This case involves a sixty-year-old female patient who presented for an elective vitrectomy for the removal of excess vitreous humor. Before the procedure, the patient was advised that the voided space would be filled with a synthetic replacement fluid to prevent retinal detachment. The patient eventually suffered a detached retina and permanent vision loss in the afflicted eye. The surgeon failed to place an adequate amount of synthetic fluid in the eye that resulted in destabilization of the retinal attachments.
Question(s) For Expert Witness
- 1. What are the major complications of this procedure and how should they be avoided?
Expert Witness Response E-001032
The major complications of vitrectomy are bleeding, infection, and retinal detachment. If possible, blood thinners should be discontinued preoperatively. Intraoperatively, adequate IOP must be maintained. A drop in pressure that causes globe collapse is a major risk factor for the development of a choroidal hemorrhage. Eyes should be meticulously washed with a dilute povidone-iodine solution before the operation. Immediately after the operation, subconjunctival or topical antibiotics should be administered before the eye is patched. Topical antibiotic drops should be prescribed for at least one week after the procedure. Endophthalmitis is less common in postsurgical vitrectomized eyes because the vitreous has been removed. Retinal detachment can occur during vitrectomy if an iatrogenic retinal break is made during the procedure (similar to when an inadvertent retinal touch causes a break or sclerotomy tear). These detachments should be repaired in a manner similar to primary retinal detachment repair.