Corneal Debridement In Vitreoretinal Surgery: A Double-Edged Sword

Corneal epithelial defects occurring after vitreoretinal surgery may arise spontaneously or be secondary to intraoperative debridement. In the present study, we focused specifically on iatrogenic epithelial lesions. Our objective was to evaluate the impact of corneal transparency on surgical performance, to analyze the clinical course of epithelial defects under treatment, and to identify the challenges encountered by the vitreoretinal surgeon during postoperative follow-up.

This study was conducted in a tertiary ophthalmology center specializing in vitreoretinal surgery and advanced ocular care. It included 84 patients who underwent pars plana vitreoretinal surgery for various posterior segment conditions. Intraoperative corneal epithelial debridement was performed when necessary to improve surgical visualization due to corneal surface irregularities or edema. All procedures followed standardized surgical protocols performed by experienced surgeons.

Following surgery, all patients received a standardized postoperative regimen that included topical healing eye drops aimed at promoting corneal epithelial regeneration and restoring ocular surface integrity. The treatment protocol was maintained according to institutional guidelines and adjusted when clinically indicated. Patients were prospectively followed for a period of six months after surgery, with scheduled postoperative visits to assess corneal epithelial healing, visual recovery, and the occurrence of any complications related to epithelial debridement or ocular surface impairment. Clinical outcomes were systematically recorded and analyzed.

Complete epithelial healing was achieved in a mean of four days. However, delayed epithelialization occurred in 12 patients, and 5 patients presented persistent epithelial defects at day 10, necessitating therapeutic escalation. These cases required additional consultations and intensified management, including autologous serum eye drops and amniotic membrane transplantation in refractory situations. Corneal surface disruption generated significant postoperative discomfort and complicated follow-up by limiting fundus visualization, thereby challenging posterior segment assessment and surgical evaluation.

Intraoperative corneal debridement may lead to chronic epithelial defects and, in some cases, corneal opacity. The cornea thus becomes a major concern for the vitreoretinal surgeon, as its integrity directly determines access to the fundus and the quality of postoperative assessment. These findings underscore the importance of effective prevention and early management in order to preserve corneal transparency.

In the postoperative setting, the cornea therefore represents both a functional issue for the patient and a technical challenge for the vitreoretinal surgeon.