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Rapizzi E, Barosco G, Zemella N, Samassa F, Rassu N, Frattolillo A, Buratto L. Routine use of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment. Eur J Ophthalmol 2024; 34:816-824. [PMID: 37849334 DOI: 10.1177/11206721231206842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) and complete drainage of subretinal fluid. METHODS For this retrospective study, we reviewed the medical charts of 273 patients (275 eyes) who consecutively underwent PPV, subretinal fluid drainage and filtered air tamponade to treat primary RRD between 2018 and 2022. As primary outcome we evaluated the anatomical success considered as retinal reattachment after single surgery. As secondary outcomes: final mean best corrected distance visual acuity (BCDVA), complications, and mean intraocular pressure (IOP) trends. RESULTS The anatomical success was reached by 262 (95.6%) of cases. Mean BCDVA improved from 0.73 LogMAR at baseline, to 0.21 LogMAR at the end of follow-up. As complications we recorded: 5 cases of clinically relevant macular pucker, 1 full thickness macular hole, and 1 PFO bubble under the retina. The mean IOP remained on normal values during the overall follow-up period.
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Affiliation(s)
- Emilio Rapizzi
- Eye Clinic, Ospedale dell'Angelo - ULSS 3 Serenissima, Venezia, Italy
| | - Guido Barosco
- Eye Clinic, Ospedale dell'Angelo - ULSS 3 Serenissima, Venezia, Italy
| | - Nicola Zemella
- Eye Clinic, Ospedale di Conegliano - ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Francesco Samassa
- Eye Clinic, Ospedale dell'Angelo - ULSS 3 Serenissima, Venezia, Italy
| | - Nicolò Rassu
- Eye Clinic, Ospedale dell'Angelo - ULSS 3 Serenissima, Venezia, Italy
| | | | - Lenni Buratto
- Eye Clinic, Ospedale dell'Angelo - ULSS 3 Serenissima, Venezia, Italy
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Moussa G, Jalil A, Lippera M, Cristescu IE, Ferrara M, Ally N, Ziaei H, El-Faouri M, Patton N, Jasani KM, Dhawahir-Scala F, Ivanova T. SF 6 COMPARED WITH C 2 F 6 FOR INFERIOR RHEGMATOGENOUS RETINAL REPAIR : The Manchester Pseudophakic Retinal Detachment Study. Retina 2024; 44:791-798. [PMID: 38236936 DOI: 10.1097/iae.0000000000004051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
Abstract
PURPOSE To compare SF 6 relative with C 2 F 6 in the anatomical and functional outcomes following pars plana vitrectomy for uncomplicated primary pseudophakic rhegmatogenous retinal detachment with inferior causative breaks. METHODS This is a retrospective, comparative study on eyes with pseudophakic rhegmatogenous retinal detachment with inferior causative breaks that had small-gauge pars plana vitrectomy repair using SF 6 and C 2 F 6 tamponade between 2011 and 2020 at a tertiary centre in the United Kingdom. Primary outcome was single surgery anatomical success, and the secondary outcome was best-corrected visual acuity. Propensity score matching, using preoperative findings as covariates to account for relevant confounders, was performed. RESULTS From 162 pseudophakic rhegmatogenous retinal detachment eyes with inferior causative breaks, the median (interquartile range) follow-up was 82 (52-182) days. The single surgery anatomical success was 156 (96.3%) overall: 47 of 47 (100.0%) and 109 of 115 (94.8%) in the SF 6 and C 2 F 6 groups, respectively ( P = 0.182). Relative to the SF 6 group, the C 2 F 6 group had a higher mean number of tears (SF 6 : 3.1[2.0], C 2 F 6 : 4.5[2.7], P = 0.002) and greater retinal detachment extent (SF 6 : 5.3[2.9], C 2 F 6 : 6.2[2.6] clock hours, P = 0.025). Following propensity score matching analysis, 80 eyes were matched with 40 in each group to homogenize preoperative factors. No significant difference was found in single surgery anatomical success and best-corrected visual acuity between the groups following propensity score matching. CONCLUSION Primary pars plana vitrectomy with gas tamponade leads to a high single surgery anatomical success rate in uncomplicated pseudophakic rhegmatogenous retinal detachment with inferior causative breaks with no additional benefit associated with long-acting tamponade when comparing C 2 F 6 with SF 6 .
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Affiliation(s)
- George Moussa
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Myrta Lippera
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | | | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester, United Kingdom
- School of Medicine, University of Málaga, Málaga, Spain; and
| | - Naseer Ally
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Hadi Ziaei
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Muhannd El-Faouri
- Manchester Royal Eye Hospital, Manchester, United Kingdom
- The Hashemite University, Zarqa, Jordan
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Kirti M Jasani
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | | | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester, United Kingdom
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Moussa G, Jalil A, Lippera M, Ivanova T, Cristescu I, Ally N, Jasani K, Patton N, Dhawahir-Scala F, Ferrara M. THE LONG-TERM RECOVERY OF VISION IN PSEUDOPHAKIC MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENTS. Retina 2024; 44:421-428. [PMID: 37973046 DOI: 10.1097/iae.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To assess the long-term visual recovery in uncomplicated macula-off pseudophakic rhegmatogenous retinal detachment treated with pars plana vitrectomy and gas tamponade in the absence of other visual comorbidities. METHODS Single-center retrospective longitudinal study on eyes with macula-off pseudophakic rhegmatogenous retinal detachment successfully treated with pars plana vitrectomy between 2011 and 2020 and with at least 2 follow-ups (FU), first gas-free FU (first-FU) and a final-FU, were included. Patients with subsequent ocular surgery or comorbidities affecting best-corrected visual acuity were excluded. The duration between operation date and final-FU was calculated (total days FU) and split into total days quintiles-1: ≤57, 2: >57 and ≤77, 3: >77 and ≤152, 4: >152 and ≤508, and 5: >508 days. Multivariable regression was performed with logMAR gain between the first and the final-FU as the dependent variable. RESULTS In 209 eyes, the authors report association with increase of logMAR gain between the first and the final-FU, with reducing clock hours of pseudophakic rhegmatogenous retinal detachment ( P = 0.041) and relative to the total days Quintile 1. Mean (SD) logMAR gain between the first and the final-FU was 0.02 (0.07) in the first quintile, increasing to 0.14 (0.13) ( P < 0.001) by the fifth quintile on multivariable regression. For patients not achieving 0.30 logMAR at the first-FU, this was attained at the final-FU with a sensitivity of 51.9% and specificity of 95.5% at a cut off ≤0.58 logMAR at the first-FU (area under the curve 0.756 [95% confidence interval 0.664-0.848], P < 0.001). CONCLUSION The authors report a significant time-dependent visual improvement after uncomplicated pars plana vitrectomy with gas tamponade for macula-off pseudophakic rhegmatogenous retinal detachment without visual confounders and provide important quantitative data for counselling patients with macula-off repair.
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Affiliation(s)
- George Moussa
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Assad Jalil
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Myrta Lippera
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Irina Cristescu
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Naseer Ally
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Kirti Jasani
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
| | | | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- School of Medicine, University of Málaga, Málaga, Spain
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Liang Q, Sun D, Xue S, Li X, Liu X, Du Q, Zhang Z, Ma X, Li J. A Comparison of Adjustable Positioning and Free Positioning After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: A Prospective Randomized Controlled Study. Clin Ophthalmol 2023; 17:3389-3396. [PMID: 37954908 PMCID: PMC10637227 DOI: 10.2147/opth.s436825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose To compare the effectiveness and safety of adjustable and free postoperative positioning after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Design Prospective, randomized controlled study. Methods A total of 94 eyes with RRD were enrolled from April 2020 to April 2023 and monitored postoperatively for at least 3 months. All patients underwent PPV combined with silicone oil injection or gas tamponade and were randomly divided postoperatively into two groups: an adjustable positioning group and a free positioning group. The success of the outcome was based on the retinal reattachment rate, best corrected visual acuity (BCVA), postoperative complications, and ocular biometric parameters such as anterior chamber depth (ACD) and lens thickness (LT). Results The initial retinal reattachment rate was 97.9% in the adjustable positioning group and 95.7% in the free positioning group, manifesting no statistical difference between the two groups. Similarly, no statistical difference was observed between the two groups in the final BCVA, which was significantly improved compared to the preoperative BCVA. The comparison of the 1-month postoperative ACD and LT with the preoperative values showed no statistically significant differences in the two groups. The rates of complications were not statistically different in the two groups. Conclusion After treating RRD using PPV, neither the adjustable nor the free postoperative positioning affected the retinal reattachment rate or the incidence of complications. Therefore, our study showed that it is safe and effective to adopt free positioning postoperatively, which may provide more options for patients with RRD undergoing PPV.
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Affiliation(s)
- Qianqian Liang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Difang Sun
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Shuyue Xue
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Xinying Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Xin Liu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Qing Du
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Zhichun Zhang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Xiubin Ma
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
| | - Jun Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, People’s Republic of China
- School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, People’s Republic of China
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Bonnar J, Tan CH, McCullough P, Wright DM, Williamson T, Lois N. Scleral Buckle, Vitrectomy, or Combined Surgery for Inferior Break Retinal Detachment: Systematic Review and Meta-Analysis. Ophthalmol Retina 2023; 7:837-847. [PMID: 37187441 DOI: 10.1016/j.oret.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
TOPIC To compare outcomes of scleral buckle (SB), pars plana vitrectomy (PPV), and combined PPV-SB to treat rhegmatogenous retinal detachments (RRDs) with inferior retinal breaks (IRBs). CLINICAL RELEVANCE Rhegmatogenous retinal detachments with IRBs are not uncommon; their management is challenging with higher risk of failure. There is no consensus about their treatment, specifically whether SB, PPV, or PPV-SB should be performed. METHODS Systematic review and meta-analysis. Randomized controlled trials, case-control, and prospective/retrospective series (if n > 50) in English were eligible. Medline, Embase, and Cochrane databases were searched up to January 23, 2023. Standard systematic review methods were followed. The following outcomes at 3 (± 1) and 12 (± 3) months were evaluated: number of eyes with retinal reattachment after ≥ 1 surgeries, change in best-corrected visual acuity from preoperative to postoperative levels, and number of eyes with improvement of > 10 and > 15 ETDRS letters after surgery. Authors of eligible studies were asked for individual participant data (IPD) and IPD meta-analysis was undertaken. Risk of bias was assessed using National Institutes of Health study quality assessment tools. This study was registered prospectively in PROSPERO (CRD42019145626). RESULTS A total of 542 studies were identified: 15 were eligible and included and 60% were retrospective. Individual participant data was obtained from 8 studies (1017 eyes). Given that only 26 patients had received SB alone, these data were not considered in the analysis. There was no evidence for differences between treatment groups (PPV versus PPV-SB) in the probability of having a flat retina at 3 or 12 months postoperatively after 1 (P = 0.067; odds ratio [OR], 0.47; P = 0.408; OR 2.55; respectively) or > 1 (OR, 0.54; P = 0.21; OR, 0.89; P = 0.926; respectively) surgery. Pars plana vitrectomy-SB showed less improvement in vision postoperatively at 3 months (estimate, 0.18; 95% confidence interval, 0.01-0.35; P = 0.044), but this difference was no longer observed at 12 months (estimate, -0.07; 95% confidence interval, -0.27, 0.13; P = 0.479). CONCLUSION Available evidence suggests a lack of benefit of adding SB to PPV to treat RRDs with IRBs. Evidence, however, comes mainly from retrospective series and, thus, despite the large number of eyes included, should be interpreted with caution. Further research is needed. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jonathan Bonnar
- Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Chin Han Tan
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Philip McCullough
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - David M Wright
- Center for Public Health, Queen's University Belfast, Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland.
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Moussa G, Jalil A, Ivanova T, Cristescu IE, Ferrara M, Lippera M, Jasani KM, Dhawahir-Scala F, Patton N. Expansile gas concentration in primary pseudophakic retinal detachment repair, effect on intraocular pressure and outcomes; the Manchester Pseudophakic Retinal Detachment Study. Graefes Arch Clin Exp Ophthalmol 2023; 261:2517-2524. [PMID: 37119305 DOI: 10.1007/s00417-023-06067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023] Open
Abstract
PURPOSE To investigate the effect of isovolumetric and expansile gas tamponade concentrations on single surgery anatomical success (SSAS) and day 1 intraocular pressure (IOPD1) following pars plana vitrectomy (PPV) for mild-moderate complexity primary pseudophakic rhegmatogenous retinal detachment (PRD). METHODS We conducted a single-centre retrospective continuous and comparative study on eyes that had undergone small-gauge PPV using isovolumetric versus expansile gas for PRD repair between 2011 and 2020 at a single tertiary vitreoretinal centre in UK. We performed propensity score matching (PSM) using preoperative findings as covariates to account for relevant confounders. Significant risk factors such as proliferative vitreoretinopathy C or giant retinal tears were excluded. RESULTS From 456 eyes, PSM analysis matched 240 eyes with 120 in each group. The median (interquartile range) follow-up was 96 (59 to 218) days. The SSAS was 229/240 (95.8%) overall; 115/120 (95.8%) and 114/120 (95.0%) in isovolumetric and expansile groups, respectively (p = 1.000). Relative to the isovolumetric group, the expansile group had lower proportion of eyes with IOP ≤ 21 mmHg (odds ratio, 95% confidence interval, 0.40 [0.23-0.68], p < 0.001); but significantly higher number of eyes with IOP ≥ 22 mmHg (2.53 [1.48-4.34], p < 0.001), ≥ 25 mmHg (2.77 [1.43-5.33], p < 0.001), ≥ 30 mmHg (2.90 [1.28-6.58], p = 0.006) and ≥ 40 mmHg (p = 0.029, isovolumetric: 0 [0%] vs expansile group: 6 [5%]). There was only one case of hypotony (≤ 5 mmHg) 1/240 (0.4%) which occurred in the expansile group. CONCLUSIONS Expansile gas concentration does not impact SSAS but is associated with significantly raised IOPD1 with no reduction in hypotony rates following PPV for primary PRD.
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Affiliation(s)
- George Moussa
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Assad Jalil
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | | | - Myrta Lippera
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Kirti M Jasani
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK.
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Yorston D, Donachie PHJ, Laidlaw DA, Steel DH, Aylward GW, Williamson TH. Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study. Eye (Lond) 2023; 37:1527-1537. [PMID: 37100934 PMCID: PMC10219959 DOI: 10.1038/s41433-023-02388-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD). METHODS A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery. RESULTS There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. C2F6 tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10-25%), and 10.1% are at high risk (>25%) of failure. CONCLUSIONS Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.
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Affiliation(s)
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK
| | - D A Laidlaw
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - G W Aylward
- Moorfields Eye Hospital City Road, EC1V 2PD, London, UK
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Moussa G, Ch'ng SW, Ziaei H, Jalil A, Park DY, Patton N, Ivanova T, Lett KS, Andreatta W. The use of fluorinated gases and quantification of carbon emission for common vitreoretinal procedures. Eye (Lond) 2023; 37:1405-1409. [PMID: 35764874 PMCID: PMC10169801 DOI: 10.1038/s41433-022-02145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/16/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the contribution to carbon dioxide equivalent mass [CO2EM] of various types of VR surgery performed across three tertiary referral centres, according to their indication and fluorinated gas used. We secondarily reported on the difference in tamponade choice, and CO2EM between the different centres. MATERIALS Retrospective, continuous, comparative multicentre study of all procedures using fluorinated gases between 01/01/17-31/12/20 at the Manchester Royal Eye Hospital and Birmingham and Midland Eye Centre, and between 01/01/19-31/12/2020 at the University Hospitals Coventry and Warwickshire. RESULTS Across 4877 procedures, the use of fluorinated gases produced 284.2 tonnes (71.2 tonnes annually) CO2EM; an annual consumption of 30,330 l of gasoline. Rhegmatogenous-retinal-detachment (RRD) and macular hole repair had the highest CO2EM by indication, accounting for 191.4 tonnes CO2EM (67.3%) and 28.6 tonnes CO2EM (10.1%); a mean 60.0 kg and 32.0 kg of CO2EM produced per surgery respectively. The use of fluorinated gases and their respective CO2EM contributions were significantly different across all three centres (p < 0.001) for all indications. SF6, despite being used in 1883 procedures (38.6%), contributed to 195.5 tonnes CO2EM (68.8%). Relative to C2F6, procedures using C3F8 and SF6 produced 1.9 and 4.4 times more CO2EM. CONCLUSION We demonstrated that SF6 causes significantly higher carbon emissions relative to C2F6 and C3F8 with RRD and macular hole repair having the greatest environmental impact. We also reported large variations between different large VR centres in fluorinated gas use, and therefore in carbon emission contributions depending on indications for surgery. Evidence-based protocols might help in making VR surgery "greener".
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Affiliation(s)
- George Moussa
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
- Birmingham and Midland Eye Centre and Academic Unit of Ophthalmology, University of Birmingham, Birmingham, UK.
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - Soon Wai Ch'ng
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Hadi Ziaei
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Assad Jalil
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Dong Young Park
- University Hospital Coventry and Warwickshire, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Niall Patton
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Tsveta Ivanova
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kim Son Lett
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Walter Andreatta
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
- University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
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Zhu A, Wu J, Yuan Y, Zeng L, Wang X, Tan W. The Efficacy and Safety of Air Tamponade in the Repair of Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis. Ophthalmic Res 2023; 66:892-902. [PMID: 37088076 DOI: 10.1159/000530690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy (PPV) combined air tamponade has many advantages compared with PPV combined gas tamponade. However, there are controversial outcomes in RRD cases involving the lower quadrants. OBJECTIVE This study aimed to evaluate the efficacy and safety of PPV combined air tamponade in patients with RRD compared with PPV combined gas tamponade and whether it could be a safe alternative to PPV combined gas tamponade. METHODS The PubMed, Embase, and Cochrane Library databases published until September 2022 were comprehensively searched for studies that compared PPV combined with air tamponade and gas tamponade in patients with RRD. The rate of primary treatment success, best-corrected visual acuity (BCVA), and postoperative complications were extracted from the final eligible studies. Study quality was assessed using the Jadad scale and Newcastle-Ottawa scale (NOS). The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals. The systematic review and meta-analysis were prospectively registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/; registration number CRD42022353479). RESULTS A total of 8 studies with 668 eyes in the air tamponade group and 944 in the gas tamponade group were included. There was no significant difference in the rate of primary treatment success between the air tamponade group and the gas tamponade group (RR = 1.00, p = 0.79). In addition, the subgroup analysis suggested that whether retinal breaks were located above or below, there was no significant difference in either rate of primary treatment success (RR = 0.99, p = 0.89; RR = 1.02, p = 0.45). There was no significant difference in mean BCVA 3 months after surgery (MD = -0.02, p = 0.50). For postoperative complications, mean postoperative intraocular pressure was lower in the air tamponade group at 1 day (MD = -4.24, p < 0.001), and there was no significant difference between the two groups at 7 days (MD = -0.45, p = 0.71), 1 month (MD = -0.69, p = 0.33), and 3 months (MD = 0.69, p = 0.35) after surgery. The rate of epiretinal membrane development was lower in the air tamponade group (RR = 0.48, p = 0.04). CONCLUSIONS For patients with uncomplicated RRD, PPV combined air tamponade is a feasible and safe alternative to PPV combined gas tamponade, regardless of the position of retinal breaks, with a similar primary treatment success rate, postoperative BCVA, and fewer postoperative complications.
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Affiliation(s)
- Anmin Zhu
- The Department of Ophthalmology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China,
| | - Jiangni Wu
- The Department of Geriatrics, The People's Hospital of Muchuan, Leshan, China
| | - Yuan Yuan
- The Department of Ophthalmology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lan Zeng
- The Department of Ophthalmology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaocong Wang
- The Department of Ophthalmology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Tan
- The Department of Ophthalmology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
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10
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Zhou Y, Lu Q, Chen Z, Lu P. A Prediction Nomogram for Recurrent Retinal Detachment. Risk Manag Healthc Policy 2023; 16:479-488. [PMID: 37013114 PMCID: PMC10066632 DOI: 10.2147/rmhp.s403136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose Recurrent retinal detachment (re-RD) is one of the complications in rhegmatogenous retinal detachment patients who underwent surgical treatment. We investigated the risk factors for re-RD and developed a nomogram for estimating clinical risk. Methods Univariate and multivariable logistic regression models were performed to determine the association between variables and re-RD, and a nomogram was then developed for re-RD. The nomogram performance was assessed based on its discrimination, calibration, and clinical usefulness. Results This study analyzed 15 potential variables of re-RD in 403 rhegmatogenous retinal detachment patients who underwent initial surgical treatment. Axial length, inferior breaks, retinal break diameter, and surgical methods were independent risk factors for re-RD. A clinical nomogram incorporating these four independent risk factors was constructed. The diagnostic performance of the nomogram was excellent (area under the curve = 0.892, 95% CI: 0.831-0.953). Our study further validated this nomogram by bootstrapping for 500 repetitions. The area under the curve of the bootstrap model was 0.797 (95% CI: 0.712-0.881). This model showed good calibration curve fitting and a positive net benefit in decision curve analysis. Conclusion Axial length, inferior breaks, retinal break diameter, and surgical methods could be risk factors for re-RD. We have developed a prediction nomogram of re-RD for rhegmatogenous retinal detachment following initial surgical treatment.
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Affiliation(s)
- Yongying Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Department of Ophthalmology, Children’s Hospital of Wujiang District, Suzhou, People’s Republic of China
| | - Qianyi Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zhigang Chen
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Peirong Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Correspondence: Peirong Lu, Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, Jiangsu Province, 215006, People’s Republic of China, Email
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11
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Ong SS, Ahmed I, Gonzales A, Aguwa UT, Beatson B, Dai X, Pham AT, Shah YS, Zhou A, Arsiwala LT, Wang J, Handa JT. Management of uncomplicated rhegmatogenous retinal detachments: a comparison of practice patterns and clinical outcomes in a real-world setting. Eye (Lond) 2023; 37:684-691. [PMID: 35338355 PMCID: PMC9998441 DOI: 10.1038/s41433-022-02028-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To investigate practice patterns and clinical outcomes in the repair of uncomplicated rhegmatogenous retinal detachments (RRD) in a real-world setting over a 10-year period. METHODS We compared preferences for scleral buckling (SB), pars plana vitrectomy (PPV), PPV/SB, or pneumatic retinopexy (PR) over time, and examined the 1-year single surgery anatomic success (SSAS) and best-corrected visual acuity (BCVA) at a tertiary academic institution from 2008-2018. RESULTS Eight hundred eight eyes had RRD repair between 2008-2011 (n = 240), 2012-2014 (n = 271), and 2015-2017 (n = 297). Compared to 2008-2011, PPV was preferred over SB in 2012-2014 (OR: 2.93; 95% CI: 1.86-4.63) and 2015-2017 (OR: 5.94; 95% CI: 3.76-9.38), and over PPV/SB in 2012-2014 (OR: 2.74; 95% CI: 1.65-4.56) and 2015-2017 (OR: 3.16; 95% CI: 31.96-5.12). PR was uncommonly utilized (<10%). Younger surgeons (graduating 2010-2017) favored PPV over SB when compared to older surgeons [graduating 1984-2000 (OR: 1.77; 95% CI: 1.18-2.65) and 2001-2009 (OR 1.73; 95% CI: 1.14-2.65)], but similarly selected PPV vs. PPV/SB as their older counterparts (p > 0.05). Compared to PPV, SSAS was higher with SB (OR: 1.53; 95% CI: 1.03-2.26) and PPV/SB (OR: 2.55; 95% CI: 1.56-4.17). One-year BCVA was markedly improved compared to baseline only for eyes that achieved SSAS (p < 0.001). CONCLUSIONS Over the past 10 years, PPV has become the favored approach to repair uncomplicated RRD and this appears to be driven by younger surgeons' preferences. Given the superior long-term SSAS in SB and PPV/SB as compared to PPV, SB and PPV/SB should be more frequently considered when determining the appropriate repair strategy for uncomplicated RRD.
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Affiliation(s)
- Sally S Ong
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ishrat Ahmed
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony Gonzales
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ugochi T Aguwa
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bradley Beatson
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Xi Dai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alex T Pham
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yesha S Shah
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley Zhou
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lubaina T Arsiwala
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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12
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Zhou C, Gu C, Li B, Wang Y, Hu Y, She X, Shi Y, Ma M, Sun T, Qiu Q, Fan Y, Chen F, Wang H, Liu K, Sun X, Xu X, Zheng Z. The cause of redetachment after vitrectomy with air tamponade for a cohort of 1715 patients with retinal detachment: an analysis of retinal breaks reopening. EYE AND VISION (LONDON, ENGLAND) 2023; 10:9. [PMID: 36732872 PMCID: PMC9896834 DOI: 10.1186/s40662-022-00325-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To investigate the prevalence and predictors of retinal breaks reopening after vitrectomy with air tamponade in rhegmatogenous retinal detachment (RRD). METHODS A retrospective cohort study was conducted in Shanghai General Hospital. Chart review was performed among 1715 patients with primary RRD who received pars plana vitrectomy (PPV) with air tamponade as initial management. Patients were followed up for recurrence. The clinical features of the eyes with retinal breaks reopening were recorded. Logistic regression was constructed to investigate the predictors for breaks reopening. RESULTS A total of 137 (7.99%) patients had recurrent retinal detachment after PPV with air tamponade. The causes of surgery failure included new or missed retinal breaks (48.9%), reopening of original tears (43.8%) and proliferative vitreoretinopathy (7.3%). The median time to recurrence for the patients with breaks reopening was 18.0 days. Multivariate logistic regression indicated that the presence of retinal break(s) ≥ 1.5 disc diameters (DD) (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 11.04-6.92, P = 0.041), and shorter period for restricted activities (OR: 0.94, 95% CI: 0.89-0.99, P = 0.020) were the independent predictors for breaks reopening. CONCLUSIONS Breaks reopening is an important cause for retinal redetachment after PPV with air tamponade in primary RRD. The first 2-4 weeks after surgery is the "risk period" for breaks reopening. Special attention should be paid for patients with retinal break(s) ≥ 1.5 DD. A prolonged period for restricted activities is recommended.
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Affiliation(s)
- Chuandi Zhou
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Chufeng Gu
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Bo Li
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Yujie Wang
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Yanan Hu
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Xinping She
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Ya Shi
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Mingming Ma
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Tao Sun
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Qinghua Qiu
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Ying Fan
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Fenge Chen
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Hong Wang
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Kun Liu
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Xiaodong Sun
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Xun Xu
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
| | - Zhi Zheng
- grid.412478.c0000 0004 1760 4628Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Ocular Fundus Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China ,Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Haining Road, Hongkou District, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China
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13
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Shen P, Kong X, Chen G, Jiang J, Yan S, Lu X, He M. 25-Gauge pars plana vitrectomy combined with air tamponade for primary rhegmatogenous retinal detachment. J Int Med Res 2022; 50:3000605221139702. [PMID: 36495193 DOI: 10.1177/03000605221139702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study was performed to evaluate the outcomes of 25-gauge (25-G) pars plana vitrectomy (PPV) with air tamponade for primary rhegmatogenous retinal detachment (RRD). METHODS This retrospective consecutive case series included 126 eyes of 125 patients with primary RRD who underwent 25-G PPV with air tamponade. The patients were followed up for at least 6 months following surgery. The main outcome measures were the primary and final anatomical success rates and postoperative complications. RESULTS The mean age of the 125 patients (80 men and 45 women) was 53.7 ± 10.0 years. The mean follow-up period was 8.3 ± 2.2 months (range, 6-18 months). Twenty-four eyes (19.0%) presented with high myopia, and 13 eyes (10.3%) were pseudophakic. Of the 126 eyes, 37 (29.4%) had inferior breaks, 2 (1.6%) had choroidal detachment, and 86 (68.3%) had macular detachment. The single- and final-operation success rates were 96.0% and 100%, respectively. Postoperative complications included macular hole formation in two eyes. During follow-up, secondary cataract surgery was performed in 27 (23.9%) of the 113 phakic eyes. CONCLUSION 25-G PPV with air tamponade is effective and safe in treating selected patients with primary RRD with a high anatomical success rate.
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Affiliation(s)
- Peiyang Shen
- Department of Ophthalmology, The Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China.,Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangbin Kong
- Department of Ophthalmology, The Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Guo Chen
- Department of Ophthalmology, The Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Jianhua Jiang
- Department of Ophthalmology, The Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Shigang Yan
- Department of Ophthalmology, The Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Xiaohe Lu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingguang He
- Centre for Eye Research Australia, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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14
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Amara A, Bernabei F, Chawki MB, Buffet J, Adam R, Akesbi J, Sellam A, Azan F, Lehmann M, Guerrier G, Rodallec T, Nordmann JP, Rothschild PR. Comparison between air and gas as tamponade in 25-gauge pars plana vitrectomy for primary superior rhegmatogenous retinal detachment. Eye (Lond) 2022; 36:2028-2033. [PMID: 34413491 PMCID: PMC9499964 DOI: 10.1038/s41433-021-01739-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to compare surgical outcomes and postoperative characteristics, between eyes that underwent pars plana vitrectomy (PPV) for RRD, with air or different gas agents as tamponade. SUBJECTS/METHODS The records of 262 patients that underwent PPV for RRD with air or different gas tamponades and a follow-up of at least 6 months were examined. Only cases with superior retinal breaks were included. Demographic, pre-, intra- and postoperative characteristics including rate of recurrence and complications were analysed. RESULTS 48 patients were treated with air and 214 were treated with gas. No differences were found in success rate between air and gas group at both 3 and 6 months (respectively, 93.8% vs 93.6 and 100% vs 100%, all P values > 0.05). Postoperative best-corrected visual acuity (BCVA) was significantly higher in the air group compared with the gas group 7 days and 1 month postoperatively (respectively, 0.2 ± 0.4 vs 2.6 ± 0.5, P < 0.001 and 0.1 ± 0.4 vs 0.4±0.9, P = 0.04). The occurrence ocular hypertension at 1 month postoperatively was significantly higher in the gas group compared with the air group (15.4 % vs 0%, P < 0.001). At 6 months, the prevalence of epiretinal membrane (ERM) was significantly higher in the gas group compared with air group (4.2% vs 16.8%, P = 0.02). CONCLUSIONS Air was comparable to gas tamponades in terms of surgical outcome and BCVA at 6 months. In addition, air allowed an earlier visual recovery and resulted in a lower rate of postoperative ocular hypertension and ERM.
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Affiliation(s)
- Amélie Amara
- Centre Hospitalier National d'Ophtalmologie des XV-XX, service du Pr. J-P Nordmann, 28 rue de Charenton, 75012, Paris, France
| | - Federico Bernabei
- Service d'Ophtalmologie, Ophtalmopôle de Paris, Hôpital Cochin, AP-HP, F-75014, Paris, France
| | | | - Jenna Buffet
- Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 rue de Charenton, 75012, Paris, France
| | - Raphaël Adam
- Centre Hospitalier National d'Ophtalmologie des XV-XX, service du Pr. J-P Nordmann, 28 rue de Charenton, 75012, Paris, France
| | - Jad Akesbi
- Centre Hospitalier National d'Ophtalmologie des XV-XX, service du Pr. J-P Nordmann, 28 rue de Charenton, 75012, Paris, France
| | - Alexandre Sellam
- Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 rue de Charenton, 75012, Paris, France
| | - Frédéric Azan
- Centre Hospitalier National d'Ophtalmologie des XV-XX, service du Pr. J-P Nordmann, 28 rue de Charenton, 75012, Paris, France
| | - Mathieu Lehmann
- Service d'Ophtalmologie, Ophtalmopôle de Paris, Hôpital Cochin, AP-HP, F-75014, Paris, France
| | - Gilles Guerrier
- Anaesthetic and Intensive Care Department, Hôpital Cochin, Paris Descartes University, 75014, Paris, France
| | - Thibaut Rodallec
- Centre Hospitalier National d'Ophtalmologie des XV-XX, service du Pr. J-P Nordmann, 28 rue de Charenton, 75012, Paris, France
| | - Jean-Philippe Nordmann
- Centre Hospitalier National d'Ophtalmologie des XV-XX, service du Pr. J-P Nordmann, 28 rue de Charenton, 75012, Paris, France
| | - Pierre-Raphaël Rothschild
- Service d'Ophtalmologie, Ophtalmopôle de Paris, Hôpital Cochin, AP-HP, F-75014, Paris, France.
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, UMR_1138, F-75006, Paris, France.
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Xu C, Wu J, Li Y, Zhang R, Feng C. Clinical characteristics of primary pars plana vitrectomy combined with air filling for rhegmatogenous retinal detachment. Sci Rep 2022; 12:7916. [PMID: 35551229 PMCID: PMC9098505 DOI: 10.1038/s41598-022-12154-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/28/2022] [Indexed: 11/26/2022] Open
Abstract
To detect the prognostic factors associated with initial reattachment after primary pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD). We retrospectively reviewed 92 eyes of 92 patients with RRD. All eyes underwent PPV with air tamponade and a follow-up of at least 6 months. Initial anatomical success was defined as reattachment of the retina by a single operation. We performed univariate analysis to detect the presence of any difference between eyes with a successful initial reattachment and those that failed. We also performed multivariate logistic regression analysis to assess the influence of each preoperative factor on initial success. The rate of initial reattachment success was 93.5%. The percentage of retinal detachment involving the inferior quadrants in the initial success group was less than that in the initial failure group, and the difference was statistically significant (P = 0.043). There were no significant differences noted for other factors, such as symptom duration (P = 0.078) or location of retinal breaks (P = 0.065). Multiple logistic regression analysis using preoperative factors indicated that older age (odds ratio, 0.90; 95% confidence interval, 0.82–0.97; P = 0.010) and non-involvement of inferior quadrants (odds ratio, 9.90; 95% confidence interval, 1.36–71.92; P = 0.023) were significantly associated with initial success. PPV combined with air may be an effective treatment for some simple RRDs (proliferative vitreoretinopathy [PVR] grade ≤ C1). Non-involvement of the inferior quadrants and older age at presentation are associated with a greater likelihood of anatomic success. The volume of air in the eye after surgery is also very important, which may also affect the reduction of retinal detachment.
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Affiliation(s)
- Changzhong Xu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jianhua Wu
- Aier Eye Hospital of Wuhan University, No.481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Yanzi Li
- Aier Eye Hospital of Wuhan University, No.481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Rui Zhang
- Aier Eye Hospital of Wuhan University, No.481 Zhongshan Road, Wuchang District, Wuhan, China
| | - Chao Feng
- Aier Eye Hospital of Wuhan University, No.481 Zhongshan Road, Wuchang District, Wuhan, China.
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16
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Tang Y, Lin B, Chen J, Chen D, Wu R. Outcomes of 25-gauge pars plana vitrectomy alone with air tamponade for the management of rhegmatogenous retinal detachment with inferior breaks. BMC Ophthalmol 2022; 22:213. [PMID: 35549685 PMCID: PMC9097233 DOI: 10.1186/s12886-022-02445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study was investigated the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRBs) that were repaired by 25-gauge pars plana vitrectomy (PPV) with air tamponade. Methods This retrospective review included 81 consecutive patients who had RRD with IRBs and underwent PPV with air tamponade in our hospital from January 2017 to January 2020. The main outcomes were single surgery anatomical success (SSAS) rate, postoperative best-corrected visual acuity (BCVA), and complications. Results The patient population consisted of 29 women and 52 men (mean age, 52.12 years); the mean follow-up interval was 8.88 months. The mean number of affected quadrants was 1.65 (range, 1–4 quadrants) and the mean number of breaks was 3.25. A single break was present in 20 cases (24.7%); two to 10 breaks were present in 61 (75.3%) cases. The SSAS rate was 91.36% (74/81) and the final anatomical success rate was 96.30% (78/81). More than half of the patients had BCVA < 0.3 logarithm of the minimum angle of resolution at the last follow-up. Axial length and patient age were candidate risk factors for redetachment (axial length, p = 0.03; age, p = 0.002). Postoperative complications included macular epiretinal membrane formation in one patient, lens opacity in three patients, and clinically significant macular edema in one patient. Conclusions PPV with air tamponade may be effective for the treatment of primary RRD with IRBs. Extensive preoperative discussion may be necessary for young patients and patients with particularly long axial length.
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Affiliation(s)
- Yongping Tang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Bo Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jing Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Daosen Chen
- Yuying Children's Hospital, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ronghan Wu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
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17
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Shen P, Kong X, Zhou L, Su P, Lu X, He M. Air Tamponade for Rhegmatogenous Retinal Detachment With Inferior Breaks After 25-Gauge Pars Plana Vitrectomy: Technique and Outcome. Front Med (Lausanne) 2022; 9:724234. [PMID: 35463018 PMCID: PMC9021743 DOI: 10.3389/fmed.2022.724234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/18/2022] [Indexed: 01/18/2023] Open
Abstract
To evaluate the outcomes of 25-guage (G) pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD) with inferior breaks. This retrospective consecutive case series included fifty-two eyes of fifty-two RRD patients with inferior breaks who underwent 25-G PPV with air tamponade. These patients were followed up for at least 6 months following surgery. Primary and final anatomical success rates and postoperative complications were the main outcome measures. The mean age of the patients (39 men and 13 women) was 51.8 ± 11.8 years. There were 49 primary RRDs (94.2%) and three recurrent RRDs (5.8%). The mean follow-up period was 8.2 ± 1.6 months (range: 6–13 months). Sixteen eyes (30.8%) presented with high myopia, and six eyes (11.5%) were pseudophakic. Proliferative vitreous retinopathy grade was C1 in four eyes (7.7%). Of the 52 eyes, two (3.8%) were complicated with choroidal detachment, and forty (76.9%) had the macula detached. The single- and final-operation success rates were 96.2% and 100%, respectively. During follow-up, secondary cataract surgery was performed in eight eyes (17.4%) of the 46 phakic eyes. 25-G PPV with air tamponade is effective in treating selected RRD patients with inferior breaks. Patients can benefit from early visual recovery and less complications.
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Affiliation(s)
- Peiyang Shen
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Ophthalmology, The Second People's Hospital of Foshan, Affiliated Foshan Hospital of Southern Medical University, Foshan, China
| | - Xiangbin Kong
- Department of Ophthalmology, The Second People's Hospital of Foshan, Affiliated Foshan Hospital of Southern Medical University, Foshan, China
| | - Lijun Zhou
- Department of Ophthalmology, The Second People's Hospital of Foshan, Affiliated Foshan Hospital of Southern Medical University, Foshan, China
| | - Peng Su
- Department of Ophthalmology, The Second People's Hospital of Foshan, Affiliated Foshan Hospital of Southern Medical University, Foshan, China
| | - Xiaohe Lu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingguang He
- Department of Surgery, Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, VIC, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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18
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Gao Y, Ruan T, Chen N, Yu B, Xing X, Du Q, Qi Y, Li J. A Comparison of Face-Down Positioning and Adjustable Positioning After Pars Plana Vitrectomy for Macular Hole Retinal Detachment in High Myopia. Front Med (Lausanne) 2022; 9:780475. [PMID: 35252235 PMCID: PMC8889034 DOI: 10.3389/fmed.2022.780475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the anatomical and functional outcomes of macular hole retinal detachment (MHRD) in high myopia after pars plana vitrectomy (PPV) with face-down positioning and adjustable positioning. Methods Fifty-three eyes from 53 patients with MHRD were analyzed in this study. All patients received PPV with silicon oil for tamponade and then subdivided into 2 groups: 28 were included in a face-down positioning group and 25 were included in the adjustable positioning group. Patients were followed up for at least 6 months. The main outcome was the rate of anatomical macular hole (MH) closure and retinal reattachment. Secondary outcome measures were the best-corrected visual acuity and postoperative complications. Results There was no significant difference in the rate of MH closure (53.6 vs. 72.0%, p = 0.167) and retinal reattachment (100 vs. 96%, p = 0.472) between the face-down group and adjustable group. Compared with the mean preoperative best-corrected visual acuity (BCVA), the mean postoperative BCVA at the 6-month follow-up improved significantly in both groups (p = 0, both). But there was no significant difference in the mean postoperative BCVA (p = 0.102) and mean BCVA improvement (p = 0.554) at 6 months after surgery between the two groups. There was no significant difference in the high intraocular pressure (IOP) after surgery between the two groups (53.6 vs. 44%, p = 0.487). There were no other complications that occurred during the follow-up. Conclusion Adjustable positioning after PPV with silicon oil tamponade for MHRD repair is effective and safe. Face-down positioning does not seem to be necessary for all patients with MHRD.
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Affiliation(s)
- Yan Gao
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Ting Ruan
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Nan Chen
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Bin Yu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaoli Xing
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Qing Du
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yan Qi
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Jun Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
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19
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Air versus sulfur hexafluoride gas tamponade in vitrectomy for uncomplicated retinal detachment with inferior breaks. Retina 2022; 42:1262-1267. [DOI: 10.1097/iae.0000000000003470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Moussa G, Andreatta W, Ch’ng SW, Ziaei H, Jalil A, Patton N, Ivanova T, Lett KS, Park DY. Environmental effect of air versus gas tamponade in the management of rhegmatogenous retinal detachment VR surgery: A multicentre study of 3,239 patients. PLoS One 2022; 17:e0263009. [PMID: 35081126 PMCID: PMC8791455 DOI: 10.1371/journal.pone.0263009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To report the potential reduction of carbon emissions by utilising air-tamponade (AT), where possible, instead of fluorinated gases in the management of rhegmatogenous retinal detachment (RRD). We compared the carbon CO2 emissions produced at two large tertiary referral vitreoretinal (VR) centres where RRD are exclusively repaired using fluorinated gases to a tertiary VR mass of each gas used according to the Intergovernmental Panel on Climate Change. Materials and methods Retrospective, continuous, comparative multicentre study of all procedures using fluorinated gases between 01/01/17-31/12/20 at the Manchester Royal Eye Hospital (MREH) and Birmingham and Midland Eye Centre (BMEC), and between 01/01/19-31/12/2020 at the University Hospitals Coventry and Warwickshire (UHCW). Results We report on 3,239 (SF6:1,415 [43.7%], C2F6:1,235 [38.1%], C3F8:541 [16.7%], Air:48 [1.5%]) procedures. UHCW and BMEC utilise single use 30ml and 75ml cannisters, respectively and MREH use multi-use gas cylinders. UHCW used AT in 48 (70%) of RRD repairs. Mean equivalent mass CO2/patient was MREH:115.9kg, BMEC:7.9kg and UHCW:1.9kg. If assuming all centres used 30ml cannisters, the mean equivalent mass CO2/patient was MREH:3.5 kg, BMEC:3.1kg and UHCW:1.9kg. AT enabled UHCW to greatly reduce the need for the most environmentally damaging SF6 gas, leading to lower CO2 emissions by 47.0% and 41.1% compared to MREH and BMEC, respectively. Conclusion We demonstrate how AT vs. the fluorinated gases can reduce in carbon footprint in the management of RRD. Further studies are required to determine the most ‘environment-friendly’ intraocular tamponade without compromising patient outcomes centre that also routinely employs AT in selected RRD cases.
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Affiliation(s)
- George Moussa
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- Birmingham and Midland Eye Centre and Academic Unit of Ophthalmology, University of Birmingham, Birmingham, United Kingdom
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
| | - Walter Andreatta
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- Kantonsspital Winterthur, Winterthur, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Soon Wai Ch’ng
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Hadi Ziaei
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Assad Jalil
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Niall Patton
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Tsveta Ivanova
- Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Son Lett
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Dong Young Park
- University Hospital Coventry and Warwickshire, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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21
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Moussa G, Mathews N, Makhzoum O, Park DY. Retinal Detachment Repair With Vitrectomy: Air Tamponade Integration to a Vitreoretinal Service, Comparison With Gas Tamponade, and Literature Review. Ophthalmic Surg Lasers Imaging Retina 2022; 53:87-95. [PMID: 35148215 DOI: 10.3928/23258160-20220121-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy and gas tamponade (GT) has significant clinical and quality-of-life impacts compared with repair by short-acting air tamponade (AT). With AT, most authors minimize cryotherapy because of prolonged chorioretinal scar formation and use perfluorocarbon to maximize subretinal fluid drainage; this deviates from traditional technique, which discourages popularization of AT. PATIENTS AND METHODS Prospective 12-month study from January to December 2019 of all primary macula-on RRD cases. Patients fulfilling the inclusion criteria for the Pneumatic Retinopexy Versus Vitrectomy for Retinal Detachment Trial received AT and otherwise were assigned to receive GT. RESULTS Forty-six patients were enrolled: 22 (48%) receiving AT and 24 (52%) receiving GT. The primary success rate of AT was 21 (95%) and the primary success rate of GT was 23 (96%), with 100% final success. Cryopexy was used in 64% of AT cases and 58% of GT cases. Cataract surgery was required less when AT was used (1 [6%]) than when GT was used (3 [21%]). AT was used in 48% of primary macula-on RRD and 27% of all primary RRD cases. CONCLUSIONS AT has visual and anatomical outcomes comparable to those of GT with conventional vitrectomy techniques, with faster postoperative rehabilitation enabling a swift return to normal daily activities. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:87-95.].
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Starr MR, Hsu J, Yonekawa Y, Mittra RA, Ryan C, Forbes NJ, Ammar M, Patel LG, Obeid A, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Ryan EH. Surgical techniques for primary rhegmatogenous retinal detachments between surgeons with high versus low single surgery success rates. Acta Ophthalmol 2021; 99:e1501-e1508. [PMID: 33720540 DOI: 10.1111/aos.14821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/25/2020] [Accepted: 02/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS To identify differences in preoperative characteristics and intraoperative approaches between surgeons with higher versus lower single surgery success rates (SSSR) for repair of rhegmatogenous retinal detachments (RRDs). METHODS This study is a sub-analysis of subjects who underwent RRD repair in the Primary Retinal Detachment Outcomes (PRO) study, a multi-institutional, retrospective comparative interventional study. The PRO study examined consecutive primary RRD surgeries from January 1, 2015 through December 31, 2015. The primary outcome was variations in surgical approach to different types of RRDs with secondary analyses of pre and intraoperative metrics for surgeons with SSSR > 90% compared to those <80% who performed at least 40 operations during the study period. RESULTS A total of 689 surgeries were included in the analysis. The mean SSSR was 94% for the higher tier and 75% for the lower tier (p < 0.0001). Surgeons with >90% SSSR were more likely to have graduated fellowship more recently (p = 0.0025), use less perfluorocarbon liquid (p < 0.0001), perform less 360 degree laser retinopexy (p < 0.0001), and perform a higher percentage of primary buckles and combined PPV/SB (p < 0.0001). For pseudophakic eyes there was no difference between PPV and PPV/SB use (p = 0.6211). CONCLUSION Surgeons with high SSSR typically performed SB as well as combination PPV/SB for more RRDs. Similar numbers of PPV and PPV/SB were performed for pseudophakic eyes, suggesting that the difference in SSSR between the two groups may be related to a combination of preoperative and intraoperative decisions as well as differences in technique.
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Affiliation(s)
- Matthew R. Starr
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Jason Hsu
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | | | | | | | - Michael Ammar
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Luv G. Patel
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Anthony Obeid
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Antonio Capone
- Associated Retinal Consultants Oakland University William Beaumont School of Medicine Royal Oak MI USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | - Omesh P. Gupta
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Carl D. Regillo
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
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PATCHING RETINAL BREAKS WITH HEALAFLOW IN 27-GAUGE VITRECTOMY FOR THE TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2021; 40:1900-1908. [PMID: 31860522 PMCID: PMC7505154 DOI: 10.1097/iae.0000000000002701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. This study evaluates the effectiveness of Healaflow as a retinal patch in primary rhegmatogenous retinal detachment repaired by 27-G pars plana vitrectomy combined with air tamponade. This protocol results in a high reattachment rate in the treatment of rhegmatogenous retinal detachment. Purpose: To report the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) repaired by 27-gauge pars plana vitrectomy combined with Healaflow patch and air tamponade. Methods: In an initial vitro experiment, we observed and compared the dissolution and displacement of the dispersion spots of 0.05-mL Healaflow and sodium hyaluronate. We then performed a prospective, interventional cohort study on 38 eyes in 37 consecutive patients with primary rhegmatogenous retinal detachment. All eyes underwent pars plana vitrectomy combined with Healaflow patch and air tamponade; the postoperative period did not involve prone positioning. The primary and final anatomical attachment rate, best-corrected visual acuity, and intraoperative and postoperative complications were evaluated. Results: In the in vitro experiment, the viscoelastic Healaflow remained adherent with no change in the size of the area; however, the control dissolved completely in the balance solution. The patient study included 16 women (43.2%) and 21 men (56.8%) (mean age, 59.5 ± 9.5 years; mean follow-up period, 8.9 ± 3.8 months). A single break was present in 21 (55.3%) and 2 to 5 breaks in 17 cases (44.8%). The macula was involved in 25 (65.8%) and attached in 13 cases (34.2%) intraoperatively. Initial reattachment was achieved in 37 (97.4%) and final reattachment in 38 cases (100%). In one case (2.6%), the macula redetached because of failure of the chorioretinal scar to develop around the treated break. Mean preoperative and postoperative best-corrected visual acuities were 1.02 ± 0.82 logarithm of the minimum angle of resolution (median Snellen acuity: 20/125, range: 20/20,000–20/20) and 0.23 ± 0.17 logarithm of the minimum angle of resolution (median Snellen acuity: 20/32, range: 20/100–20/20), respectively (P < 0.001). Intraocular pressure was elevated transiently in 28 eyes (73.7%). There were no other intraoperative complications or postoperative scleral incision leakage. Conclusion: A 27-gauge pars plana vitrectomy combined with Healaflow patch, and air tamponade results in a high reattachment rate in the treatment of rhegmatogenous retinal detachment. Thus, patients can benefit from early visual recovery and less complications.
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Arjmand P, Felfeli T, Mandelcorn ED. Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks. Clin Ophthalmol 2021; 15:3515-3519. [PMID: 34434043 PMCID: PMC8380623 DOI: 10.2147/opth.s321371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. Patients and Methods This is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020. Results A total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period. Conclusion The combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.
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Affiliation(s)
- Parnian Arjmand
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Efficacy of PPV Combined with Air Tamponade for Treatment of Inferior Retinal Breaks. J Ophthalmol 2021; 2021:9597584. [PMID: 34336261 PMCID: PMC8318743 DOI: 10.1155/2021/9597584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To observe the efficacy and safety of pars plana vitrectomy (PPV) combined with filtered air tamponade in the treatment of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. Methods This retrospective study included 20 patients (20 eyes) with inferior retinal breaks in RRD; all underwent PPV combined with filtered air tamponade. Preoperative examinations included BCVA, IOP, anterior segment, fundus and locations, numbers, and sizes of retinal breaks and ocular B-mode ultrasonography. Postoperative examinations included BCVA, IOP, residual gas volume, retinal reattachment, and complications. Results After follow-up for 1 year, the primary retinal reattachment rate was 95% and the final reattachment rate was 100%. Pre- and postoperative BCVA averaged 1.51 ± 0.63 and 0.97 ± 0.58 logMAR, respectively; the difference was statistically significant (P < 0.001). Average pre- and postoperative IOP were not statistically different. The average volume of residual gas on the first day after the surgery was 77.5%; the gas was absorbed in all patients within 2 weeks; no significant postoperative complications were observed. Conclusion PPV combined with filtered air tamponade is a safe and effective treatment for RRD with inferior retinal breaks. Notably, the retinal reattachment rate is high, gas absorption is rapid, and incidence of complications is low.
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Narde HK, Puri P, Shaikh NF, Agarwal D, Kumar A. Vitrectomy without encircling band for rhegmatogenous retinal detachment with inferior break utilizing 3D heads up viewing system. Indian J Ophthalmol 2021; 69:1208-1212. [PMID: 33913861 PMCID: PMC8186608 DOI: 10.4103/ijo.ijo_2028_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: This study aimed to determine the anatomical and functional outcomes of pars plana vitrectomy without encircling band for primary rhegmatogenous retinal detachments with inferior breaks utilizing 3D heads up viewing system. Method: This prospective, single-center study included 22 consecutive eyes with primary rhegmatogenous retinal detachments with only inferior breaks with proliferative vitreoretinopathy (PVR) CP2 or less, who underwent pars plana vitrectomy without encircling band, with silicon oil as tamponade. All surgeries were performed by a single surgeon. The single operation success rate was recorded after silicon oil removal. Results: The patient population consisted of 08 women (36%) and 14 men (64%) with a mean age of 56.6 +/− 14.7 years. The mean follow-up period was 8 months. A single break was present in 13 cases (59%), and 2–4 breaks were present in 9 cases (40.9%). The mean time for the surgical procedure was 35 min (range: 25–50). The macula was found to be detached in 19 cases (86.36%) and attached in 3 cases (13.6%). Single operation success rate (SOSR) of vitrectomy, after silicon oil removal without encircling band, for primary rhegmatogenous retinal detachment (RRD) with inferior breaks was 95.4%. One case redetached due to PVR changes and underwent re-surgery. Final reattachment was achieved in all 22 cases (100%). Mean best-corrected visual acuity (BCVA) significantly improved from 1.43 ± 0.59 logarithm of the minimum angle of resolution (logMAR) to postoperative BCVA was 0.48 ± 0.34 logMAR (P = 0.001). Conclusion: Pars plana vitrectomy without encircling band, utilizing 3D heads up the system in RRDs with inferior breaks in eyes with PVR grade C2 or less, provides good outcome.
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Affiliation(s)
- Harpreet K Narde
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Prabhav Puri
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Divya Agarwal
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Atul Kumar
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Singh A, Boustani G, Michez M, Bali E. Routine use of air tamponade in pars plana vitrectomy for primary rhegmatogenous retinal detachment repair. Ophthalmologica 2021; 244:543-550. [PMID: 34044413 DOI: 10.1159/000516519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Alexandra Singh
- Department of Ophthalmology, Delta Hospital Chirec, Brussels, Belgium
| | - Gabriel Boustani
- Department of Ophthalmology, Delta Hospital Chirec, Brussels, Belgium
| | - Marine Michez
- Department of Ophthalmology, Delta Hospital Chirec, Brussels, Belgium
| | - Ernesto Bali
- Department of Ophthalmology, Delta Hospital Chirec, Brussels, Belgium
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Huang Q, Cheng Y. The Effectiveness of the Supine Position in Managing Inferior Breaks in Rhegmatogenous Retinal Detachment After Vitrectomy with Gas Tamponade. Int J Gen Med 2021; 14:1179-1184. [PMID: 33833558 PMCID: PMC8021250 DOI: 10.2147/ijgm.s306006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to determine whether the supine position is effective for the management of inferior peripheral breaks after pars plana vitrectomy with gas tamponade. Methods A total of 29 patients (29 eyes) with acute rhegmatogenous retinal detachment and causative peripheral inferior breaks, located between the four o’clock and eight o’clock positions, underwent pars plana vitrectomy with gas tamponade. These patients maintained a face-up supine position for at least six hours each day for 14 days postoperatively. The alternate lateral position was used for the remaining hours, depending on the distribution of the retinal breaks. Results The final retinal reattachment rate was 100%, and the visual acuity improvement rate was 100% postoperatively, with no recurrence during the one-year follow up. No patients suffered from any sight-threatening complications. Of the 16 patients with preoperatively clear lenses, 3 were documented to have a cataract during their three-month postoperative follow up. Four patients were documented to have increased intraocular pressure, which was controllable during the early postoperative days. Conclusion Postoperative pars plana vitrectomy and gas tamponade in the supine position is effective for managing primary rhegmatogenous retinal detachment with causative breaks between the four o’clock and eight o’clock positions.
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Affiliation(s)
- Qiong Huang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People's Republic of China
| | - Yang Cheng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People's Republic of China
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Computational fluid dynamics (CFD) simulation analysis on retinal gas cover rates using computational eye models. Sci Rep 2021; 11:4937. [PMID: 33654177 PMCID: PMC7925587 DOI: 10.1038/s41598-021-84574-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/15/2021] [Indexed: 11/08/2022] Open
Abstract
We investigated the change in the retinal gas cover rates due to intraocular gas volume and positions using computational eye models and demonstrated the appropriate position after pars plana vitrectomy (PPV) with gas tamponade for rhegmatogenous retinal detachments (RRDs). Computational fluid dynamic (CFD) software was used to calculate the retinal wall wettability of a computational pseudophakic eye models using fluid analysis. The model utilized different gas volumes from 10 to 90%, in increments of 10% to the vitreous cavity in the supine, sitting, lateral, prone with closed eyes, and prone positions. Then, the gas cover rates of the retina were measured in each quadrant. When breaks are limited to the inferior retina anterior to the equator or multiple breaks are observed in two or more quadrants anterior to the equator, supine position maintained 100% gas cover rates in all breaks for the longest duration compared with other positions. When breaks are limited to either superior, nasal, or temporal retina, sitting, lower temporal, and lower nasal position were maintained at 100% gas cover rates for the longest duration, respectively. Our results may contribute to better surgical outcomes of RRDs and a reduction in the duration of the postoperative prone position.
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Starr MR, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. RETINAL DETACHMENT WITH INFERIOR RETINAL BREAKS: Primary Vitrectomy Versus Vitrectomy With Scleral Buckle (PRO Study Report No. 9). Retina 2021; 41:525-530. [PMID: 33600131 DOI: 10.1097/iae.0000000000002917] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rhegmatogenous retinal detachments with inferior retinal breaks are believed to have a higher risk of recurrent rhegmatogenous retinal detachment. This study compared anatomic and visual outcomes between primary pars plana vitrectomy (PPV) and combination PPV with scleral buckle (PPV/SB) for rhegmatogenous retinal detachments with inferior retinal breaks. METHODS This is an analysis of the Primary Retinal Detachment Outcomes study, a multi-institutional cohort study of consecutive primary rhegmatogenous retinal detachment surgeries from January 1, 2015, through December 31, 2015. The primary outcome was single-surgery success rate. Only eyes with inferior retinal breaks (one break in the detached retina between five and seven o'clock) were included. RESULTS There were 238 eyes that met the inclusion criteria, 95 (40%) of which underwent primary PPV and 163 (60%) that underwent combined PPV/SB. The single-surgery success rate was 76.8% for PPV and 87.4% for PPV/SB (P = 0.0355). This remained significant on multivariate analysis (P = 0.01). Subgroup analysis showed that a superior single-surgery success rate of PPV/SB was especially noted in phakic eyes (85.2% vs. 68.6%; P = 0.0464). CONCLUSION Retinal detachment with inferior retinal breaks had a higher single-surgery success rate if treated with PPV/SB compared with PPV alone, particularly in phakic eyes.
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Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota
| | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
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Casswell EJ, Yorston D, Lee E, Heeren TFC, Harris N, Zvobgo TM, Tarafdar S, Xing W, Bourmpaki E, Bunce C, Keane P, Charteris DG. Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair: The PostRD Randomized Clinical Trial. JAMA Ophthalmol 2021; 138:634-642. [PMID: 32297923 DOI: 10.1001/jamaophthalmol.2020.0997] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance A lack of consensus exists with regard to the optimal positioning regimen for patients after macula-involving retinal detachment (RD) repair. Objective To evaluate the effect of face-down positioning vs support-the-break positioning on retinal displacement and distortion after macula-involving RD repair. Design, Setting, and Participants A prospective 6-month single-masked randomized clinical trial was conducted at a multicenter tertiary referral setting from May 16, 2016, to May 1, 2018. Inclusion criteria were fovea-involving rhegmatogenous RD; central visual loss within 14 days; patients undergoing primary vitrectomy and gas surgery, under local anesthetic; patients able to give written informed consent; and 18 years old and older. Analysis was conducted following a modified intention-to-treat principle, with patients experiencing a redetachment or failure to attach the macula being excluded from analysis. Interventions Participants were randomized 1:1 to receive face-down positioning or support-the-break positioning for a 24-hour period postoperatively. Positioning compliance was not monitored. Main Outcomes and Measures The proportion of patients with retinal displacement on autofluorescence imaging at 6 months postoperatively. Secondary outcomes included proportion of patients with displacement at 2 months; amplitude of displacement at 2 and 6 months; corrected Early Treatment Diabetic Retinopathy Study visual acuity; objective Distortion Scores; and quality of life questionnaire scores at 6 months. Results Of the 262 randomized patients, 239 were analyzed (171 male [71.5%]; mean [SD] age, 60.8 [9.8] years). At 6 months, retinal displacement was detected in 42 of 100 (42%) in the face-down positioning group vs 58 of 103 (56%) in the support-the-break positioning group (odds ratio, 1.77; 95%CI, 1.01-3.11; P = .04). The degree of displacement was lower in the face-down group. Groups were similar in corrected visual acuity (face-down, 74 letters vs support-the-break, 75 letters), objective D Chart Distortion Scores (range: 0, no distortion to 41.6, severe distortion; with face-down at 4.5 vs support-the-break at 4.2), and quality of life scores (face-down 89.3 vs support-the-break 89.0) at 2 and 6 months. Retinal redetachment rate was similar in both groups (face-down group, 12.2% and support-the-break group, 13.7%). Retinal folds were less common in the face-down positioning group vs the support-the-break positioning group (5.3% vs 13.5%, respectively; odds ratio, 2.8; 95% CI, 1.2-7.4; P = .03). Binocular diplopia was more common in the support-the-break group compared with the face-down positioning group (7.6% vs 1.5%, respectively; odds ratio, 5.3; 95% CI, 1.3-24.6; P = .03). Amplitude of displacement was associated with worse visual acuity (r = -0.5; P < .001) and distortion (r = 0.28; P = .008). Conclusions and Relevance In this study, findings suggest that face-down positioning was associated with a reduction in the rate and amplitude of postoperative retinal displacement after macula-involving RD repair and with a reduction in binocular diplopia. No association was found with visual acuity or postoperative distortion. Trial Registration ClinicalTrials.gov Identifier: NCT02748538.
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Affiliation(s)
- Edward J Casswell
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - David Yorston
- Tennent Institute of Ophthalmology, Gartnavel Hospital, Glasgow, United Kingdom
| | - Edward Lee
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Tjebo F C Heeren
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Nicola Harris
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | | | - Sonali Tarafdar
- Tennent Institute of Ophthalmology, Gartnavel Hospital, Glasgow, United Kingdom
| | - Wen Xing
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Elli Bourmpaki
- Unit of Medical Statistics, Faculty of Life Sciences, King's College London School of Population Health & Environmental Sciences, London, United Kingdom
| | - Catey Bunce
- Unit of Medical Statistics, Faculty of Life Sciences, King's College London School of Population Health & Environmental Sciences, London, United Kingdom
| | - Pearse Keane
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - David G Charteris
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
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Cheng YH, Wang H, Li B, Ji M, Shi Q, Qi Y, Hu YG, Xie AM, Pei C. Vitrectomy with air tamponade for surgical repair of rhegmatogenous retinal detachment by eye position guided fluid-air exchange. Int J Ophthalmol 2020; 13:1417-1422. [PMID: 32953581 DOI: 10.18240/ijo.2020.09.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To observe the efficacy and safety of pars plana vitrectomy (PPV) with eye position guided fluid-air exchange (FAX) and air tamponade in the treatment of rhegmatogenous retinal detachment (RRD). METHODS RRD patients without severe proliferative vitreoretinopathy (PVR) C1 or more were enrolled. All patients underwent PPV combining with air tamponade. During operation, the primary retinal break(s) were placed at lower site and subretinal fluid was aspirated through the break(s) at the same time when eye position guided FAX was proceeding. Sufficient laser spots were made to seal the retinal break(s) after FAX, and filtered air was left in vitreous cavity as tamponade agent finally. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure. RESULTS A total of 37 eyes (20 males and 17 females) with a follow-up time of ≥6mo were included. The range of RRD was 5.6±1.8h, and the number of retinal breaks was 1.9±1.2. The breaks located at inferior quadrants (between 3:00 and 9:00) in 5 cases (13.5%), and both superior and inferior breaks were found in 3 cases (8.1%). A total of 25 cases (67.6%) with macular detached involvement, 9 cases (24.3%) with intraocular lens, and 8 patients (21.6%) were treated with phacoemulsification and intraocular lens implantation together. The success rate of primary retinal reattachment was 100% (37/37). At 6mo postoperatively, BCVA (logMAR) was increased from 1.13±1.07 to 0.23±0.15 (P<0.001). Phacoemulsification combined with intraocular lens implantation was performed in 2 patients (5.4%), and one of them underwent macular epiretinal membrane peeling in addition (2.7%). Furthermore, high intraocular pressure was found in 4 cases (10.8%). CONCLUSION PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD, and it has the advantages of short postoperative prone time and fewer operative complications.
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Affiliation(s)
- Yu-Hong Cheng
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Hua Wang
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.,AnKang Hospital of Traditional Chinese Medicine, Ankang 725000, Shaanxi Province, China
| | - Bo Li
- Department of Ophthalmology, Shaanxi Province Mianxian Hospital, Hanzhong 724200, Shaanxi Province, China
| | - Meng Ji
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.,AnKang Hospital of Traditional Chinese Medicine, Ankang 725000, Shaanxi Province, China
| | - Qiang Shi
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yun Qi
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ya-Guang Hu
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - An-Ming Xie
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Cheng Pei
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Abdelkader AME, Abouelkheir HY. Supine positioning after vitrectomy for rhegmatogenous retinal detachments with inferior retinal breaks. Int J Retina Vitreous 2020; 6:41. [PMID: 32944286 PMCID: PMC7490905 DOI: 10.1186/s40942-020-00247-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background To evaluate the effectiveness of face up position (FUP) following pars plana vitrectomy (PPV) and silicone oil injection in cases of rhegmatogenous retinal detachment (RRD) with multiple peripheral and inferior breaks. Method Thirty-two eyes of 32 patients with RRD due to multiple peripheral breaks were managed with PPV and silicone oil as endotamponade. Postoperatively, all patients were instructed to assume face up (supine) position for at least 10 days. Silicone oil was removed 3 to 6 months postoperatively in eyes with attached retina and the patients were followed up for 6 months. Results Thirty eyes (94%) got a successful attachment of the retina and remained attached after silicone oil removal. One case showed lower redetachment under silicone oil while the other case showed recurrent RRD after silicone oil removal. Conclusion Although postoperative FUP is not a popular one, it is effective in the treatment of RRD with peripheral breaks whatever the number or the distribution of these breaks. This may in some way or another change the traditional trends of postoperative positioning after vitrectomy for RRD.
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Affiliation(s)
- Amr Mohammed Elsayed Abdelkader
- Department of ophthalmology, Lecturer of ophthalmology, Mansoura ophthalmic center, faculty of medicine, Mansoura university, Mansoura, Egypt
| | - Hossam Youssef Abouelkheir
- Assistant professor of ophthalmology, Mansoura ophthalmic center, faculty of medicine, Mansoura university, Mansoura, Egypt
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Yu S, Framme C, Menke MN, Berger LE, Zinkernagel MS, Munk MR, Wolf S, Ebneter A. Neuroprotection with rasagiline in patients with macula-off retinal detachment: A randomized controlled pilot study. Sci Rep 2020; 10:4948. [PMID: 32188915 PMCID: PMC7080767 DOI: 10.1038/s41598-020-61835-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/02/2020] [Indexed: 01/08/2023] Open
Abstract
We aimed to evaluate the neuroprotective efficacy of rasagiline in pseudophakic patients who had surgery for macula-off rhegmatogenous retinal detachment (RRD). This was a 6-month, prospective, randomized, double-blind, placebo-controlled pilot study. Patients presenting with acute macula-off RRD were recruited and randomized 1:1 to receive rasagiline 1 mg/day or placebo for 7 days. Best-corrected visual acuity (BCVA) and optical coherence tomography were acquired 1 day before as well as 2 days, 3 weeks, 3 months and 6 months after surgery. We screened 26 patients with RRD whereof 23 were eventually included and randomized. The primary outcome was final BCVA. Secondary outcomes included central retinal thickness (CRT) and adverse events (AE). We evaluated photoreceptor cells (prc) recovery through morphological measurements. The baseline characteristics were comparable between groups. BCVA significantly improved in both groups (letters gained: rasagiline 61.5 ± 18.1 vs placebo 55.3 ± 29.2, p = 0.56), but no significant inter-group difference was found at any visit. CRT was stable 3 weeks after surgery onwards, with no inter-group difference. No treatment-emergent AE occurred. Significant prc restoration was observed from 3 weeks to 6 months after surgery, without inter-group difference at either visit. Ellipsoid zone integrity (β = 0.517, p = 0.008) and foveal bulge (β = 0.387, p = 0.038) were significant predictors of good final BCVA. In conclusion, perioperative oral treatment with rasagiline 1 mg/day for 7 days did not show significant benefits on visual or anatomical outcomes in macula-off RRD patients.
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Affiliation(s)
- Siqing Yu
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carsten Framme
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Klinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany
| | - Marcel Nico Menke
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Ophthalmology, Kantonsspital Aarau, Herzogstrasse 15, Aarau, Switzerland
| | - Lieselotte Erika Berger
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Sebastian Zinkernagel
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marion Rohit Munk
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Soliman MK, Nithianandan H, McDonald H, Lingley AJ, Tuli R. Outcomes of Rhegmatogenous Retinal Detachment Repair With Nonrestricted Postoperative Positioning. JOURNAL OF VITREORETINAL DISEASES 2020; 4:110-118. [PMID: 37008374 PMCID: PMC9976251 DOI: 10.1177/2474126419885081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To investigate the anatomical success rate associated with rhegmatogenous retinal detachment (RRD) repair without postoperative head positioning. Methods: Data on 182 individuals undergoing pars plana vitrectomy (PPV) with or without phacoemulsification or scleral buckle for primary RRD with intraocular tamponade were retrospectively reviewed. The primary outcome was the initial anatomical success rate. Secondary outcome measures were the change in best-corrected visual acuity and the final reattachment rate. Results: A total of 122 eyes from 122 patients who underwent RRD repair without postoperative positioning were included in this study. PPV alone was performed in 39% of cases, whereas the remaining patients had PPV combined with phacoemulsification (35%), with scleral buckle (19%), or both (7%). Inferior breaks between the 4 o’clock and 8 o’clock positions were present in 47% of cases. Primary and final anatomical success was achieved in 86% and 98% of cases, respectively. The most common cause for redetachment was proliferative vitreoretinopathy. Age and combined inferior retinal and superior breaks were predictive of recurrence in the logistic regression model. The mean baseline best-corrected visual acuity improved from 1.2 (Snellen equivalent, 20/320) to 0.76 (Snellen, 20/125) logarithm of the minimum angle of resolution after retinal reattachment ( P < .001). Conclusions: PPV combined with or without phacoemulsification or scleral buckle for primary RRD in pseudophakic eyes or those rendered pseudophakic is associated with good anatomical outcomes without restricted postoperative head positioning. Retinal detachment in eyes with combined retinal inferior and superior breaks may have a lower success rate, and whether this is due to lack of postoperative positioning needs further evaluation in prospective, controlled studies.
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Affiliation(s)
- Mohamed Kamel Soliman
- Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Heather McDonald
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Raman Tuli
- Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
- Retina Center of Ottawa, Ottawa, Ontario, Canada
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SURGICAL OUTCOMES OF 25-GAUGE PARS PLANA VITRECTOMY USING AIR AS AN INTERNAL TAMPONADE FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2020; 40:2077-2082. [PMID: 31922498 DOI: 10.1097/iae.0000000000002744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report surgical outcomes of 25-gauge pars plana vitrectomy using air as an internal tamponade for patients with primary rhegmatogenous retinal detachment (RRD). METHODS A retrospective clinical study of 59 eyes of 59 consecutive patients presented with primary RRD at the Beijing Tongren Eye Center in China. From August 2016 to May 2018, medical records of the patients who underwent 25-gauge pars plana vitrectomy with air tamponade for RRD were reviewed. The main outcome measures were primary and final anatomical success (retinal re-attachment) rates, and postoperative complications. RESULTS Of the 59 patients, aged 54.47 ± 11.81 years, 31 (52.5%) were men. Vitrectomy was performed 3 to 40 (averaged 16.98 ± 10.17) days after the onset of symptoms, and the mean follow-up period was 12.90 ± 5.92 months (ranging 6.07-26.10 months). Forty-two eyes (71.2%) had RRD with retinal breaks in the superior half of the retina, and the mean number of retinal breaks was 1.75 ± 0.94. Three eyes (5.1%) had RRD with giant retinal tears. Of the 59 eyes, 35 (59.3%) had RRD with inferior quadrants involved. Proliferative vitreoretinopathy (PVR) gradings were C1 in 2 (3.4%) eyes and B or below in 57 (96.6%) eyes. The primary and final anatomical success rates were 94.9% (56/59) and 98.3% (58/59), respectively. Of the three eyes which developed re-detachment of the retina, one eye had postoperative progression of PVR and two eyes were RRD associated with macular hole in high myopia. Postoperative complications included 5 eyes (8.5%) with serous choroidal detachment within 3 days after surgery and 4 eyes (6.8%) with macular epiretinal membrane formation 1 to 8 months after surgery. Secondary cataract surgery was performed in 13 of the 53 phakic eyes (24.5%) during follow-up. CONCLUSION Small-gauge pars plana vitrectomy with air tamponade may be effective in treating selected cases of relatively simple primary RRD. Additional studies are needed to verify the efficacy of this surgical approach for more complicated cases such as those with giant retinal tears.
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Tetsumoto A, Imai H, Hayashida M, Otsuka K, Matsumiya W, Miki A, Nakamura M. The comparison of the surgical outcome of 27-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment between air and SF6 gas tamponade. Eye (Lond) 2019; 34:299-306. [PMID: 31857712 DOI: 10.1038/s41433-019-0726-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the surgical results between air and 20% sulfur hexafluoride (SF6) tamponade in 27-gauge pars plana vitrectomy (27GPPV) for rhegmatogenous retinal detachment (RRD). METHODS A retrospective, observational, and consecutive study. All patients underwent 27GPPV for RRD were divided into two groups. Group A comprised patients who underwent 20% SF6 gas tamponade. Group B comprised patients who underwent air tamponade. The anatomical success rate, visual outcome, and the type and frequency of complications were investigated and compared between the groups. All patients were followed-up for 12 months after surgery. RESULTS Seventy eyes were enrolled (Group A: 35 eyes, Group B: 35 eyes). Seventeen eyes in Group A and 13 eyes in Group B had RRD with superior retinal breaks, while 14 eyes in Group A and 19 eyes in Group B had RRD with inferior retinal breaks. There was no statistically difference in preoperative demographic date between the groups. The initial and final anatomical success rates were 97.1% and 100% in Group A and 94.3% and 100% in Group B, respectively. The success rates between the groups were not statistically different (p = 1). The best corrected visual acuity (BCVA) (logMAR) at 12 months after surgery was -0.02 ± 0.14 in Group A and -0.03 ± 0.27 in Group B. The BCVA between the groups was not statistically different (p = 0.27). CONCLUSIONS The surgical results of air tamponade were not inferior to 20% SF6 tamponade in 27GPPV for RRD irrespective of retinal break locations in the present cohort.
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Affiliation(s)
- Akira Tetsumoto
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hisanori Imai
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Mayuka Hayashida
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keiko Otsuka
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Kobe Kaisei Hospital, 3-11-15 Shinohara Kitamachi, Nada-ku, Kobe, 657-0068, Japan
| | - Wataru Matsumiya
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Akiko Miki
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Rhegmatogenous retinal detachments: primary reattachment rates and visual outcomes over a 4-year period. Ir J Med Sci 2019; 189:355-363. [PMID: 31418155 DOI: 10.1007/s11845-019-02084-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/08/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success. METHODS A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6 months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success. RESULTS A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25-91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6 months post procedure. Macular status (chi-square test p = 0.15, X2 = 2.072) and lens status (chi-square test p = 0.2974, X2 = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X2 = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501). CONCLUSIONS This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.
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Talcott KE, Obeid A, Gao X, Adika A, Regillo CD. Pars Plana Vitrectomy Alone for Primary Rhegmatogenous Retinal Detachments Associated With Inferior Breaks in Phakic Eyes. Ophthalmic Surg Lasers Imaging Retina 2019; 50:153-158. [DOI: 10.3928/23258160-20190301-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
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Ghazza A, Bakhsh M, Hajji I, Moutaouaki A. [Treatment of retinal detachment of the pseudophak: vitrectomy without episcleral indentation versus ab externo surgery]. Pan Afr Med J 2019; 32:44. [PMID: 31143349 PMCID: PMC6522180 DOI: 10.11604/pamj.2019.32.44.15489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
Several factors predispose to the occurrence of rhegmatogenous retinal detachment, including cataract surgery, myopia, and degenerative lesions of the peripheral retina as well as eye trauma. This study aims to compare the anatomical and functional outcome of the two surgical techniques (AB interno vs AB externo) in our Hospital. We conducted a descriptive, retrospective study in the Department of Ophthalmology at the University Hospital Mohamed VI in Marrakech, over a period of 3 years, ranging from January 2013 to December 2015. During the study period we compared two groups of people: the first group undergoing surgery by an external approach (cryoapplication of the dehiscences with episcleral indentation) while the second undergoing surgery by endo-ocular approach. Group A or AB externo group included 26 eyes (26 patients) while Group B or vitrectomy with internal tamponade group included 22 eyes (22 patients). In the AB externo group, the average age was 54.92 years against 51.64 years in the AB interno group, with a slight predominance of males in both groups. After the first surgery, retinal reapplication was obtained in both groups with no significant difference, (about 80.76% in Group A versus 81.82% of the second group). In both groups failure was caused advanced vitreoretinal proliferation (4 cases), de novo breaks (3 cases) and breaks which had not been detected on first examinations (2 cases). All these cases underwent reoperation by AB interno approach: patients of group A underwent complete vitrectomy with revision of the indentation +/- internal limiting membrane peeling with internal gas tamponade while patients of group B underwent complementary vitrectomy with dissection of proliferative vitreoretinopathy (PVR) and an internal tamponade with silicone oil. After a mean follow-up period of 12 months, there was no significant difference in visual acuity between the 2 groups, with more than one third of the patients who had regained visual acuity between 1/10 and 5/10 (about 34,61% in AB externo group and 36,36% in AB interno group). Given the technological advances in vitrectomy, the current trend is the endo-ocular surgery however ab-externo surgery is mainly used in the treatment of retinal detachment with visible breaks which can be easily treated with indentation without advanced vitreoretineal proliferation (PVR A-B).
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Affiliation(s)
- Ahmed Ghazza
- Service d'Ophtalmologie, CHU Mohamed VI, Marrakech, Maroc
| | - Maha Bakhsh
- Service d'Ophtalmologie, CHU Mohamed VI, Marrakech, Maroc
| | - Ibtissam Hajji
- Service d'Ophtalmologie, CHU Mohamed VI, Marrakech, Maroc
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Kim JH, Lee KW, Kang HG. Subretinal Fluid Drainage through Original Breaks without Perfluorocarbon Liquid for Rhegmatogenous Retinal Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.9.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lin Z, Liang QH, Lin K, Hu ZX, Chen TY, Wu RH, Moonasar N. Air tamponade and without heavy liquid usage in pars plana vitrectomy for rhegmatogenous retinal detachment repair. Int J Ophthalmol 2018; 11:1779-1783. [PMID: 30450308 DOI: 10.18240/ijo.2018.11.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To report the results of rhegmatogenous retinal detachment (RRD) repair after pars plana vitrectomy (PPV) without operative use of heavy liquid, and utilizing air tamponade in selected cases. METHODS RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5d. RESULTS Totally 36 eyes of 36 patients (24 males, 66.7%) aged 53.8±10.9y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes (29, 80.6%) had retinal detachment involving more than one quadrant. Twenty-two (61.1%) eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4% (34/36). Six (16.7%) eyes had intraocular pressure higher than 25 mm Hg. The visual acuity (logMAR) improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively (P<0.001). CONCLUSION The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.
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Affiliation(s)
- Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Qi-Hua Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Ke Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zhi-Xiang Hu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Tian-Yu Chen
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Rong-Han Wu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Nived Moonasar
- Department of Ophthalmology, University of the West Indies, St. Augustine Trinidad and Tobago
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Chen QY, Tang YX, He YQ, Lin HM, Gao RL, Li MY, Hou JT, Ma HJ, Zhang JL. Air tamponade in retinal detachment surgery followed by ultra-widefield fundus imaging system. Int J Ophthalmol 2018; 11:1198-1203. [PMID: 30046539 DOI: 10.18240/ijo.2018.07.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/25/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To report the surgical result of pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD) by ultra-widefield fundus imaging system. METHODS Of 25 consecutive patients (25 eyes) with fresh primary RRD and causative retinal break and vitreous traction were presented. All the patients underwent PPV with air tamponade. Visual acuity (VA) was examined postoperatively and images were captured by ultra-widefield scanning laser ophthalmoscope system (Optos). RESULTS Initial reattachment was achieved in 25 cases (100%). The air volume was >60% on the postoperative day (POD) 1. The ultra-widefield images showed that the retina was reattached in all air-filled eyes postoperatively. The retinal break and laser burns in the superior were detected in 22 of 25 eyes (88%). A missed retinal hole was found under intravitreal air bubble in 1 case (4%). The air volume was range from 40% to 60% on POD 3. A double-layered image was seen in 25 of 25 eyes with intravitreal gas. Retinal breaks and laser burns around were seen in the intravitreal air. On POD 7, small bubble without effect was seen in 6 cases (24%) and bubble was completely disappeared in 4 cases (16%). Small oval bubble in the superior area was observed in 15 cases (60%). There were no missed and new retinal breaks and no retinal detachment in all cases on the POD 14 and 1mo and last follow-up. Air disappeared completely on a mean of 9.84d postoperatively. The mean final postoperative best-corrected visual acuity (BCVA) was 0.35 logMAR. Mean final postoperative BCVA improved significantly relative to mean preoperative (P<0.05). Final VA of 0.3 logMAR or better was seen in 13 eyes. CONCLUSION PPV with air tamponade is an effective management for fresh RRD with superior retinal breaks. The ultra-widefield fundus imaging can detect postoperative retinal breaks in air-filled eyes. It would be a useful facility for follow-up after PPV with air tamponade. Facedown position and acquired visual rehabilitation may be shorten.
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Affiliation(s)
- Qian-Yin Chen
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Yun-Xia Tang
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Yan-Qiong He
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Hui-Min Lin
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Ru-Long Gao
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Meng-Yuan Li
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Jin-Tong Hou
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China
| | - Hong-Jie Ma
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China.,Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Province, China
| | - Jing-Lin Zhang
- Guangzhou Aier Eye Hospital, Guangzhou 510010, Guangdong Province, China.,Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Province, China
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Ajlan R, Isenberg J, Cordahi G, Duval R, Olivier S, Rezende F. Primary rhegmatogenous retinal detachment with inferior retinal breaks postoperative prone positioning results: 1 day versus 7 days. Int J Retina Vitreous 2017; 3:47. [PMID: 29214057 PMCID: PMC5713118 DOI: 10.1186/s40942-017-0100-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/15/2017] [Indexed: 11/11/2022] Open
Abstract
Background To compare the primary anatomical outcome of pars plana vitrectomy, 360° peripheral endolaser, and 15% octafluoropropane C3F8 gas tamponade in patients with uncomplicated rhegmatogenous detachment and inferior retinal breaks, after 24-h postoperative prone positioning to similar patients with 1 week postoperative prone positioning. Methods Records of 5500 patients who underwent pars plana vitrectomy between 2008 and 2015 were retrieved. Collected data included age, gender, number of retinal quadrants with retinal breaks, number of retinal breaks, macula status on presentation (attached or detached), phakic status (phakic, pseudophakic, or aphakic), and primary anatomical outcome (at 1 and 3 months post-operative). Results 270 patients met the study inclusion criteria (78 females, and 192 males). In the 24-h positioning arm (183 patients), the overall anatomical success rate was 96.2% at 1 month and 83.6% at 3 months. In the 1-week positioning group (87 patients), the overall anatomical success rate was 93% at 1 month and 79% at 3 months. Both positioning groups did not show statistical difference in outcome at 1 month (p-value = 0.7) or at 3 months (p-value = 0.39). Logistic regression analysis found that the number of retinal breaks correlates with the postoperative anatomical success at 3 months (odd ratio 0.8, p-value = 0.016). Conclusion This short term retrospective study demonstrated that patients with uncomplicated rhegmatogenous retinal detachment due to inferior retinal breaks, who underwent pars plana vitrectomy, 360° endolaser, 15% C3F8 gas, and limited (24-h) prone positioning did not show statistical difference in the anatomical outcome (at 1, and 3 months) when compared with 1 week postoperative positioning. Larger prospective studies are warranted to further elucidate positioning role.
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Affiliation(s)
- Radwan Ajlan
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Jordan Isenberg
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Ghassan Cordahi
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Renaud Duval
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Sébastien Olivier
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Flavio Rezende
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
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Exclusive Use of Air as Gas Tamponade in Rhegmatogenous Retinal Detachment. J Ophthalmol 2017; 2017:1341948. [PMID: 28785481 PMCID: PMC5530412 DOI: 10.1155/2017/1341948] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. Methods This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. Results The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p = 0.951). BCVA was significantly better in the air group at 1 month (p = 0.021) but not at 3 months postoperatively (p = 0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p = 0.041). Conclusions In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358.
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Reply. Ophthalmology 2017; 124:e52. [DOI: 10.1016/j.ophtha.2017.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/12/2017] [Indexed: 11/17/2022] Open
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Tripathy K. Re: Martínez-Castillo et al.: Pars plana vitrectomy alone for the management of pseudophakic rhegmatogenous retinal detachment with only inferior breaks ( Ophthalmology . 2016;123:1563-1569). Ophthalmology 2017; 124:e52. [DOI: 10.1016/j.ophtha.2017.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/13/2016] [Accepted: 01/12/2017] [Indexed: 12/01/2022] Open
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Zhang Z, Peng M, Wei Y, Jiang X, Zhang S. Pars plana vitrectomy with partial tamponade of filtered air in Rhegmatogenous retinal detachment caused by superior retinal breaks. BMC Ophthalmol 2017; 17:64. [PMID: 28499427 PMCID: PMC5427555 DOI: 10.1186/s12886-017-0459-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/08/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the anatomic and functional outcomes of pars plana vitrectomy (PPV) with partial tamponade of filtered air for rhegmatogenous retinal detachment (RRD) caused by superior retinal breaks. METHODS Retrospective, comparative, consecutive case series study. Patients with RRD caused by superior retinal breaks undergone PPV with partial tamponade (Group A) and whole tamponade (Group B) of filtered air were included. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and rate of postoperative cataract surgery. RESULTS Forty-one patients (41 eyes) were included in Group A and 36 patients (36 eyes) were included in Group B. There were no significant differences in primary or final success rates between Groups A and B (P = 0.618 and P = 1.000, respectively). The patients in Group A experienced quicker postoperative vision improvement (from the Week 1 follow-up) than the patients in Group B (from the Month 3 follow-up). The postoperative cataract surgery rate of Group A (7/31) was lower than that of Group B (13/26) (P = 0.031). CONCLUSIONS PPV with partial tamponade of air is effective in achieving a high anatomic success rate, quicker postoperative vision improvement, and lower rate of postoperative cataract surgery in RRD caused by superior retinal breaks.
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Affiliation(s)
- Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Manjuan Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Xintong Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China
| | - Shaochong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China.
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The Safety and Efficacy of Adjustable Postoperative Position after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment. J Ophthalmol 2017; 2017:5760173. [PMID: 28409022 PMCID: PMC5377055 DOI: 10.1155/2017/5760173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/27/2016] [Accepted: 01/31/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose. To report the safety and efficacy of adjustable postoperative position for rhegmatogenous retinal detachment (RRD). Methods. Retrospective review of 536 consecutive RRD eyes that underwent vitrectomy surgery for retina repair from year 2008 to 2014. The retinal breaks were divided into superior, lateral (nasal, temporal, and macular), and inferior locations, according to the clock of breaks. Patients with superior and lateral break location were allowed to have facedown position or lateral decubitus position postoperatively, while patients with inferior break location were allowed to have facedown position. Results. 403 eyes of 400 patients were included. The mean follow-up interval was 22.7 ± 21.3 months. The overall primary retinal reattachment rate was 93.3%. There were 24 (6.0%), 273 (67.7%), and 106 (26.3%) patients with superior, lateral, and inferior break location, respectively. The primary reattachment rate was 95.8%, 92.3%, and 95.3% accordingly. After further divided the break location into subgroups as a function of duration of symptom, postoperative lens situation, number of retinal breaks, and different vitreous tamponade, the primary reattachment rates were all higher than 82%. Conclusion. Adjustable postoperative positioning is effective and safe for RRD repair with different break locations. Choosing postoperative position appropriately according to retinal break locations could be recommended.
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Lee SJ, Kwon HJ, Park KY, Park SW, Byon IS, Lee JE. Prognostic Factors of Anatomical Success in Microincisional Vitrectomy for Rhegmatogenous Retinal Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.10.1613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seok Jae Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Han Jo Kwon
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Kang Yoon Park
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
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