Retinotomies

A retinotomy is a planned incision through the retina made during vitreoretinal surgery to access the subretinal space, drain subretinal fluid, or remove subretinal material. It is a controlled, full-thickness retinal incision that may be temporary or extended, and the surrounding edges are usually treated with laser photocoagulation to promote adhesion and retinal reattachment. Retinotomy is distinct from retinectomy, which involves removing a portion of the retina.

Indications for retinotomy include complex rhegmatogenous retinal detachment, especially with proliferative vitreoretinopathy, giant retinal tears, and cases requiring drainage of subretinal fluid or blood. It is also used to access and remove subretinal membranes or fibrovascular tissue, to permit delivery of endophotocoagulation, or to facilitate retrieval of intraocular foreign bodies located posterior to the retina. The procedure is typically considered when conventional approaches cannot adequately reattach the retina or clear subretinal pathology.

Technique and intraoperative considerations involve performing the surgery via pars plana vitrectomy, selecting a retinal site away from the fovea and major vessels, and creating a controlled full-thickness incision. Perfluorocarbon liquids may be used to flatten the retina, and the retinotomy edges are laser-b coagulated to create chorioretinal adhesions. Tamponade with a gas or silicone oil bubble is commonly used postoperatively, and patient positioning is guided by the specific retinal pathology.

Outcomes depend on the underlying disease, extent of detachment, and timing of surgery. Potential complications include recurrent or recurrent detachment, progression of proliferative vitreoretinopathy, macular damage, hemorrhage, infection, and issues related to silicone oil or gas tamponade. Retinotomies are part of a broader repertoire of vitreoretinal techniques and are chosen when their benefits outweigh these risks.