retinotomy

Retinotomy is a surgical incision through the retina performed as part of vitreoretinal surgery. It is used to gain access to the subretinal space or to relieve traction on the retina, and is usually performed via a pars plana vitrectomy. The incision is typically small (about 0.5 to 1.0 millimeters) and is located away from the fovea when possible. After creating the retinotomy, subretinal fluid may be drained, or subretinal membranes, hemorrhages or foreign bodies can be accessed and removed. The edges are usually treated with laser photocoagulation to create chorioretinal adhesions, and the retina is often reattached using a tamponade agent such as gas or silicone oil to stabilize the retina as it heals.

Indications include complex rhegmatogenous retinal detachments associated with proliferative vitreoretinopathy, giant retinal tears, recurrent detachments with subretinal membranes, and cases requiring drainage of subretinal hemorrhage or subretinal fibrous tissue. Retinotomies may also be employed to gain access to the subretinal space for membrane peeling or to facilitate removal of subretinal foreign bodies.

Complications include creation of new retinal breaks, enlargement of the retinotomy, recurrent or persistent detachment, hemorrhage, infection, cataract progression in phakic eyes, and the development or progression of proliferative vitreoretinopathy. The visual outcome is largely determined by the underlying pathology and the extent of retinal damage prior to surgery.

With careful technique, retinotomy can improve anatomic reattachment rates in complex detachments, and functional outcomes depend on macular involvement and duration of detachment.