Risk Factors for Iatrogenic Retinal Breaks in Eyes Requiring Surgical Induction of Posterior Vitreous Detachment

Purpose: To determine risk factors for retinal breaks (RB) during the surgical induction of posterior vitreous detachment (IPVD). Methods: We retrospectively reviewed electronic records for all adult patients undergoing 25-G or 27-G vitrectomy surgery between November 2019 and January 2024 requiring intraoperative IPVD. We excluded eyes with pre-existing PVD, panretinal photocoagulation, trauma, or missing information. The outcome measure was non-sclerotomy-related iatrogenic RB. We assessed the effect of age, gauge size (25-G vs 27-G), surgical indication (epiretinal membrane [ERM] vs macular hole[MH]/vitreomacular traction syndrome[VMTS] vs Other), lens status (Phakic vs Aphakic/Pseudophakic) and surgeon (Consultant vs Fellow) on the odds of RB. Results: Among 253 eyes included in our study, 17% experienced a RB during IPVD. Breaks were predominantly located in the inferior retina (58%). Multivariable analysis revealed gauge size significantly impacted RB rate (27G OR 0.14, 95%CI 0.05-0.40, p = 0.0003). Other factors including age (OR 0.98, 95%CI 0.96-1, p = 0.069), lens status (Phakic OR 0.47, 95%CI 0.21-1.1, p = 0.068), surgeon grade (Fellow OR 2.5 95%CI 0.52-12, p = 0.25) and surgical indication (MH OR 0.70 95%CI 0.30-1.6, p = 0.40) were not significantly associated with odds of RB. Conclusions: There is a high rate of iatrogenic RB in eyes requiring IPVD. Smaller instrument gauge size reduced the odds of RB. Neither age, surgical indication nor lens status were associated with odds of RB.