The incidence of retinal breaks induced by posterior hyaloid separation during 27-gauge pars-planar vitrectomy

Rubina Rahman, Ajay Patil, John Stephenson

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As advances are made in smaller gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and also appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25 and 23 gauge vitrectomy is known, but no studies exist looking at the incidence in 27 gauge vitrectomy with an attached posterior hyaloid face. This study set out to characterize the incidence.

A retrospective, consecutive, observational study of patients undergoing 27 gauge transconjunctival sutureless vitrectomy (TSV) for macular pathology or floaters. This was a single surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, UK. Inclusion criteria included only those with an attached posterior hyaloid face at the disc, identified intraoperatively.


Data was collected and analysed in 94 patients. Preoperative diagnosis frequency was as follows: Epiretinal membrane 24 (25.5%), Macular hole 47 (50.0%), Vitreo-macular traction 11 (11.7%) and Floaters 12 (12.8%). In 82 out of 94 patients (89.1 %), 27g vitrectomy was combined with 2.2 mm micro-incisional phakocoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27-gauge PPV was 17% (16 cases).


This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27 g vitrectomy. Our single surgeon case series of 27 gauge PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no post-operative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with the outcome (incidence of retinal tear).
Original languageEnglish
Pages (from-to)76-79
Number of pages4
JournalJournal of VitreoRetinal Diseases
Issue number2
Publication statusPublished - 1 Mar 2019


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