Simple method to reduce iatrogenic retinal trauma during vitreous surgery

Sir,

Posterior iatrogenic retinal trauma is a known complication of vitreous surgery.¹ We have had two cases where the endoillumination pipe has caused direct retinal trauma during epiretinal or internal-limiting membrane peel. This is a delicate procedure that demands intense concentration, often using a viewing lens that greatly restricts the visible field.

To reduce the likelihood of trauma during this stage of the procedure, we employed the simple use of a length of butterfly tubing (Figures 1, 2) threaded along the illumination pipe to limit the depth to which the illumination instrument can be inserted into the eye. This butterfly tubing can be adjusted in length as required. This has also been employed during a complex four-port diabetic delamination surgery, where an assistant holds the light pipe. The technique should be particularly useful for trainee retinal surgeons.

Figure 1

Butterfly tubing cut to desired length and threaded along endoillumination pipe.

Figure 2

Butterfly tubing cut to desired length and threaded along endoillumination pipe.

Thankfully, we have not had any similar iatrogenic breaks after employing this device.