Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Srimati Kanuri Santamma Centre for Vitreoretinal Diseases; Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2022 Mar;70(3):902-907. doi: 10.4103/ijo.IJO_1918_21.
To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS).
The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed.
Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion-fluid-related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air-filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases.
JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.
评估玻璃体视网膜手术（VRS）期间射流损伤（JSI）相关医源性视网膜裂孔（IRB）的原因。
从病历中记录了精确的手术环境，包括手术适应证和类型、视网膜状况、仪器和流体参数的详细信息以及导致 IRB 的射流特征。分析了 IRB 的性质及其愈合情况，以及对解剖和视觉结果的影响。
纳入了五名患者的五只眼，这些患者均有完整的 JSI 和 IRB 记录。两例因黄斑裂孔进行了手术，一例因玻璃体积血，一例因视网膜脱离，一例因眼内炎进行了手术。一例与灌注液相关的 JSI，而四例是由于注射手术辅助药物（药物、PFCL 和染料）引起的。当玻璃体腔内充满液体时，JSI 在两例中发生，而在三例中则为空气填充。在四例中，液体迁移到视网膜下腔，需要进一步操作，此后裂孔愈合，但在两例中直接导致视力丧失。
JSI 相关的 IRB 虽然罕见，但如果影响黄斑，则可能直接导致视力丧失。射流速度、距视网膜表面的距离、中间介质（玻璃体腔）和视网膜健康之间的平衡起着重要作用。它可能是由于灌注和注射射流引起的。在容易发生并发症的情况下，必须采取预防措施，并建议修改手术技术。
