Multiple subretinal fluid blebs after pars plana vitrectomy for rhegmatogenous retinal detachment repair

  • Yuki Otsuka
  • Akio OishiEmail author
  • Kenji Suda
  • Akitaka Tsujikawa
  • Toshiaki Kurakazu
Retinal Disorders



To investigate the incidence of and clinical risk factors for multiple subretinal fluid (SRF) blebs after pars plana vitrectomy (PPV).


This study examined patients who underwent PPV (25- or 27-gauge) to repair a primary rhegmatogenous retinal detachment (RRD). Clinical characteristics, including age, sex, axial length, symptom duration, and postoperative best-corrected visual acuity (BCVA), were compared between eyes with and without multiple SRF blebs. Intentional drainage retinotomy and cryotherapy use were also performed. Main outcome measures were the effect of these parameters on multiple SRF bleb incidence 1 month after surgery.


A total of 108 eyes of 106 patients (76 men and 32 women; mean age = 58.9 ± 9.0 years) were included. Multiple SRF blebs were observed in 8 eyes (7.4%). Logistic regression analysis showed that creation of intentional drainage retinotomy and 27-gauge PPV are risk factors for the development of multiple SRF blebs. The number and size of blebs spontaneously decreased over time, and SRF had completely resolved in 5 eyes (62.5%) 1 year after surgery.


Multiple SRF blebs developed even after small gauge vitrectomy. The SRF did not affect postoperative BCVA and gradually absorbed without treatment.


Multiple subretinal fluid blebs Pars plana vitrectomy 27-gauge Rhegmatogenous retinal detachment 



This study was partly supported by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Tokyo, Japan.

Compliance with ethical standards

Conflict of interest

Akio Oishi received a grant from Novartis (Basel, Switzerland) and speaker’s honoraria from Alcon (Tokyo, Japan), Bayer (Leverkusen, Germany), and Santen (Osaka, Japan); Akitaka Tsujikawa received grants from Novartis, Santen, Bayer, HOYA (Tokyo, Japan), Kowa (Nagoya, Japan), Pfizer (New York, NY), AMO Japan (Tokyo, Japan), Senju (Osaka, Japan), Wakamoto (Tokyo, Japan), Alcon, Japan Medical Industry Association (Tokyo, Japan), Tomey (Nagoya, Japan), JFC Sales Plan (Tokyo, Japan), and Atsuzawa Prosthesis (Tokyo, Japan) and speaker’s honoraria from Alcon, Bayer, Santen, Novartis, Pfizer, Senju, Nidek (Gamagori, Japan), AMO Japan, Kowa, Chugai (Tokyo, Japan), Sanwa Kagaku (Nagoya, Japan), Kyoto Soyaku (Kyoto, Japan), HOYA, Otsuka (Tokyo, Japan), Daiichi Sankyo (Tokyo, Japan), and Wakamoto; Toshiaki Kurakazu received speaker’s honoraria from Santen, HOYA, Kowa, Pfizer, AMO Japan, Senju, Alcon, Japan Medical Industry Association, and Nidek. The following authors have no financial disclosures: Yuki Otsuka and Kenji Suda.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Institutional Review Board and Ethics Committee (IRB/EC) of Hidaka Medical Center (Toyooka Japan). Because of this study’s retrospective nature, the IRB/EC waived the requirement of informed consent.


  1. 1.
    Machemer R, Buettner H, Norton EW, Parel JM (1971) Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 75(4):813–820. Google Scholar
  2. 2.
    Fujii GY, De Juan E, Humayun MS, Pieramici DJ, Chang TS, Awh C, Sommerville DN (2002) A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology 109(10):1807–1812. CrossRefGoogle Scholar
  3. 3.
    Eckardt C (2005) Transconjunctival sutureless 23-gauge vitrectomy. Retina 25(2):208–211. CrossRefGoogle Scholar
  4. 4.
    Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y (2010) A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology 117(1):93–102.e2. CrossRefGoogle Scholar
  5. 5.
    Mitsui K, Kogo J, Takeda H, Shiono A, Sasaki H, Munemasa Y et al (2016) Comparative study of 27-gauge vs 25-gauge vitrectomy for epiretinal membrane. Eye (Lond) 30(4):538–544. CrossRefGoogle Scholar
  6. 6.
    Romano MR, Cennamo G, Ferrara M, Cennamo M, Cennamo G (2017) Twenty-seven-gauge versus 25-gauge vitrectomy for primary rhegmatogenous retinal detachment. Retina 37(4):637–642. CrossRefGoogle Scholar
  7. 7.
    Khan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU et al (2016) Outcomes of 27 gauge microincision vitrectomy surgery for posterior segment disease. Am J Ophthalmol 161:36–43.e2. CrossRefGoogle Scholar
  8. 8.
    Rizzo S, Barca F, Caporossi T, Mariotti C (2015) Twenty-seven-gauge vitrectomy for various vitreoretinal diseases. Retina 35(6):1273–1278. CrossRefGoogle Scholar
  9. 9.
    Wolfensberger TJ (2004) Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery. Ophthalmology 111(7):1340–1343. CrossRefGoogle Scholar
  10. 10.
    Yoneda K, Morikawa K, Oshima Y, Kinoshita S, Sotozono C (2017) Surgical outcomes of 27-gauge vitrectomy for a consecutive series of 163 eyes with various vitreous diseases. Retina 37(11):2130–2137. CrossRefGoogle Scholar
  11. 11.
    Naruse S, Shimada H, Mori R (2017) 27-gauge and 25-gauge vitrectomy day surgery for idiopathic epiretinal membrane. BMC Ophthalmol 17(1):188. CrossRefGoogle Scholar
  12. 12.
    Avins LR, Hilton GF (1980) Lesions simulating serous detachment of the pigment epithelium: occurrence after retinal detachment surgery. Arch Ophthalmol 98(8):1427–1429. CrossRefGoogle Scholar
  13. 13.
    Lobes LA, Grand MG (1980) Subretinal lesions following scleral buckling procedure. Arch Ophthalmol 98(4):680–683. CrossRefGoogle Scholar
  14. 14.
    Piguet B, Bovey E, Zografos L (1997) Subretinal lesions following a scleral buckling procedure. Ophthalmologica 211(2):112–114. CrossRefGoogle Scholar
  15. 15.
    Kaga T, Fonseca RA, Dantas MA, Yannuzzi LA, Spaide RF (2001) Optical coherence tomography of bleb-like subretinal lesions after retinal reattachment surgery. Am J Ophthalmol 132(1):120–121. CrossRefGoogle Scholar
  16. 16.
    Benson SE, Schlottmann PG, Bunce C, Xing W, Charteris DG (2007) Optical coherence tomography analysis of the macula after scleral buckle surgery for retinal detachment. Ophthalmology 114(1):108–112. CrossRefGoogle Scholar
  17. 17.
    Kang SW, Kim JH, Shin WJ, Kim JI (2008) Subretinal fluid bleb after successful scleral buckling and cryotherapy for retinal detachment. Am J Ophthalmol 146(2):205–210. CrossRefGoogle Scholar
  18. 18.
    Gharbiya M, Malagola R, Mariotti C, Parisi F, De Vico U, Ganino C, Grandinetti F (2015) Spectral-domain optical coherence tomography analysis of persistent subretinal fluid after scleral buckling surgery for macula-off retinal detachment. Eye 29(9):1186–1193. CrossRefGoogle Scholar
  19. 19.
    Kim Y-K, Ahn J, Woo SJ, Hwang DJ, Park KH (2014) Multiple subretinal fluid blebs after successful retinal detachment surgery: incidence, risk factors, and presumed pathophysiology. Am J Ophthalmol 157(4):834–841. CrossRefGoogle Scholar
  20. 20.
    Theodossiadis PG, Georgalas IG, Emfietzoglou J, Kyriaki TE, Pantelia E, Gogas PS et al (2003) Optical coherence tomography findings in the macula after treatment of rhegmatogenous retinal detachments with spared macula preoperatively. Retina 23(1):69–75. CrossRefGoogle Scholar
  21. 21.
    Heath H, Beck TC, Foulds WS (1962) Chemical composition of subretinal fluid. Br J Ophthalmol 46(7):385–396. CrossRefGoogle Scholar
  22. 22.
    Kashani AH, Cheung AY, Robinson J, Williams GA (2015) Longitudinal optical density analysis of subretinal fluid after surgical repair of rhegmatogenous retinal detachment. Retina 35(1):149–156. CrossRefGoogle Scholar
  23. 23.
    Veckeneer M, Derycke L, Lindstedt EW, van Meurs J, Cornelissen M, Bracke M, Van Aken E (2012) Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review. Graefes Arch Clin Exp Ophthalmol 250(6):795–802. CrossRefGoogle Scholar
  24. 24.
    Chen X, Zhang Y, Yan Y, Hong L, Zhu L, Deng J et al (2017) Complete subretinal fluid drainage is not necessary during vitrectomy surgery for macula-off rhegmatogenous retinal detachment with peripheral breaks. Retina 37(3):487–493. CrossRefGoogle Scholar
  25. 25.
    Seo JH, Woo SJ, Park KH, Yu YS, Chung H (2008) Influence of persistent submacular fluid on visual outcome after successful scleral buckle surgery for macula-off retinal detachment. Am J Ophthalmol 145(5):915–922. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology and Visual SciencesKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of OphthalmologyHidaka Medical CenterToyookaJapan

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