Postoperative Care

540

64 Postoperative Care

Table 64.1 Postvitrectomy complications

Early (E) vs

Complication (sign

late (L)a

or symptom)

presentation

Comment

Treatment

Pain

E/L

E: corneal erosionb

Erosion: topical steroid is

A lid speculum that was

needed in the first 10

spread too wide.

days; in addition: artificial

Extensive pulling on the

tears, corneal gels,

extraocular musclesc

therapeutic contact lens,

Elevated IOPd

amniotic membrane.

Patients who underwent

Especially if the erosion

repeated surgeries,

recurs, surgical

especially if these

intervention may be

closely follow each

indicatede

other, experience more

Elevated IOP: according to

pain and irritation

the etiology (see below)

L: elevated IOP (see below)

plus antiglaucoma drops,

acetazolamide tablets,

surgery

Loss of visionf

E

A tight scleral suture,

None or according to the

especially after 20 g

etiology

surgery, can also cause

astigmatism

Presence of air or gas

tamponade

Intraocular hemorrhage

Cataractg

High IOP due to gas

expansion

Intraorbital hemorrhageh

Endophthalmitis

E

See Chap. 45

Inflammation

E

May be a normal reaction;

Topical, occasionally

in some cases it may be

systemic, steroid

very strong

Irritation

E

Repeated surgeries (see

Suture removal if ointment is

above)

insufficient to deal with

Suture on the eyeball’s

the irritation

surface, which may

The subconjunctival oil

cause neovascularization

should be removed when

and granuloma

the intraocular oil is

Subconjunctival silicone oil

removedi

Corneal edema

E

Especially after scraping

Topical steroid

the epithelium, which

may not heal for

extended periods in

diabetics

Zonular opacity

L

Silicone oil touch is the

According to the etiology;

(band

most common culprit,

EDTA and abrasion

keratopathy)

but many other,

systemic or local, causes

may also be responsible

(continued)

64 Postoperative Care

541

Table 64.1 (continued)

Early (E) vs

Complication (sign

late (L)a

or symptom)

presentation

Comment

Treatment

Positional

E

Pigment and other debris on

None needed

keratopathyj

the corneal endothelium.

Not really a

complication; it simply

shows that the patient

complied with the

positioning instructions

Hypotony

E/L

E: Wound leakage,

E: Closure of the wound;

choroidal detachment

drainage; viscoelastic or

L: Ciliary body shutdown

pure SF6 gas implantation

into the AC

L: Ciliary body debulking,

silicone oil implantation

Anterior segment

L

May occur after encircling

Cutting the band

ischemia

band placement if the

band is very tightk

Hyphema

E/L

Much more common as an

None or, if the IOP is high,

E complication; if it is

irrigation or clot removal

L, the cause may be the

with the probe (see

original diseasel or

Chap. 47)

rubeosis

Permanently

E

Extensive lasering over the

Pilocarpine drops, surgery to

dilated pupil

long ciliary nerves

constrict the pupil

Glaucoma

E/L

There are different

According to the etiology. In

mechanisms how the

neovascular glaucoma

IOP can get elevated:

anti-VEGF injection into

extensive inflammation,

the AC is of great benefit

hemorrhagem, lens-

relatedn, epithelial

ingrowth etc.

Cataracto

E/L

With the rare exception of

Extraction

iatrogenic rupture of the

posterior capsule, the

cataract is usually a L

complication – or, in

truth, a side effect. With

time all eyes undergoing

PPV will develop

cataract, most probably

due to the increased O2

level in the vitreous. The

cataract is typically

nuclear, which is best

seen with the naked eye,

not at the slit lamp (see

Table 7.1)

(continued)

542

64 Postoperative Care

Table 64.1 (continued)

Early (E) vs

Complication (sign

late (L)a

or symptom)

presentation

Comment

Treatment

VH

E/L

The E is much more

None, lavage, or re-PPV (see

common; it obscures the

Sect. 62.4)

fundus at a time when it

would be the most

important to inspect it

EMP

L

May occur primarilyp or

None or re-PPV

recur; ILM peeling

prevents both

RD

E/L

May be caused by

Re-PPV (see Sect. 54.7)

inappropriate surgeryq

or a secondary break; it

also occurs in up to a

fifth of eyes after

silicone oil removal

PVR

L

The most dreaded L

Re-PPV with silicone oil

complication of PPV

implantation (see Chap.

53)