Article Text

Download PDFPDF
Intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for stage 3 and stage 4 idiopathic macular holes
  1. Yanping Yu,
  2. Biying Qi,
  3. Xida Liang,
  4. Zengyi Wang,
  5. Jing Wang,
  6. Wu Liu
  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Wu Liu, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; wuliubj{at}


Aims To investigate characteristics of intraoperative iatrogenic retinal breaks in 23-gauge vitrectomy for idiopathic macular hole and classify the breaks based on their causes to analyse the risk factors.

Methods This retrospective study enrolled patients with stage 3 or 4 idiopathic macular hole who underwent 23-gauge vitrectomy in Beijing Tongren Hospital from July 2015 to August 2018. The intraoperative iatrogenic retinal breaks were classified into three types: by induction of posterior vitreous detachment (type 1), by peripheral vitreous cutting (type 2) and by others (type 3). The types, incidence and distribution of the breaks were analysed, and all clinical features were compared between eyes with and without the breaks.

Results A total of 364 eyes from 341 patients were recruited. Twenty-five breaks from 24 eyes (6.6%) were encountered, 52% (13/25) of which distributed in the superior region. Type 1 and type 2 breaks contributed 52% (13/25) and 44% (11/25) to all, respectively. Eyes with stage 3 and stage 4 holes showed no significant differences in incidence or distribution in type 2 breaks. No breaks occurred on the surface of lattice degenerations. All clinical features showed no significant differences between eyes with and without the breaks.

Conclusion Distribution of intraoperative iatrogenic retinal breaks shows no preference for the superior or inferior region. Induction of posterior vitreous detachment and traction from peripheral vitreous cutting are major causes of the breaks, which classify them into two main types. The presence of lattice may not be one of the risk factors if treated properly.

  • macula
  • retina
  • tears
  • treatment surgery

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • YY and BQ contributed equally.

  • Contributors Study design, data acquisition and statistical analysis: YY, BQ, WL. Interpretation of data: YY, BQ, XL, ZW, JW, WL. Writing (original draft): YY, BQ. Writing (review and editing): YY, WL. Support of statistical techniques: XL, ZW, JW. Final approval of manuscript: all authors. Supervision and surgical support: WL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study adhered to the Helsinki Declaration and its later amendments, and the whole protocol was approved by the ethical review committee of Beijing Tongren Hospital, Capital Medical University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. The deidentified participant data are in the team’s database, which is available only from the corresponding author. For reusing, please contact WL ( for permission.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas