Title : Management of common vitreoretinal lesions: an overview and update
Abstract:
Aim: To provide an educational update on the presentation and management of common vitreoretinal disease.
Methods: Lesions covered include peripheral retinal degeneration, posterior vitreous detachment (PVD), retinal breaks, retinal detachment, macular hole and epiretinal membrane.
Results: Peripheral retinal degenerations can be classified as lattice, or non-lattice. Non-lattice includes white-without-pressure, microcystoid, reticular and pavingstone degeneration. Mostly, these are not treated. Lattice degeneration is less often treated with retinopexy than previously, based on natural history studies that suggest many lesions do not progress to retinal detachment. Round holes are sometimes treated, and U-tears are usually treated. An algorithm is provided to help decide if retinopexy is needed. PVD management primarily involves ruling out retinal breaks, but detection techniques differ, including indented fundoscopy, contact lenses, and widefield imaging. The merits of each are considered. Shafer’s sign remains an important discriminator of retinal breaks. The management of retinal detachment has evolved relatively little in recent years, and the trend for far fewer cryobuckles is now firmly cemented in most clinical settings. Experimental techniques explore viscobuckle vitrectomy surgery without the need for gas tamponade. Macular hole classification has changed from stage I to IV to a system based on size and vitreomacular adhesion. Surgery is similar to previously, but the use of internal limiting membrane flaps has increased, and it is debated if posture is needed for small holes. Gasless surgery is being explored. Epiretinal membrane peel remains much the same as previously, but the availability of safer vital dyes has increased, with a distinction between epiretinal proliferation and epiretinal membrane.
Conclusions: Whilst the presentation of the most common vitreoretinal diseases remains much the same, management has evolved due to a series of incremental improvements in understanding, surgery and technology.
