachment requires surgery. The choise of procedure depends on the cause, although repeat surgery typically favours vitrectomy.
Characterised by seeding of the vitreous/retinal surfaces by cells that produce collagen and then membrane contraction with consequent tractional retinal detachment (RD).[65] Scar formation is visible on clinical examination.
PVR is a natural consequence of untreated rhegmatogenous RD; risk for PVR increases following surgery and may be influenced by operator experience. 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) may develop in eyes undergoing surgery for rhegmatogenous RD.[45] Common symptoms are metamorphopsia and diplopia. This complication may be prevented in eyes undergoing vitrectomy by removing the internal limiting membrane or prescribing systemic corticosteroid therapy; treatment of epiretinal membranes is typically by vitrectomy.[45][69]
Important intraoperative complications include sub-retinal haemorrhage from transscleral drainage and retinal pigment epithelium damage from over freezing.
Important post-operative complications include myopia, diplopia, strabismus, astigmatism, sub-retinal gas/air injection, anterior segment ischaemia, macular pucker, and proliferative vitreoretinopathy.[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 post-operative complications include cataract, macular pucker, proliferative vitreoretinopathy, new retinal detachment, maculopathy (e.g., dye or light toxicity), and post-surgical 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 sub-retinal haemorrhage from transscleral drainage and retinal pigment epithelium damage from over freezing. Both of these are rare but potentially severe.
Important post-operative complications include cataract and recurrent rhegmatogenous retinal detachment 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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