Complications of Vitreo Retinal Surgery, 1st Edition

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Library of Congress Cataloging-in-Publication Data

Complications of vitreo-retinal surgery / [edited by] Noemi Lois, David Wong.

   p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-1938-1 (alk. paper)
I. Lois, Noemi, editor of compilation. II. Wong, D. (David), 1952- editor of compilation.
[DNLM: 1. Vitreoretinal Surgery. 2. Intraoperative Complications. 3. Postoperative
Complications. 4. Retinal Diseases—surgery. 5. Vitreous Body—surgery. WW 270]
RE551
617.7935059–dc23
2013004404

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 To my Dad , Jo s e Lois Estévez, always my inspiration
and s o u r ce of strength, in memoriam.

To my Mu m , M a del Carmen Puente Araujo,

fo r h er dedication and love.
N oemi L ois
u

In lo vin g memory of Din, my sister.

To Noemi’s d a u g h ter, Emilia, for her inspiring artwork.

DAVID WONG

(c) 2015 Wolters Kluwer. All Rights Reserved.

 Contributors
Ehab Abdelkader, FRCS, FRCOphth Alberto Arteaga, MD
Lecturer of Ophthalmology Retina Fellowship
Department of Ophthalmology Retina and Vitreous Department
Medical School Instituto de Microcirurgia Ocular
Menoufia University Barcelona, Spain
Shibin El Kom, Egypt
Ophthalmologist, Retina Specialist
Associate Specialist Ophthalmologist Department of Ophthalmology
Department of Ophthalmology Clinica Oftalmologica
Aberdeen Royal Infirmary Madero, Tamaulipas, Mexico
Aberdeen, UK
Jose Garcia Arumi, MD
Nur Acar, MD, FEBO Professor
Associate Professor Department of Ophthalmology
Department of Vitreoretinal Disease Autonomous University of Barcelona
World Eye Hospital Barcelona, Spain
Etiler, Istanbul, Turkey
Chairman
Richard M. Ahuja, MD Department of Ophthalmology
Clinical Associate Professor Hospital de la Vall d’Hebron
Department of Ophthalmology Barcelona, Spain
Chicago Medical School
North Chicago, IL George William Aylward, FRCS,
FRCOphth, MD
Residency Director Consultant Vitreoretinal Surgeon
Director of Vitreoretinal Services Moorfields Eye Hospital
Department of Ophthalmology London, UK
Stroger Cook County Hospital
Chicago, IL Augusto Azuara-Blanco, MD, PhD,
FRCS(Ed), FRCOphth
Sofia Androudi, MD Professor of Clinical Ophthalmology
Lecturer Centre for Vision and Vascular Science
Department of Ophthalmology Queen’s University Belfast
University of Thessaly
Larissa, Greece Honorary Consultant Ophthalmologist
Department of Ophthalmology
J. Fernando Arevalo, MD, FACS Belfast Health and Social Care Trust
Professor Belfast, UK
Wilmer Eye Institute
The John Hopkins University Philip J. Banerjee, BMedSCi,
Baltimore, MD FRCOphth
Vitreoretinal Research Fellow
Chief Vitreoretinal Unit
Vitreoretinal Division Moorfields Eye Hospital
The King Khaled Eye Specialist Hospital London, UK
Riyadh, Kingdom of Saudi Arabia v

(c) 2015 Wolters Kluwer. All Rights Reserved.

 vi C ontrib utors

Susanne Binder, MD Ulrik Correll Christensen, MD, PhD

Professor Fellow
Department of Ophthalmology Department of Ophthalmology
Ludwig Boltzmann Institute for Retinology University of Copenhagen
and Biomicroscopic Lasersurgery Copenhagen, Denmark
Vienna, Austria
Fellow
Chair, Director Department of Ophthalmology
Rudolf Foundation Clinic Glostrup Hospital
Vienna, Austria Glostrup, Denmark

Silvia Bopp, PhD, DM John B. Christoforidis, MD

Senior Consultant, Assistant Professor Assistant Professor
Augenklinik Universitaetsallee Physician and Surgeon
MVZ GmbH Department of Ophthalmology
Bremen, Germany The Ohio State University College of Medicine
Columbus, OH
Periklis Brazitikos, MD
Associate Professor Lucienne Collet, MD
Ophthalmology Retina Fellowship
University of Thessaly Retina and Vitreous Department
Larissa, Greece Instituto de Microcirurgia Ocular
Barcelona, Spain
Juan Diego Carpio, MD
Retina Fellowship Ophthalmologist, Retina Specialist
Retina and Vitreous Department Department of Ophthalmology
Instituto de Microcirurgia Ocular Admira Vision
Barcelona, Spain Barcelona, Spain

Ophthalmologist, Retina Specialist Inés Contreras, MD, PhD

Ophthalmology Retina Specialist
Clínica Oftalmológica Oftalmolaser Department of Ophthalmology
Barcelona, Spain Hospital Universitario Ramón Y Cajal
Madrid, Spain
Steve Charles, MD
Ophthalmology Borja Corcostegui, MD
Heritage Institute Professor of Ophthalmology
University of Tennessee European School of Advance Studies in
Memphis, TN Ophthalmology
Campus Lugano
David G. Charteris, MD, FRCS, Lugano, Switzerland
FRCOphth
Consultant Vitreoretinal Surgeon Medical Director
Vitreoretinal Unit Instituto de Microcirurgia Ocular
Moorfields Eye Hospital Barcelona, Spain
London, UK
Sven Crafoord, MD, PhD
Associate Professor
Department of Ophthalmology
Orebro University Hospital
Orebro, Sweden

(c) 2015 Wolters Kluwer. All Rights Reserved.

 C ontri butors vii

Lyndon da Cruz, MBBS, MA, Marta S. Figueroa, MD, PhD

FRCOphth, PhD, FRACO Retina Specialist
Honorary Reader Department of Ophthalmology
UCL Institute of Ophthalmology Hospital Universitario Ramón Y Cajal
University College London Madrid, Spain
London, UK
Rhona Flin, PhD
Consultant Ophthalmic Surgeon Professor of Applied Psychology
Vitreo-retinal and Medical Retina Department Industrial Psychology Research Centre
Moorfields Eye Hospital NHS Foundation Trust University of Aberdeen
London, UK Aberdeen, Scotland, UK

Kunal K. Dansingani, MB, BS, MA, John V. Forrester, MD, ChB

FRCOphth Emeritus Professor
Locum Consultant Ophthalmic Surgeon Section Immunology and Infection, DAM
Retina Department School of Medicine and Dentistry
Moorfields Eye Hospital University of Aberdeen
London, UK Aberdeen, Scotland, UK

Marc D. de Smet, MDCM, PhD, FRCSC, Valentina Franco-Cardenas, MD

FRCOphth, FMH Association for Preventing Blindness in
Professor Mexico
Department of Ophthalmology Ophthalmology, Retina Department
University of Amsterdam Mexico City, Mexico
Amsterdam, The Netherlands
Arnd Gandorfer
Director Professor of Ophthalmology
Retina and Inflammation Department of Ophthalmology
MIOS Ludwig Maximilians University
Lausanne, Switzerland Munich, Germany

Milton Nunes de Moraes-Filho, MD Medical Director

Retina and Vitreous Fellowship MVZ Memmingen Augen-MKG
Department of Ophthalmology Memmingen, Germany
Sao Paulo Hospital, Unifesp/EPM
Sao Paulo, SP, Brazil Justin Gottlieb, MD
Associate Professor
Federica Genovesi Ebert, MD, PhD Department of Ophthalmology and Visual
Assistant Sciences
Ophthalmic Surgery Clinic University of Wisconsin-Madison
New Santa Chiara Hospital, Cisanello, Pisa Madison, WI
Pisa, Italy
Zdenek J. Gregor, FRCS(Eng),
Mostafa A. Elgohary, MBChB, MS, MD, FRCOphth
FRCSI, FRCSEd, FRCOphth Consultant Vitreoretinal Surgeon
Fellow Moorfields Eye Hospital
Department of Vitreoretinal Surgery London, UK
Moorfields Eye Hospital
London, UK

(c) 2015 Wolters Kluwer. All Rights Reserved.

 vii i C ontrib utors

Eoin Guerin, FRCOphth, MD Andrew M. Hendrick, MD

Vitreoretinal Fellow Vitreoretinal Fellow
Department of Ophthalmology Clinical Instructor
Manchester Royal Eye Hospital Department of Ophthalmology
Manchester, UK University of Wisconsin-Madison
Madison, WI
David Guyton, MD
The Zanvyl Krieger Professor of Kuhl Huh, MD, PhD
Ophthalmology Professor
Department of Ophthalmology Department of Ophthalmology
The Krieger Children’s Eye Center at The Korea University
Wilmer Institute Guro Hospital
The John Hopkins University School of Seoul, Korea
Medicine
Baltimore, MD Kazuaki Kadonosono, MD, PhD
Professor
Active Staff Department of Ophthalmology
Department of Ophthalmology Yokohama City University
The John Hopkins Hospital Yokohama-shi, Kanagawa, Japan
Baltimore, MD
Chair
Christos Haritoglou, MD Ophthalmology
Professor Yokohama City University Medical Center
Department of Ophthalmology Yokohama-shi, Kanagawa, Japan
Ludwig Maximilians University
Munich, Germany Anthony J. King, MD, MMedSci,
FRCOphth
Richard Haynes, MB, BCh, Honorary Associate Professor of Clinical
FRCOphth, DM Ophthalmology
Honorary Senior Lecturer Department of Ophthalmology
Academic Department of Ophthalmology University of Nottingham
University of Bristol Nottingham, UK
Bristol, UK
Consultant Ophthalmologist
Consultant Ophthalmic Surgeon Department of Ophthalmology
Retinal Department Nottingham University Hospital
Bristol Eye Hospital Nottingham, UK
Bristol, UK
Lazaros Konstantinidis, MD
Heinrich Heimann, MD Vitreo-Retinal Department
Honorary Senior Lecturer Royal Liverpool University Hospital
Department of Eye and Vision Science Liverpool, UK
University of Liverpool
Liverpool, UK

Consultant Ophthalmic Surgeon

St Paul´s Eye Unit
Royal Liverpool University Hospital
Liverpool, UK

(c) 2015 Wolters Kluwer. All Rights Reserved.

 C ontri butors ix

Thomas C. Kreutzer, MD Noemi Lois, MD, PhD, FRCS(Ed),

Consultant FRCOphth
University Eye Hospital Professor of Clinical Ophthalmology
Ludwig Maximilians University Centre for Vision and Vascular Science
Munich, Germany Queens University
Belfast, Northern Ireland, United Kingdom
Consultant
Department of Ophthalmology Honorary Consultant Vitreoretinal Surgeon
Allgemeines Krankenhaus Linz Department of Ophthalmology
Linz, Austria Belfast Health and Social Care Trust
Belfast, Northern Ireland, UK
Lucia Kuffová, MD, PhD, FRCOphth
Senior Lecturer Jose Lorenzo, MD, PhD
Section Immunology and Infection, DAM Vitreoretinal Consultant
School of Medicine and Dentistry Ophthalmology
University of Aberdeen Hospital POVISA
Aberdeen, Scotland, UK Vigo, Spain

Consultant Srilakshmi Maguluri, MD

Department of Ophthalmology Clinical Assistant Professor
Aberdeen Royal Infirmary Department of Surgery
Aberdeen, Scotland, UK University of Illinois
College of Medicine
Morten la Cour, MD, FEBO, Peoria, IL
Dr Med Scia
Professor Ophthalmologist
Eye Department Department of Surgery
University of Copenhagen Thorek Memorial Hospital
Copenhagen, Denmark Chicago, IL

Consultant Mauricio Maia, MD, PhD

Eye Department Assistant Professor
Glostrup Hospital Ophthalmology, Vitreoretinal Surgery Unit
Glostrup, Denmark Federal University of Sao Paulo
Sao Paulo, SP, Brazil
Alistair Laidlaw, MD, FRCOphth,
FRCS(Glas) Director of Vitreoretinal Surgery
Consultant Vitreoretinal Surgeon Department of Ophthalmology
Department of Ophthalmology Brazilian Institute of Fighting Against Blindness
St. Thomas’ Hospital Assis, SP, Brazil
London, UK
Andre Maia, MD
Wensheng Li, MD, PhD Chief of Retina and Vitreous Department
Professor Ophthalmology, Vitreoretinal Surgery Unit
Cataract and Retina Federal University of Sao Paulo
Eye Hospital Sao Paulo, SP, Brazil
Wenzhou Medical College
Wenzhou, Zhejiang, China Director of Vitreoretinal Surgery
Department of Ophthalmology
Clinica Oftalmologica São Lucas
São Paulo, SP, Brazil

(c) 2015 Wolters Kluwer. All Rights Reserved.

 x C ontrib utors

Pei Jian Miao, MD Mario R. Romano, MD, PhD

Associate Chief Doctor Head of Vitreo-Retinal Service
Xuzhou First People’s Hospital Department of Ophthalmology
Glaucoma Department Istituto Clinico e Ricerca Humanitas
Institute of Eye Disease Prevention and Control Milan, Italy
Xuzhou, Jiangsu, China
Steven D. Schwartz, MD
Timothy G. Murray, MD, MBA, FACS Ahmanson Professor of Ophthalmology
Founding Director, Professor Jules Stein Eye Institute, Retina Division
Murray Ocular Oncology and Retina University of California
Jackson Memorial Hospital Los Angeles, CA
Miami, FL
Guy Shanks, MD, MA
Yusuke Oshima, MD, PhD Consultant Ophthalmologist
Associate Professor Department of Ophthalmology
Department of Ophthalmology Örebro University
Osaka University Graduate School of Medicine Örebro, Sweden
Suita, Osaka, Japan
Consultant Ophthalmic Surgeon
Ian Pearce, FRCOphth Department of Ophthalmology
Consultant Vitreo-Retinal Surgeon Örebro University Hospital
St. Paul’s Eye Unit Örebro, Sweden
Royal Liverpool University Hospital
Liverpool, UK Manoharan Shunmugam, FRCOphth
Vitreoretinal Fellow
Siegfried G. Priglinger, MD, FEBO Department of Ophthalmology
Professor of Ophthalmology St. Thomas’ Hospital
Department of Ophthalmology Westminster Bridge Road
Ludwig Maximilians University London, UK
Munich, Germany
William E. Smiddy, MD
Chairman Professor of Ophthalmology
Department of Ophthalmology Ophthalmology
General Hospital Linz, AKH Bascom Palmer Eye Institute
Linz, Austria University of Miami Miller School of
Medicine
Adriana Ramirez, MD Miami, FL
Retina Fellow
Department of Ophthalmology Martin S. Spitzer, MD, PhD
University of California, Los Angeles Assistant Professor
David Geffen School of Medicine Department of Ophthalmology
Jules Stein Eye Institute University Eye Hospital Tübingen
Los Angeles, CA Tübingen, Germany

Stanislao Rizzo, MD
Chief
Ophthalmic Surgery Clinic
New Santa Chiara Hospital, Cisanello, Pisa
Pisa, Italy

(c) 2015 Wolters Kluwer. All Rights Reserved.

 C ontri butors xi

Theodor Stappler, MD Paul E. Tornambe, MD

Honorary Clinical Lecturer Director
Eye and Vision Science Retina Research Foundation of San Diego
University of Liverpool Poway, CA
Liverpool, UK
Jose Luis Vallejo-Garcia, MD
Consultant Vitreoretinal Surgeon Consultant
St. Paul’s Eye Unit Medical Retina and Vitreoretinal Department
Royal Liverpool University Hospital Istituto Clinico Humanitas
Liverpool, UK Rozzano, Milan, Italy

David Steel, MBBS, FRCOphth Jan Van Meurs, MD, PhD

Honorary Senior Lecturer Professor of Ophthalmology
Institute of Genetic Medicine Department of Ophthalmology
University of Newcastle Upon Tyne Erasmus University Rotterdam
Tyne and Wear, UK Erasmus Medical Center
Rotterdam, The Netherlands
Consultant Ophthalmologist
Sunderland Eye Infirmary VR Surgeon
Sunderland, UK Vitreoretinal Surgery
The Rotterdam Eye Hospital
Kevin K. Suk, MD Rotterdam, The Netherlands
Instructor
Bascom Palmer Eye Institute Rachel Williams, PhD
University of Miami Reader
Department of Ophthalmology Department of Eye and Vision Science
Anne Bates Leach Eye Hospital University of Liverpool
Miami, FL Liverpool, UK

Paul Sullivan, MBBS, MD, FRCOphth Tom Williamson, MBChB, FRCS(Glas),

Director of Education FRCOphth, MD
Consultant Vitreoretinal Surgeon Consultant
Vitreoretinal Surgery Department of Ophthalmology
Moorfields Eye Hospital St. Thomas’ Hospital
London, UK London, UK

Chrysanthos Symeonidis, MD David Wong, MB, ChB

Research Associate Chief of Service
2nd Department of Ophthalmology Department of Ophthalmology
Aristotle University of Thessaloniki Queen Mary Hospital
Thessaloniki, Macedonia, Greece Pok Fu Lam, Hong Kong

Associate Specialist Ian Y. Wong, FCOphthHK, FHKAM

2nd Department of Ophthalmology Clinical Assistant Professor
Papageorgiou General Hospital Eye Institute
Thessaloniki, Macedonia, Greece The University of Hong Kong
Pok Fu Lam, Hong Kong
Peter Szurman, MD, PhD
Head of Department Honorary Associate Consultant
Department of Ophthalmology Queen Mary Hospital
Knappschaft’s Eye Hospital Pok Fu Lam, Hong Kong
Sulzbach/Saar, Germany

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 xii C ontrib utors

Roger Wong, MBBS, BA, FRCOphth Miguel Angel Zapata, MD

Vitreoretinal Consultant Associated Professor
Department of Ophthalmology Department of Ophthalmology
St. Thomas’ Hospital Autonomous University of Barcelona
London, UK Barcelona, Spain

Howard Ying, MD, PhD Consultant

Assistant Professor Department of Ophthalmology
Retina Hospital de la Vall d’Hebron
Wilmer Eye Institute Barcelona, Spain
Baltimore, MD
Qinxiang Zheng, MD, PhD
Assistant Professor Associate Professor, Associate Chief Doctor
Department of Ophthalmology Cataract Department
John Hopkins Hospital Eye Hospital
Baltimore, MD Wenzhou Medical College
Wenzhou, Zhejiang, China

(c) 2015 Wolters Kluwer. All Rights Reserved.

 Foreword

“U
nfortunately, there were some complications.” The phrase con-
jures the image of the surgeon, mask hanging down but still tied
around the neck, speaking postoperatively to the patient’s now-
distressed loved ones. Yes, complications are certainly unwelcome and fre-
quently eventful, even disastrous, in a given surgical situation, but to view
them only negatively would be to miss the extraordinary value they have
in guiding and improving our surgery. To attain this other vantage point
requires that we study our complications carefully, try our best to under-
stand every aspect, and most importantly, share our experiences and out-
comes with one another. Seen in this positive light, complications are essen-
tial and informative features inherent in our surgical landscape like the
crevasses that shape safe passage across a glacier. Indeed, the deep respect
we feel when we are in the company of a distinguished surgeon is, in great
measure, a respect for their lifelong experience, painful and triumphal, with
every imaginable complication.
Vitreoretinal surgeons will welcome this marvelous book “Complica-
tions of Vitreo-Retinal Surgery” skillfully edited by Drs. Noemi Lois and
David Wong and crafted with the help of a highly experienced group of dis-
tinguished surgeons. Each chapter has a simplified and uniform structure
that includes concise introductory information followed by Pathogenesis/
Risk Factors. Then, in the heart of each chapter, there are “Pearls on how
to avoid it” followed by “Pearls on how to solve it.” Each chapter concludes
with a brief section on “Expected outcomes: what is the worst possible sce-
nario?”; it was quite interesting to read these and see where the authors
drew their line, although I, regrettably, could frequently envision something
worse!
The information contained in this book is practical and useful in the
extreme, and the enjoyment I found in reading it was most akin to discuss-
ing challenging surgical issues with a trusted colleague in an informal and
congenial setting. Tables and illustrations are well done and thoughtfully
used, and the overall impression of the book is one of remarkable clarity,
innovation, and insight. Although many of the complications will always
be with us and have been the subject of prior scholarly offerings, others
have been most worthily assembled for the first time. To offer just a few
examples, “Retinal Slippage” explains this often-mystifying subject in a way
that every vitreoretinal fellow will welcome. “Poor View of the Fundus” is
an excellent analysis of the most important part of every actual surgery, i.e.,
visualization of the tissues. “Refractive Changes Associated with Vitreoreti-
nal Surgery” is an avant-garde treatment of a subject of growing importance
due to the ever-increasing demand for improved visual outcomes in mod-
ern ophthalmic surgery. “Preventing Surgical Complications by the Use of
Non-technical Skills” a thorough discussion of the complex and often
underappreciated environment in which the surgery—and the surgeon—are
embedded will be required reading on my service, as will the indispensable
(though necessarily frightening) chapter on “Intraocular Bleeding.”
xiii

(c) 2015 Wolters Kluwer. All Rights Reserved.

xiv F oreword

I express my gratitude to Drs. Lois and Wong and the authors for this
magnificent sharing of vitreoretinal complications in such an engaging and
approachable format. I am certain that this volume will be read by the wide
audience that it deserves, and that our surgeries, and our field, will move
forward.

Donald J. D’Amico, MD
New York, NY

(c) 2015 Wolters Kluwer. All Rights Reserved.

 Preface

V
itreoretinal surgery is a fascinating, challenging and ever-changing
field. Such a demanding subspecialty requires manual dexterity, sur-
gical training, extensive knowledge, and sound reasoning. Many ordi-
nary surgeons can perform vitreoretinal surgery well. The one attribute that
distinguishes a great surgeon is perhaps the ability to avoid and to manage
complications.
This book was conceived with the goal of compiling the best advice,
given in a most succinct manner by leading vitreoretinal surgeons through-
out the world, on what to do to prevent and treat surgical complications
encountered in daily practice. It encompasses specific complications related
to scleral buckling, pneumatic retinopexy, and 20-, 23-, and 25-gauge vitrec-
tomy. It also covers general complications that can occur with any of these
different surgical techniques. In each chapter, the complication is defined,
its pathogenesis reviewed, and the risk factors for its occurrence are listed.
Importantly, pearls on how to prevent and treat these complications are
given in a clear, “bullet point” format.
This book has been written for vitreoretinal surgeons. Experienced sur-
geons may find it helpful as it contains approaches to prevent and treat com-
plications that may be different or better than those they currently use. For
newly trained vitreoretinal surgeons and fellows in training, this book may
provide them with a useful guide to avoid complications and may add to their
surgical armamentarium for handling complications when they do occur.
Knowledge of these complications and tips to prevent them and solve them
will help build confidence and achieve better surgical outcomes. We believe
this book would be a great companion in the operating room. Outstanding
scrub nurses may also enjoy reading this book; it will certainly increase their
awareness of potential problems that can occur intraoperatively and help
them anticipate the remedial actions surgeons may need to take when these
complications occur. This book will provide useful background information
for general ophthalmologists, residents, and optometrists who are involved
in looking after patients before and after vitreoretinal procedures.
It is our hope that this book will help vitreoretinal surgeons to reduce
the occurrence of complications associated with their procedures and to
help them managing these complications in a more skillful and efficient
manner, with the ultimate goal of improving patient’s care.

Noemi Lois and David Wong

xv

(c) 2015 Wolters Kluwer. All Rights Reserved.

 Acknowledgments

W
e are extremely grateful to all authors who have generously giving
up their time to contribute with chapters for this book. We thank
them for sharing their expertise on the subjects discussed and for
providing us with their best “tips” to prevent and solve complications we
may all encounter at some point during our daily practice of vitreoretinal
surgery.
We would like to thank Ms Emilie Moyer and Ms Franny Murphy for
their expert technical assistance on the elaboration of this book and to
Ms Giovanna Santoni for her masterly performed drawings which illustrate
this publication.
We would wish to thank Mr Jonathan Pine, Executive Editor, Lippincott
Williams & Wilkins, for his support during the early stages of preparation of
this book, and to Mr Ryan Shaw, Acquisitions Editor, Lippincott Williams &
Wilkins for his expert technical assistance and advice throughout the publica-
tion process of this book.

xv i

(c) 2015 Wolters Kluwer. All Rights Reserved.

 Contents
Section I
Complications During or Following the Surgical Procedure  1

Part A. Complications
of Scleral Buckling Procedures—
Intraoperative Complications 3
Chapter 1 u Complications Associated with Suturing the Scleral Buckle 3
Lucienne Collet, Alberto Arteaga, Juan Diego Carpio, and Borja Corcostegui

Chapter 2 u Complications Associated with Drainage of Subretinal Fluid 10

Borja Corcóstegui, Alberto Arteaga, Juan Diego Carpio, and Lucienne Collet

Chapter 3 u Complications Associated with the Injection of Air/Gas 17

George William Aylward

Chapter 3A u Air/Gas Injection Under Tenon’s Conjunctiva 17

Chapter 3B u “Fish-Egg” Air/Gas Bubble Formation 19

Chapter 3C u Air/Gas Injection Behind the Lens 21

Chapter 3D u Subretinal Injection of Air/Gas 23

Chapter 4 u Complications of “Buckling” the Retinal Break 25

William E. Smiddy

Chapter 4A u Cannot Find Retinal Break 25

Chapter 4B u Inability to Close the Retinal Break on the Buckle 30

Chapter 5 u Scleral Perforation and Penetration into the Eye 34

Lazaros Konstantinidis and Ian Pearce

Part B. Complications ofScleral Buckling Procedures–

Postoperative Complications 39
Chapter 6 u Exposure and Infection of the Scleral Buckle 39
Mario R. Romano, John B. Christoforidis, and Jose Luis Vallejo-Garcia

Chapter 7 u Migration of the Scleral Buckle 48

Christos Haritoglou

Part C. Complications of Pneumatic Retinopexy 57

Chapter 8 u Missed and New Retinal Breaks 57
Paul E. Tornambe

xvii

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xvi ii C ontents

Part D. Complications ofPars Plana Vitrectomy—Intraoperative

Complications 63
Chapter 9 u Complications Related to the Setting Up, Maintaining, and
Closing off the Ports 63
Jose Garcia Arumi and Miguel Angel Zapata

Chapter 9A u Subconjunctival Hemorrhage, Marked Chemosis 63

Chapter 9B u Difficulties Related to the Location /Size of Sclerostomies 64

Chapter 9C u “ Losing” the Tunnels During Trocar Insertion in

Small-Bore Vitrectomy 66

Chapter 9D u Suprachoroidal and Subretinal Infusion 67

Chapter 9E u Accidental Intraoperative Removal of the Infusion Port 69

Chapter 9F u Vitreoretinal Incarceration at the Sclerotomy 70

Chapter 9G u Leaking Ports at the End of Surgery 73

Chapter 9H u Difficulties Suturing and Closing the Sclerotomies 76

Chapter 10 u C  omplications Related to the Crystalline Lens 77

Martin S. Spitzer and Peter Szurman

Chapter 10A u Development of Cataract Intraoperatively (Not Related to

Lens Touch) 77

Chapter 10B u Lens Touch with or without Capsular Breach 84

Chapter 10C u Crystalline Lens Subluxation and Luxation 94

Chapter 11 u C  omplications During Phaco-Vitroectomy 104

Kevin K. Suk and Timothy G. Murray

Chapter 11A u Continuous Flattening of the Anterior Chamber 104

Chapter 11B u Posterior Capsule Rupture (Can I Insert a Lens?

Can I Preserve the Capsular Bag?) and Zonulodyalysis 110

Chapter 12 u Complications Related to the Induction of a Posterior

Vitreous Detachment 121
Tom Williamson

Chapter 12A u I Cannot Detach the Vitreous in an Eye with

an Attached Retina 121

Chapter 12B u I Cannot Detach the Vitreous in an Eye with

a Detached Retina 125

Chapter 12C u D
 etaching the Vitreous in the Presence of Neovascularization 127

Chapter 12D u D
 etaching the Vitreous in “Friable” Retina 131

(c) 2015 Wolters Kluwer. All Rights Reserved.