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Optic Disc, Foveal, and Extrafoveal Damage Due to Surgical Separation of the Vitreous
Stephen R. Russell, MD;
Gregory S. Hageman, PhD
Arch Ophthalmol. 2001;119:1653-1658.
Objective To evaluate the morphologic outcomes resulting from surgical vitreoretinal separation in young adult primates.
Materials and Methods Vitrectomy and mechanical separation of the vitreous from the internal limiting lamina (ILL) of the posterior retina and surface of the optic disc were performed on 25 young adult cynomolgus monkey eyes in vivo. Lectin histochemical studies were used to evaluate the vitreoretinal interface. Morphologic outcomes were tabulated.
Results In 11 of 25 eye regions, residual vitreous remained attached to the ILL in some of the regions. Localized ILL breaks or separation of the ILL from the neural retina was noted in 9 eyes. Retinal tissue loss, including avulsion of the ganglion cell, inner plexiform, or inner nuclear layers, was observed in 7 eyes. Avulsion of axon bundles in the optic disc was noted in 9 eyes. Significantly, partial- or full-thickness foveal tears were noted in 11 eyes. Based on the surgeons' intraoperative observations, small superficial optic disc or retinal hemorrhages were observed in 3 of 25 eyes. None of the eyes on which a vitrectomy alone was performed showed ILL damage, or retinal or optic disc tissue loss.
Conclusion Damage may occur to the optic disc, fovea, and extrafoveal retina as a result of surgical separation of the vitreous from the retina in young adult primates.
Clinical Relevance These data support the contention that surgically induced damage at the level of the vitreoretinal interface may help explain the visual field defects noted after surgery to close full-thickness macular holes. These data also support the need for developing additional modalities to assist in vitreous separation, thereby reducing the risk of traumatic complications associated with purely mechanical procedures.
From the Center for Macular Degeneration, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City. The authors have no commerical, proprietary, or financial interest in the products or companies described in this article.
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