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Agarwalla A, Chawla R, Azad SV, Venkatesh P, Vohra R, Kumar V. EVALUATION OF PRONE VERSUS SUPINE POSITIONING IN FRESH RHEGMATOGENOUS RETINAL DETACHMENT TREATED WITH PARS PLANA VITRECTOMY AND GAS. Retina 2024; 44:1150-1156. [PMID: 38470916 DOI: 10.1097/iae.0000000000004075] [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: 03/14/2024]
Abstract
PURPOSE To compare Supine versus Prone positioning in fresh rhegmatogenous retinal detachments treated with vitrectomy and gas tamponade. METHODS This was a prospective randomized controlled trial of 72 eyes with fresh rhegmatogenous retinal detachment that underwent 25-gauge vitrectomy: 37 eyes were allotted supine position and 35 were allotted prone position. Cases were evaluated for single-surgery reattachment rates, best-corrected visual acuity, intraocular pressure, cataract formation, and any complications. The patients were followed up for a period of 3 months. RESULTS Both groups had similar demographics, and no significant difference was found between the two groups in terms of extent of retinal detachment, position, and number of breaks. The anatomical success after single surgery was 97.3% in the Supine group and 94.3% in the Prone group ( P = 0.609). The best-corrected visual acuity at the end of 3 months was 0.44 ± 0.27 in the Supine group and 0.35 ± 0.27 in the Prone group ( P = 0.119) with a significant increase in best-corrected visual acuity preoperatively from 0.11 ± 0.22 and 0.13 ± 0.22 in Supine and Prone groups, respectively ( P = <0.001). The intraocular pressure in the two groups was comparable at each follow-up. The rates of cataract formation were also similar in the two groups-60% and 53.8% in Supine and Prone groups, respectively ( P = 1.00). Complications such as spikes in intraocular pressure, epiretinal membrane formation, and cystoid macular edema were similar in both groups. CONCLUSION Rates of retinal reattachment were comparable in both groups showing that supine position is equally safe and effective for adequate tamponade.
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Affiliation(s)
- Anushka Agarwalla
- Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Babel A, Xu K, Chin EK, Almeida D. Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment With No Postoperative Positioning. JOURNAL OF VITREORETINAL DISEASES 2024; 8:253-256. [PMID: 38770069 PMCID: PMC11102711 DOI: 10.1177/24741264241237022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To evaluate the anatomic and visual outcomes of primary vitrectomy for rhegmatogenous retinal detachment (RRD) repair using no amount of postoperative prone positioning to clarify the role of face-down posturing for RRD reattachment. Methods: This retrospective consecutive interventional case series comprised patients who had primary vitrectomy for RRD repair. The surgical outcomes, single-surgery anatomic success rate, and postoperative best-corrected visual acuity (BCVA) were assessed. The primary objective was to evaluate the anatomic and visual outcomes of vitrectomy RRD reattachment using no postoperative prone positioning. Results: This study comprised 116 eyes of 116 patients. Single-surgery anatomic success was achieved in 112 (96.5%) of 116 eyes. The single-surgery anatomic success rate was 100% in phakic patients (n = 56) and 93% in pseudophakic patients (n = 60), with both groups having an improvement in the mean BCVA. Conclusions: Primary vitrectomy with no postoperative prone positioning is a successful surgical intervention for RRD repair. The anatomic closure rate in this study is one of the highest reported in the literature and involved a large number of macula-off RRDs, with minimal complications and a significant improvement in BCVA, primarily using 14% perfluoropropane for gas tamponade.
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Affiliation(s)
- Adrian Babel
- Boonshoft School of Medicine, Dayton, OH, USA
- Erie Retinal Surgery & Erie Retina Research, Erie, PA, USA
| | - Kunyong Xu
- Retina Consultants of Georgia, Augusta, GA, USA
| | - Eric K. Chin
- Retina Consultants of Southern California, Redlands, CA, USA
- Loma Linda Eye Institute, Veterans Affair Hospital, Loma Linda, CA, USA
| | - David Almeida
- Erie Retinal Surgery & Erie Retina Research, Erie, PA, USA
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Beltraminelli T, Hessler Q, Stappler T, Potic J, Wolfensberger TJ, Konstantinidis L. Silicone Oil Tamponade for Therapy of Primary Retinal Detachment in Patients Who Live at High Altitudes. Klin Monbl Augenheilkd 2024; 241:472-476. [PMID: 38653297 DOI: 10.1055/a-2233-0971] [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: 04/25/2024]
Abstract
BACKGROUND Uncomplicated rhegmatogenous retinal detachment (RRD) is mainly treated with vitrectomy and gas tamponade or, alternatively, scleral buckling surgery. However, gas tamponade inflates at high altitudes, causing significant complications. Silicone oil (SO) tamponade volume is unaffected by atmospheric pressure and may be used in patients who live or must undertake travel at high altitudes. PURPOSE To determine the anatomical and functional outcomes after pars plana vitrectomy (PPV) with SO tamponade in primary uncomplicated RRD. METHODS Twenty-eight consecutive cases of patients operated between January 2017 and December 2022 in Jules-Gonin University Eye Hospital in Lausanne were included in this retrospective study. All patients had a follow-up of at least 3 months after SO removal. RESULTS Primary reattachment was achieved in all 28 eyes. Mean follow-up was 17.2 months (range: 3 - 51 months) after SO removal. Mean age at the time of intervention was 60 years (range: 21 - 80 years). Vision was stabilized or improved in 27 eyes (96%). One patient demonstrated a slight visual acuity decrease due to cataract formation at the last follow-up. In all patients, SO was removed 2 to 5 months after primary repair. In 14 of the 21 phakic patients, concomitant cataract surgery was performed. No surgical complications were encountered. Postoperatively, 5 (18%) patients had ocular hypertension, presumably steroid related, that was successfully controlled with topical treatment. CONCLUSION PPV with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated RRD in patients living at high altitudes and was associated with good anatomical and functional outcome in our series. However, the need for a follow-up surgery to remove SO should be weighed in these cases.
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Affiliation(s)
- Tim Beltraminelli
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Quentin Hessler
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
- School of Medicine, University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Theodor Stappler
- Retina Surgery, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Jelena Potic
- Retina Surgery, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Thomas J Wolfensberger
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
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Rossi T, Badas MG, Angius F, Querzoli G. DO DAILY ACTIVITIES AFFECT GAS TAMPONADE‒RETINA CONTACT AFTER PARS PLANA VITRECTOMY?: A Computational Fluid Dynamics Study. Retina 2023; 43:955-963. [PMID: 36800522 PMCID: PMC10187623 DOI: 10.1097/iae.0000000000003750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
PURPOSE To calculate the retinal surface alternatively in contact with gas and aqueous because of fluid sloshing during daily activities such as ocular saccade, turning the head, standing up, and being a passenger of a braking car. METHODS Fluid dynamics of aqueous and gas tamponade was reproduced using computational methods using the OpenFOAM open-source library. The double-fluid dynamics was simulated by the volume of fluid method and setting the contact angle at the aqueous-gas-retina interface. RESULTS Sloshing increased the retinal surface in contact with aqueous by 13% to 16% regardless of fill rate and standing up determined the largest area of wet retina, followed by car braking, head rotation, and ocular saccade ( P < 0.001). All activities except the ocular saccade determined a significant increase in the surface of retina in contact with the aqueous ( P < 0.005). Car braking induced the highest shear stress (6.06 Pa); standing up determined the highest specific impulse and saccade the lowest. CONCLUSION Daily activities instantaneously reduce the amount of retina consistently in contact with gas tamponade and increase shear stress giving aqueous a potential access to the subretinal space regardless of patients' compliance.
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Affiliation(s)
- Tommaso Rossi
- IRCCS Fondazione G.B. Bietti ONLUS, Roma, Italy; and
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Sverdlichenko I, Lim M, Popovic MM, Pimentel MC, Kertes PJ, Muni RH. Postoperative positioning regimens in adults who undergo retinal detachment repair: A systematic review. Surv Ophthalmol 2023; 68:113-125. [PMID: 36116526 DOI: 10.1016/j.survophthal.2022.09.002] [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: 03/03/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
Little is known about the comparative benefit of different positioning regimens in rhegmatogenous retinal detachment (RRD) repair. We compared outcomes of different postoperative posturing regimens following pars plana vitrectomy (PPV). MEDLINE, EMBASE, and Cochrane CENTRAL were searched from 2000 to February 2022 for original studies that compared at least 2 postoperative posturing regimens in adults who underwent PPV for RRD. Seven comparative studies and 703 eyes were included. There were no differences in final visual acuity between posturing regimens. Single-procedure reattachment rates were higher with alternative positioning compared to prone positioning in patients with inferior breaks. Prone and alternative positioning were associated with similar risks of complications. In contrast, prone posturing had a higher risk of neck pain and intraocular pressure elevation than support-the-break, which had a greater risk of retinal displacement, retinal folds, and binocular diplopia. Immediate prone positioning was superior to delayed prone for the risk of retinal displacement. The present review shows that prone positioning was associated with a lower reattachment rate than alternative positioning. There were trade-offs in complications between prone and support-the-break positioning. Retinal displacement could be mitigated when prone positioning is maintained immediately after surgery.
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Affiliation(s)
| | - Michelle Lim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Miguel Cruz Pimentel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
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Takahashi Y, Hirano T, Nakamura M, Chiku Y, Hoshiyama K, Akahane S, Akahane K, Murata T. Temporal Change in Anterior Chamber Depth after Combined Vitrectomy and Cataract Surgery Using Different Sizes of Intraocular Lens. J Clin Med 2022; 11:jcm11216430. [PMID: 36362658 PMCID: PMC9656526 DOI: 10.3390/jcm11216430] [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: 09/29/2022] [Revised: 10/27/2022] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the temporal changes in the anterior chamber depth (ACD) and refractive prediction error (RPE) of 6 and 7 mm diameter intraocular lenses (IOLs) after cataract surgery or phacovitrectomy with or without sulfur hexafluoride (SF6) gas. We reviewed 120 eyes (120 patients) and divided them into six groups: three groups of cataract surgery alone and phacovitrectomy (with or without SF6), which were further divided according to IOL diameter (6 and 7 mm) used. We examined the ACD and IOL position using a swept-source anterior segment optical coherence tomograph at 1 day, 1 week, and 1 month postoperatively; and the RPE at 1 month postoperatively. The ACD and IOL position at postoperative day 1 in the SF6 injection groups were significantly smaller than those in the other groups (p < 0.01). At 1 week, the ACD and IOL position of the 6 mm IOL SF6 injection group was smaller than those in the other groups (p < 0.01); thus, complications such as synechia or pupillary capture should be considered in the early postopera-tive period of phacovitrectomy with SF6, especially in the 6 mm IOL. The ACD, IOL position, and RPE at 1 month did not significantly differ among the groups, regardless of the IOL diameter or SF6. In the SF6 injection groups, the ACD and IOL position gradually deepened with less gas.
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Affiliation(s)
- Yoshiaki Takahashi
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
- Correspondence:
| | | | | | - Ken Hoshiyama
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | | | | | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
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Ishiyama Y, Ishiyama S, Ideta R. Subretinal air migration after pars plana vitrectomy and air tamponade for rhegmatogenous retinal detachment. Am J Ophthalmol Case Rep 2022; 25:101279. [PMID: 35112020 PMCID: PMC8790594 DOI: 10.1016/j.ajoc.2022.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/14/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yukako Ishiyama
- Showa General Hospital, Hanakoganei, Kodaira, Tokyo, Japan
- Corresponding author. 8-1-1, Hanakoganei, Kodaira, Tokyo, Japan.
| | - Sosuke Ishiyama
- Nishikasai Inoue Eye Hospital, Nishikasai, Edogawa-ku, Tokyo, Japan
| | - Ryuichi Ideta
- Ideta Heisei Retinal Consultants, Minami-ku, Kumamoto, Kumamoto, Japan
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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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Abstract
ZusammenfassungDieser Beitrag beschäftigt sich mit der Behandlung der Netzhautablösung. Hier
wird unterschieden zwischen behandlungsbedürftigen Ablatiovorstufen, die
retinopexiert werden, und der manifesten Netzhautablösung, welche
weiterführender Chirurgie bedarf. Nicht immer bedeutet ein anatomischer Erfolg
zugleich auch einen funktionellen Erfolg. Typische postoperative Komplikationen
und Einflussfaktoren auf das anatomische und funktionelle Ergebnis werden
vorgestellt und diskutiert.
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Schaub F, Schick T. [Retinal Detachment Part 2 - Treatment Strategies]. Klin Monbl Augenheilkd 2020; 238:97-111. [PMID: 33207381 DOI: 10.1055/a-1243-1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review article summarizes the relevant surgical strategies for retinal detachment repair and discusses common postoperative complications, as well as factors influencing the functional and anatomical results. Treatment of retinal detachment requires surgery. In most cases, pars plana vitrectomy is performed. In phakic patients with a clear lens scleral buckling can be considered as an alternative. Laser and cryotherapy are still the standard for treatment in symptomatic retinal tears or degenerations without retinal detachment. Postoperatively, the occurrence of a re-detachment as well as the development of proliferative vitreoretinopathy can have a negative influence on postoperative results. Furthermore, typical complications include the occurrence of a cystoid macular edema, epiretinal membrane or even persistent neurosensory detachment. Functional results are significantly influenced by macular involvement and the primary anatomical success rate.
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Hostovsky A, Mandelcorn MS, Mandelcorn ED. Orbital Magnetic Resonance Imaging Demonstrates Better Contact between the Gas and Anterior Inferior Retina in Side versus Face-Down Position. Ophthalmol Retina 2020; 4:911-918. [PMID: 32446841 DOI: 10.1016/j.oret.2020.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To demonstrate the relationship between an intraocular gas bubble, the retina, and the residual intraocular fluid in different head positions using orbital magnetic resonance imaging (MRI) in 3 patients who underwent pars plana vitrectomy (PPV) with gas tamponade. DESIGN Novel study. PARTICIPANTS Patients undergoing PPV with gas-fluid exchange (sulfurhexafluoride [SF6] or perfluoropropane [C3F8]). METHODS Magnetic resonance imaging scans were obtained in 3 patients undergoing PPV with gas-fluid exchange (SF6 or C3F8). All surgeries were performed by a single surgeon (E.D.M.). On the first postoperative day, the volume of intraocular gas fill was estimated separately by 2 surgeons (A.H. and E.D.M). Four orbital MRI scans were obtained from different head positions, including face up (supine), face down (prone on a massage pillow), flat on the right side, and flat on the left side. MAIN OUTCOME MEASURE Relationship between the gas bubble and residual vitreous fluid. RESULTS The MRI images demonstrated, with excellent contrast, the gas and fluid locations in the vitreous cavity in all scans. The relationship between the gas bubble and residual vitreous fluid showed a rapid shift when the patient's head position changed. The MRI images demonstrated that with both 70% gas fill and 95% gas fill, lying on the side can give better support to the inferior retina than face-down positioning. The images demonstrated the importance of accurate head positioning, because a slight change in head position resulted in inadequate contact between the anterior inferior retina and the gas bubble. CONCLUSIONS To our knowledge, this is the first time that the relationship between an intraocular gas bubble and contact with the retina has been evaluated in different head positions in vivo using MRI imaging. The MRI images demonstrated that side positioning gives better contact between the gas bubble and the inferior and anterior retina than prone positioning even when the gas fill is only 70% of the vitreous cavity.
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Affiliation(s)
- Avner Hostovsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
| | - Mark S Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Gozawa M, Kanamoto M, Ishida S, Takamura Y, Iwasaki K, Kimura H, Inatani M. Evaluation of intraocular gas using magnetic resonance imaging after pars plana vitrectomy with gas tamponade for rhegmatogenous retinal detachment. Sci Rep 2020; 10:1521. [PMID: 32001793 PMCID: PMC6992615 DOI: 10.1038/s41598-020-58508-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 12/17/2022] Open
Abstract
We used magnetic resonance imaging (MRI) to assess how a patient’s posture affects intraocular gas changes and whether the postoperative prone position is required after pars plana vitrectomy (PPV) with gas tamponade for rhegmatogenous retinal detachments (RRDs). Eight patients with RRDs who underwent PPV combined with cataract surgery with gas tamponade were prospectively included. They underwent MRI examination both in the prone and supine positions. We separated the retina into four parts: superior–posterior, superior–anterior, inferior–posterior, and inferior–anterior. We then calculated the gas contact rate as (the length of the retina contacting the gas in each retinal part) divided by (the length of each retinal part) × 100% in both the prone and supine positions. The mean gas contact rate of the superior–anterior part of the retina was significantly higher (P = 0.006) in the supine position than in the prone position. The mean gas contact rate of the inferior–anterior part of the retina was also significantly higher (P = 0.0004) in the supine position than in the prone position. We believe that if all retinal breaks were located anterior to the equator, the supine position may provide better tamponade gas coverage for the breaks than the prone position. Although potential postoperative complications caused by the supine position require careful attention, our result may shorten the duration of postoperative prone position and may decrease the patients’ discomfort after PPV with gas tamponade for RRDs.
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Affiliation(s)
- Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan.
| | - Masayuki Kanamoto
- Radiological Center, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan
| | - Shota Ishida
- Radiological Center, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan
| | - Kentaro Iwasaki
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan
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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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15
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Love GH. The black veil: Caring for patients with retinal detachments. Nursing 2019; 49:34-40. [PMID: 31436720 DOI: 10.1097/01.nurse.0000577696.26558.a6] [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: 06/10/2023]
Abstract
Retinal detachments are a rare but serious event, and nurses have an important role in helping maintain optimal outcomes for these patients. This article addresses the causes and treatments for a detached retina.
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Affiliation(s)
- Gayla H Love
- Gayla H. Love is the dean of academic affairs at the Chamberlain College of Nursing in Atlanta, Ga
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16
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Tetsumoto A, Imai H, Otsuka K, Matsumiya W, Miki A, Nakamura M. Clinical factors contributing to postoperative aqueous flare intensity after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment. Jpn J Ophthalmol 2019; 63:317-321. [PMID: 31104165 DOI: 10.1007/s10384-019-00672-9] [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: 10/29/2018] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the perioperative clinical factors, which contribute to the postsurgical aqueous flare intensity (AFI) following 27-gauge pars plana vitrectomy (27GPPV) for primary rhegmatogenous retinal detachment (RRD). STUDY DESIGN Retrospective clinical study. METHODS We performed retrospective analyses of the medical records of 47 eyes of 47 patients with primary RRD who had undergone 27GPPV with a wide-angle viewing system. AFI was measured preoperatively and 1 week, 1 month, 3 months, 6 months, and 12 months after the surgery. RESULTS AFI was significantly increased 1 week after the surgery (p<0.01) and then decreased overtime. At 6 months after surgery it was still statistically significantly higher than preoperative AFI (p=0.03). There was no statistical difference between preoperative AFI and that at 12 months following surgery. Multiple regression analyses revealed that the number of retinal photocoagulations and the performance of scleral indentation had significant positive correlation with AFI at 1 week, 1 month, 3 months, and 6 months, and at 1 month and 3 months after the surgery, respectively. CONCLUSION Intraoperative retinal photocoagulation and scleral indentation are probable causes of increased AFI after 27G PPV for RRD.
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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.
| | - 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
| | - 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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17
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Abstract
PURPOSE To present a case of retinal and uveal necrosis caused by expanding gas tamponade after pars plana vitrectomy. METHODS Single case report. RESULTS An otherwise healthy 66-year-old woman underwent pars plana vitrectomy with intended 20% sulfur hexafluoride (SF6) tamponade for macular hole repair of her pseudophakic left eye. She developed intractable nausea, emesis and increasing left eye pain in association with gas expanded to totally fill the left eye, just hours after surgery. Extremely elevated intraocular pressure was lowered with a successful paracentesis but recurred within a few hours. She then underwent vitrectomy evacuation of all vitreous cavity gas, reformation of the anterior chamber, and silicone oil placement, normalizing intraocular pressure. Three weeks later, the left eye had no light perception, and devitalization of the retina, choroid, and iris was evident. CONCLUSION We present a case of blindness and intraocular tissue dissolution/disorganization after vitrectomy with intended 20% SF6. To our knowledge, this is the most detailed report of the under-recognized complication of expanding gas tamponade. Institutions hosting vitrectomy surgery should consider enacting a formal "Time Out" that requires all team members to witness accurate fractionation of potentially expansile gas. In the event of acute postoperative glaucoma in such eyes, a single small volume paracentesis cannot be relied upon to protect against continued gas expansion.
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18
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Kanclerz P, Grzybowski A. Complications Associated with the Use of Expandable Gases in Vitrectomy. J Ophthalmol 2018; 2018:8606494. [PMID: 30581605 PMCID: PMC6276446 DOI: 10.1155/2018/8606494] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/08/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Intraocular gases have been used in vitreoretinal surgery for over 40 years. The aim of this study was to review the complications related to the use of expandable gases in vitrectomy and their management. A PubMed, Cochrane Library, and Embase search was conducted using the terms "intraocular gas" and "vitrectomy for retinal detachment." Of the articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Intraocular pressure elevation was reported in up to 58.9% patients after vitrectomy with expandable gas administration for retinal detachment. Vitreoretinal surgery is known to induce cataract development. With that, cataract progression is associated with lens exposure to intraocular gas, the duration of such exposure, patient's age, and the magnitude of vitreous removal. With intraocular gas, the posterior surface of the lens becomes a strongly refractive factor, resulting in high myopia and temporary vision impairment. Other complications related to the use of expandable gases include anterior chamber and subconjunctival gas displacement. Single reports on subretinal and cranial gas migration were published. In vitrectomy for uncomplicated retinal detachments, attempts to shift from expandable gases towards air are observed. Nevertheless, gas tamponade remains a reasonable choice for patients suffering from retinal detachment.
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Affiliation(s)
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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19
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Naruse Z, Shimada H, Mori R. Surgical outcomes of 27-gauge and 25-gauge vitrectomy day surgery for proliferative diabetic retinopathy. Int Ophthalmol 2018; 39:1973-1980. [PMID: 30284092 DOI: 10.1007/s10792-018-1030-z] [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: 08/08/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare postoperative outcomes of 27-gauge (G) and 25-G vitrectomy conducted as day surgery for proliferative diabetic retinopathy (PDR). METHODS One hundred eighty-five consecutive PDR patients (185 eyes) who underwent primary vitrectomy (27-G in 64 eyes, 25-G in 121 eyes) were analyzed. RESULTS The 27-G and 25-G groups did not differ significantly in preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, age, or preoperative intraocular pressure. The proportions of simultaneous cataract surgery (27-G vs. 25-G: 59.4% vs. 62.4%) and air-filled eyes (76.6% vs. 85.1%) were not significantly different between two groups. Both groups showed significant improvement in ETDRS score at postoperative 1, 3, and 6 months (all, P < 0.0001). Mean gain in ETDRS score from baseline was apparently better in 27-G group than in 25-G group at 1, 3, and 6 months, but there were no significant differences (1 month: 20.3 vs. 13.1 letters, P = 0.0703; 3 months: 22.9 vs. 17.5 letters, P = 0.1561; 6 months: 24.3 vs. 19.3 letters, P = 0.3313). Operation time was apparently longer for 27-G vitrectomy, but there was no significant difference (54.0 vs. 51.1 min, P = 0.3676). The same was observed for postoperative intraocular pressure at postoperative day 1 (19.7 vs. 18.1 mmHg, P = 0.1353). Incidence of postoperative retinal detachment (1.6% vs. 0.8%) and reoperation due to vitreous hemorrhage (6.3% vs. 6.6%) was not different between two groups. CONCLUSIONS The 27G system is as safe and as useful as the 25G system when used for PDR and can be expected to achieve earlier recovery of postoperative visual acuity.
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Affiliation(s)
- Zeon Naruse
- Miyahara Ophthalmological Clinic, Saitama City, Saitama, Japan
| | - Hiroyuki Shimada
- Department of Ophthalmology, Nihon University Hospital, 1-6 Surugadai, Kanda, Chiyodaku, Tokyo, 101-8309, Japan.
| | - Ryusaburo Mori
- Department of Ophthalmology, Nihon University Hospital, 1-6 Surugadai, Kanda, Chiyodaku, Tokyo, 101-8309, Japan
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