Treatment of Inflammation Secondary to Vitreoretinal Surgery
Vitreoretinal surgery is comprised of a number of techniques, and any of them can cause inflammation for different reasons. This chapter will focus on the treatment of inflammation caused by scleral buckling, pars plana vitrectomy, and combined procedure
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Treatment of Inflammation Secondary to Vitreoretinal Surgery Carolina Arruabarrena Sánchez and Marta S. Figueroa
Contents 8.1 8.1.1 8.1.2 8.1.3
Introduction ................................................ Pars Plana Vitrectomy .................................. Scleral Buckling ........................................... Combined Procedure: Phacovitrectomy .......
8.2
Prevention of Postoperative Inflammation .............................................. Preoperative Use of Nonsteroidal Anti-inflammatory Drugs ............................. Heparin in Irrigation Solution ...................... 5-Fluorouracil in Irrigation Solution ............ Steroids in Irrigation Infusion ......................
8.2.1 8.2.2 8.2.3 8.2.4 8.3 8.3.1 8.3.2 8.3.3 8.3.4 8.3.5 8.3.6 8.3.7
Treatment of Postoperative Inflammation .............................................. Mechanism of Action of Anti-inflammatory Drugs ............................. Topical and Systemic Nonsteroidal Anti-inflammatory Drugs (NSAIDs)............ Topical Steroids ............................................ Periocular Steroids ....................................... Intravitreal Steroids ...................................... Steroid Sustained-Release Devices .............. Systemic Steroids .........................................
References ...............................................................
C.A. Sánchez, MD (*) Retina Section, Hospital Príncipe de Asturias, Alcalá de Henares, Carretera de Meco s/n, Alcalá de Henares, Madrid 28050, Spain e-mail: [email protected] M.S. Figueroa, MD, PhD Retina Section, Vissum Madrid, Santa Hortensia 58, Madrid 28002, Spain e-mail: [email protected]
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Introduction
Vitreoretinal surgery is comprised of a number of techniques, and any of them can cause inflammation for different reasons. This chapter will focus on the treatment of inflammation caused by scleral buckling, pars plana vitrectomy, and combined procedure phacovitrectomy. To aid comprehension, we will describe the inflammatory complications secondary to each procedure and then address methods of prevention and treatment.
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8.1.1
Pars Plana Vitrectomy
Sutureless microincisional surgery with 23- and 25-gauge instruments has significantly reduced postoperative inflammation. Nevertheless, it remains a significant complication in vitrectomy.
8.1.1.1 Ocular Surface Inflammation Traditional 20-gauge vitrectomy causes severe inflammation in the sclerotomies sites and conjunctiva. Microincisional surgery with 23- and 25-g. instruments can now minimize ocular surface trauma with the use of sutureless transconjunctival cannulas. However, when sclerotomies are sutured with transconjunctival sutures, local inflammation is more severe than if the sclera and conjunctiva are sutured separately (Fig. 8.1). One way of reducing this inflammation is to perform a temporary transconjunctival suture that can be removed the day after surgery under the slit lamp.
U. Pleyer e
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