Hassan Mortada (Cairo, Egypt)

Advantages:

Peeling of adherent cortical vitreous during primary vitrectomy in eyes with rhegmatogenous RD is crucial in achieving complete mobilization of the retina, to remove the scaffold for further proliferation and to achieve long-term retinal stability. The posterior hyaloid may be loosely or strongly adherent or may show vitreoschisis. The aim of this work is to present the behavior of adherent posterior cortical vitreous, techniques used for dealing with strongly adherent posterior hyaloid and complications encountered.

Methods:

200 eyes that underwent primary vitrectomy for rhegmatogenous retinal detachment, and found, intraoperatively, to have adherent posterior cortical vitreous, were included in this study. These included eyes with single or multiple breaks, large breaks, myopic macular hole, lattice degeneration and giant tears. Using Triamcinolone Acetenoide to highlight the cortical vitreous, the anatomy of the posterior hyaloid was recorded. Different techniques were used to peel adherent posterior hyaloid including use of scrapers, aspiration applied by vitrectomy probe, forceps, and bimanual manipulations. The behavior of the posterior hyaloid during peeling was recorded. Complications during posterior hyaloid peeling included bleeding, iatrogenic retinal tears and incomplete peeling.

Effectiveness / Safety:

The anatomy and behavior of adherent posterior cortical vitreous during peeling differ greatly in eyes with rhegmatogenous RD. Different techniques and manipulations using different instruments may be used in the same eye to achieve complete peeling of adherent posterior cortical vitreous.

Take home message:

Peeling of adherent posterior hyaloid during primary vitrectomy is crucial to achieve long-term stable retinal reattachment. Patience and different techniques and instruments are necessary to deal with adherent posterior hyaloid in eyes with rhegmatogenous retinal detachment.