Air Jet-Related Retinal Injury During Contemporary 25-Gauge Vitrectomy: Multimodal Imaging of 3 Cases

PURPOSE: To describe the clinical and multimodal imaging characteristics of presumed air jet-related retinal injury occurring during contemporary 25-gauge pars plana vitrectomy and to discuss its likely mechanisms and preventive implications. METHODS: We retrospectively reviewed 3 eyes of 3 patients who developed retinal injury during 25-gauge pars plana vitrectomy for macula-sparing rhegmatogenous retinal detachment. Surgical videos and multimodal imaging findings were analyzed. RESULTS: In 2 eyes, localized retinal whitening developed intraoperatively; in the third eye, postoperative imaging showed localized retinal injury in a distribution corresponding to the presumed direction of the jet. The structural phenotype ranged from full-thickness macular tissue loss to inner retinal-predominant and outer retinal-predominant injury. Fundus autofluorescence delineated lesion extent more clearly than ultrawide-field color fundus photography. CONCLUSION: Presumed air jet-related retinal injury remains a possible complication even during modern 25-gauge vitrectomy. The lesions appear to represent predominantly mechanical retinal trauma involving both inner and outer retinal layers, with variable layer predominance. Attention to abrupt decompression, excessive aspiration under air, and infusion flow directed toward the macula may reduce risk.