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Díaz-Aljaro P, Zarranz-Ventura J, Broc-Iturralde L, Romanic-Bubalo N, Díaz-Aljaro I, Chu Z, Wang RK, Valldeperas X. Quantitative Microvascular Change Analysis Using a Semi-Automated Software in Macula-off Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography. J Clin Med 2024; 13:2835. [PMID: 38792378 PMCID: PMC11122367 DOI: 10.3390/jcm13102835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: To analyze the performance of custom semi-automated software for quantitative analysis of retinal capillaries in eyes with macula-off rhegmatogenous retinal detachment (RRD) and the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. Methods: A prospective, observational, and single-center study was conducted on consecutive patients who underwent 25G pars-plana vitrectomy for primary uncomplicated macula-off RRD. Optical coherence tomography angiography (OCTA) was performed in the fellow and RRD eyes before surgery and in months 1, 3, and 6 after surgery. The preoperative values of the fellow eyes were used as surrogates of macula-off ones. The primary endpoints were the mean vessel diameter index (VDI); vessel area density (VAD); and vessel skeleton density (VSD) at month 6. Results: Forty-four eyes (44 patients) were included in the study. Considering the fellow eyes as a surrogate of preoperative values of macula-off eyes, VDI in superficial (SCP) and deep (DCP) capillary plexuses was significantly reduced at month 6 (p = 0.0087 and p = 0.0402, respectively); whereas VSD in SCP increased significantly from preoperative values (p = 0.0278). OCTA built-in software parameters were significantly reduced from month 1 to month 6 in both SCP and DCP (p values ranged between 0.0235 and <0.0001). At month 6, 25 (56.8%) eyes achieved a best-corrected visual acuity BCVA ≥ 0.3 (LogMAR). The greater the preoperative BCVA, the greater the probability of achieving good visual outcomes (Odds ratio: 11.06; p = 0.0037). However, none of the OCTA parameters were associated with the probability of achieving a BCVA improvement ≥ 0.3. Conclusions: Quantitative evaluation of capillary density and morphology through OCTA and semi-automated software represents a valuable tool for clinical assessment and managing the disease comprehensively.
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Affiliation(s)
- Pablo Díaz-Aljaro
- Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | | | - Laura Broc-Iturralde
- Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Nevena Romanic-Bubalo
- Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Ignacio Díaz-Aljaro
- Department of Ophthalmology, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Xavier Valldeperas
- Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
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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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Quiroz-Reyes MA, Babar ZUD, Hussain R, Loh ZC, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review. Int J Retina Vitreous 2024; 10:35. [PMID: 38654369 PMCID: PMC11036595 DOI: 10.1186/s40942-024-00552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events. RESULTS A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%). CONCLUSION PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization, National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, 11000, Lomas de Chapultepec, Mexico City, Mexico.
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, HD1 3DH, Queensgate, Huddersfield, UK
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
| | - Zhe Chi Loh
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization, National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, 11000, Lomas de Chapultepec, Mexico City, Mexico
- Institute of Ophthalmology, National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization, National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, 11000, Lomas de Chapultepec, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution, Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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Schöneberger V, Li JQ, Menghesha L, Holz FG, Schaub F, Krohne TU. Outcomes of short- versus long-acting gas tamponades in vitrectomy for rhegmatogenous retinal detachment. Int J Retina Vitreous 2024; 10:16. [PMID: 38317211 PMCID: PMC10840190 DOI: 10.1186/s40942-024-00530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In vitrectomy for rhegmatogenous retinal detachment, long-acting gas tamponades (LGT) such as C3F8 or C2F6 may improve surgical success rate due to their prolonged effect compared to a short-acting gas tamponade (SGT) with SF6. On the other hand, SGT allow a significantly faster visual rehabilitation after surgery and may reduce the risk of gas-related complications. As comparative data in retinal detachment surgery is limited, we assessed the outcomes of vitrectomies using either LGT or SGT. METHODS We retrospectively analyzed 533 eyes of 524 consecutive patients diagnosed with primary rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy (PVR) and treated by vitrectomy at two clinical sites. Depending on the site the patients presented at, they received either preferentially LGT (study site 1) or SGT (study site 2). Retinal re-detachment rates during a period of 6 months following surgery were analyzed. RESULTS At study site 1, 254 of 278 eyes (91.4%) were treated by LGT (C3F8 72.3%; C2F6 19.1%), whereas at study site 2, 246 of 255 eyes (96.5%) received SGT (SF6). Rates of retinal re-detachment in the LGT- and SGT-treated groups were similar with 23 of 254 eyes (9.1%) and 24 of 246 eyes (9.8%), respectively (p = 0.9). Median time to re-detachment was 5.7 weeks in the LGT-treated group and 4.4 weeks in the SGT-treated group (p = 0.4). CONCLUSION In rhegmatogenous retinal detachment repair by vitrectomy, the use of SGT results in comparable rates of successful retinal re-attachment as LGT. Given the faster visual rehabilitation with SGT, these results suggest SGT as a sensible alternative to LGT in surgery of retinal detachment without PVR.
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Affiliation(s)
- Verena Schöneberger
- Department of Ophthalmology, University Medical Center Rostock, University of Rostock, Doberaner Str. 140, 18057, Rostock, Germany.
| | - Jeany Q Li
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Leonie Menghesha
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Friederike Schaub
- Department of Ophthalmology, University Medical Center Rostock, University of Rostock, Doberaner Str. 140, 18057, Rostock, Germany
| | - Tim U Krohne
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Teh BL, Toh S, Williamson TH, Obara B, Guillemaut JY, Steel DH. Reducing the use of fluorinated gases in vitreoretinal surgery. Eye (Lond) 2024; 38:229-232. [PMID: 37419956 PMCID: PMC10810807 DOI: 10.1038/s41433-023-02639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
| | - Steven Toh
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tom H Williamson
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
- King's College Medical School, London, UK
| | - Boguslaw Obara
- School of Computing and Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jean-Yves Guillemaut
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
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Hébert M, Bourgault S, Caissie M, Tourville É, Dirani A. REtinal Detachment Outcomes Study (REDOS): study protocol for a factorial, randomized controlled trial. Trials 2023; 24:820. [PMID: 38124155 PMCID: PMC10734075 DOI: 10.1186/s13063-023-07815-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Few large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade. METHODS Eligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8-10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results. DISCUSSION This will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina's recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary. TRIAL REGISTRATION ClinicalTrials.gov NCT05863312. Registered on 18 May 2023.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Mathieu Caissie
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Éric Tourville
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada.
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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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Nishi K, Nakamura M, Nishitsuka K. Efficacy of vitrectomy with air tamponade for rhegmatogenous retinal detachment: a prospective study. Sci Rep 2023; 13:10790. [PMID: 37402777 DOI: 10.1038/s41598-023-37693-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
Rhegmatogenous retinal detachment (RRD) causes a permanent decrease in visual acuity and visual field. During pars plana vitrectomy (PPV) for RRD, long acting gas have been selected for tamponade because gas stays in the eye for a long time. Recently, several studies have showed the efficacy of air tamponade for RRD treatment. Few prospective studies have analyzed the efficacy of air tamponade. We registered 194 eyes from 190 patients who consented to a prospective study of PPV with air tamponade for RRD by a single surgeon from June 2019 to November 2022. These patients were all treated with air tamponade without silicone oil and were followed for > 3 months postoperatively. Primary success rates were 97.9% (190/194) in total cases, with no discernible difference between the uncomplicated (100%:87/87) and complicated (96.3%: 103/107) RRD groups (P = 0.13). There was no considerable difference in primary success rate between upper break (97.9%:143/146) and lower break cases (97.9%:47/48). Proliferative vitreoretinopathy (PVR) grade C was associated with initial failure by multivariate analysis (P = 0.00003). Air tamponade has a sufficient therapeutic effect in cases of RRD less than PVR grade C, regardless of the location of the retinal tear.
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Affiliation(s)
- Katsuhiro Nishi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, Yamagata, 990-9585, Japan
| | - Madoka Nakamura
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, Yamagata, 990-9585, Japan
| | - Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, Yamagata, 990-9585, Japan.
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10
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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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11
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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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12
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Chen HJ, Tsai YL, Hsiao CH, Chang CJ. Air versus Gas Tamponade for Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis. Ophthalmic Res 2023; 66:767-776. [PMID: 36972573 DOI: 10.1159/000530232] [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: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Air tamponade's effectiveness in treatment of rhegmatogenous retinal detachment (RRD) remains unclear. OBJECTIVE We aimed to review the surgical outcomes between air and gas tamponade after vitrectomy for RRD. METHOD PubMed, Cochrane Library, EMBASE, and Web of Science were reviewed. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42022342284). The primary outcome was the primary anatomical success after vitrectomy. The secondary outcome was the prevalence of postoperative ocular hypertension. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Ten studies involving 2,677 eyes were included. One study was randomized, and the others were non-randomized. The primary anatomical success after vitrectomy was not significantly different between the air and gas groups (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.68-1.48). The risk of ocular hypertension was significantly lower in the air group (OR: 0.14; 95% CI: 0.09-0.24). The certainty of evidence regarding air tamponade having a comparable anatomical outcome and lower frequency of postoperative ocular hypertension in treatment of RRD were low. DISCUSSION The current evidence base for tamponade selection in treatment of RRD has several major limitations. Further appropriately designed studies are needed to guide tamponade selection.
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Affiliation(s)
- Hung-Ju Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Hao Hsiao
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Jen Chang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan
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13
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Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery. Int J Mol Sci 2023; 24:ijms24043342. [PMID: 36834754 PMCID: PMC9961686 DOI: 10.3390/ijms24043342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Vitreous substitutes are indispensable tools in vitreoretinal surgery. The two crucial functions of these substitutes are their ability to displace intravitreal fluid from the retinal surface and to allow the retina to adhere to the retinal pigment epithelium. Today, vitreoretinal surgeons can choose among a plethora of vitreous tamponades, and the tamponade of choice might be difficult to determine in the ever-expanding range of possibilities for a favorable outcome. The currently available vitreous substitutes have disadvantages that need to be addressed to improve the surgical outcome achievable today. Herein, the fundamental physical and chemical proprieties of all vitreous substitutes are reported, and their use and clinical applications are described alongside some surgical techniques of intra-operative manipulation. The major upcoming developments in vitreous substitutes are extensively discussed, keeping a translational perspective throughout. Conclusions on future perspectives are derived through an in-depth analysis of what is lacking today in terms of desired outcomes and biomaterials technology.
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14
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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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15
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Qian T, Suo Y, Ma Y, Chen C, Liu K, Chen F, Fan Y, Wang W, Xu X. Air versus Perfluoropropane Gas in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment: A 3-Year Retrospective Study. Ophthalmic Res 2023; 66:506-515. [PMID: 36689936 DOI: 10.1159/000529261] [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: 09/06/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION This study aimed to compare anatomical outcomes of air and perfluoropropane gas (C3F8) tamponade in pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). METHODS In this retrospective study, data were gathered from 578 patients (578 eyes) with RRD. The follow-up records of all 578 patients that underwent primary vitrectomy for RRD with air or C3F8 were examined and analyzed. Surgical outcomes of the two groups were compared. RESULTS A total of 342 eyes were treated with air and 236 with C3F8. The mean follow-up period was 37.65 ± 2.33 months. Baseline and preoperative clinical characteristics were similar between groups, but the period to intraocular bubble disappearance (p < 0.0001), intraocular pressure on the first postoperative day (p < 0.0001), number of cases with intraocular pressure >21 mm Hg within 3 days post-surgery (p < 0.0001), and the number with intraocular pressure >21 mm Hg during follow-up (p = 0.0002) differed significantly between groups. Primary reattachment rates for air and C3F8 groups were 95.03% and 95.34%, respectively. Clinical characteristics were similar in those with and without successful reattachment, and the frequency of new or unclosed breaks was similar between the two groups. There was no significant difference in two groups according to the presence or absence of inferior retinal breaks and inferior detached quadrants. Univariate and multivariate logistic regression identified no risk factor for surgical failure. CONCLUSIONS Air showed equivalent effects to C3F8, with a shorter period to intraocular bubble disappearance, less risk of postoperative intraocular hypertension, and less expense.
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Affiliation(s)
- Tianwei Qian
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China,
- National Clinical Research Center for Eye Diseases, Shanghai, China,
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China,
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China,
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China,
| | - Yan Suo
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
- Department of Ophthalmology, Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Yingyan Ma
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Chong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Feng'e Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Ying Fan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Weijun Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
- Department of Ophthalmology, Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
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16
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Warren A, Wang DW, Lim JI. Rhegmatogenous retinal detachment surgery: A review. Clin Exp Ophthalmol 2023; 51:271-279. [PMID: 36640144 DOI: 10.1111/ceo.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Rhegmatogenous retinal detachment (RRD) is a serious surgical condition with significant ocular morbidity if not managed properly. Once untreatable, approaches to the repair of RRD have greatly evolved over the years, leading to outstanding primary surgical success rates. The management of RRD is often a topic of great debate. Scleral buckling, vitrectomy and pneumatic retinopexy have been used successfully for the treatment of RRD. Several factors may affect surgical success and dictate a surgeon's preference for the technique employed. In this review, we provide an overview and supporting literature on the options for RRD repair and their respective preoperative and postoperative considerations in order to guide surgical management.
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Affiliation(s)
- Alexis Warren
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | - Daniel W Wang
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | - Jennifer I Lim
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
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17
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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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18
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Govers BM, Lamers MP, Klevering BJ, Keijser S. Air versus fluorinated gas tamponades in pars plana vitrectomy treatment for primary rhegmatogenous retinal detachment. Acta Ophthalmol 2022; 100:e1600-e1605. [PMID: 35352498 PMCID: PMC9790619 DOI: 10.1111/aos.15144] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/17/2022] [Accepted: 03/15/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the treatment success of air with fluorinated gas (20% SF6 or 14% C3 F8 ) tamponade in pars plana vitrectomy for primary rhegmatogenous retinal detachment. METHODS A retrospective cohort study comprised of 1023 consecutive primary retinal detachment cases between 2014 and 2020. We employed a univariate multivariable binary logistic regression model. RESULTS We used intraocular gas tamponades in 872 cases with PVR grade B or lower: air tamponade was used in 414 eyes and 458 eyes were treated with a type of fluorinated gas tamponade. There was no significant difference in the type of tamponade with regard to the re-detachment rate (95% CI -1.0% and 4.1%). Additionally, also in the subgroup of rhegmatogenous retinal detachments with inferior located retinal defects we found no significant difference between the two types of tamponade (p = 0.54 Fisher's exact). The multivariable model, which included tamponade, PVR grade, a retinal detachment involving the 6 o'clock position and age as covariates, also showed no significant effect of tamponade choice on treatment success (OR 0.5, 95% 0.2-1.0, p = 0.10). CONCLUSION We found no difference in treatment success with air tamponade versus fluorinated gas tamponades in the repair of primary retinal detachments, this also includes inferiorly located retinal tears and detachments.
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Affiliation(s)
| | - Martijn P.M. Lamers
- Department of OphthalmologyRadboud University Medical CentreNijmegenThe Netherlands
| | - B. Jeroen Klevering
- Department of OphthalmologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Sander Keijser
- Department of OphthalmologyRadboud University Medical CentreNijmegenThe Netherlands
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19
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Ribeiro L, Oliveira J, Kuroiwa D, Kolko M, Fernandes R, Junior O, Moraes N, Vasconcelos H, Oliveira T, Maia M. Advances in Vitreoretinal Surgery. J Clin Med 2022; 11:6428. [PMID: 36362657 PMCID: PMC9658321 DOI: 10.3390/jcm11216428] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 09/05/2023] Open
Abstract
Advances in vitreoretinal surgery provide greater safety, efficacy, and reliability in the management of the several vitreoretinal diseases that benefit from surgical treatment. The advances are divided into the following topics: scleral buckling using chandelier illumination guided by non-contact visualization systems; sclerotomy/valved trocar diameters; posterior vitrectomy systems and ergonomic vitrectomy probes; chromovitrectomy; vitreous substitutes; intraoperative visualization systems including three-dimensional technology, systems for intraoperative optical coherence tomography, new instrumentation in vitreoretinal surgery, anti-VEGF injection before vitrectomy and in eyes with proliferative diabetic retinopathy, and new surgical techniques; endoscopic surgery; the management of subretinal hemorrhages; gene therapy; alternative techniques for refractory macular hole; perspectives for stem cell therapy and the prevention of proliferative vitreoretinopathy; and, finally, the Port Delivery System. The main objective of this review is to update the reader on the latest changes in vitreoretinal surgery and to provide an understanding of how each has impacted the improvement of surgical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mauricio Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04021-001, Brazil
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20
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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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21
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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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22
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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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23
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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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24
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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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25
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Nakamura M, Nishi K, Nishitsuka K. Selection Criteria for Air Tamponade During Vitrectomy for Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2022; 16:981-986. [PMID: 35386614 PMCID: PMC8977474 DOI: 10.2147/opth.s359936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare air tamponade and sulfur hexafluoride (SF6) gas tamponade during vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). Methods We reviewed 294 eyes with RRD treated with 25-gauge vitrectomy by a single surgeon between June 2011 and April 2018 retrospectively. The exclusion criteria for the proposed air tamponade selection were more than 2 weeks since onset, giant retinal tears, history of complications following cataract surgery, high myopia, and proliferative vitreoretinopathy classified as grade C or higher. We examined the differences in the therapeutic effect between the air group and SF6 group at 6-month follow-up. Results A total of 294 eyes were included in the study, 156 eyes in the air group and 138 eyes in the SF6 group. No difference was observed in the primary anatomical success rates between the air group (99.4%; 155/156 eyes) and the SF6 group (96.5%; 135/138 eyes; P = 0.102). Postoperative intraocular gas half-life was shorter in the air group (3.97 ± 0.87 days) compared with the that in the SF6 group (8.67 ± 1.47 days; P = 0.0001). The incidence of postoperative ocular hypertension was lower in the air group (19.9%; 31/156 eyes) than in the SF6 group (62.3% 86 /138 eyes; P = 0.0001). Conclusion We compared the criteria for proper selection between air and SF6 gas tamponade during vitrectomy for the treatment of RRD. Air tamponade was able to reduce the period of prone position and the risk of ocular hypertension without reducing the therapeutic effect.
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Affiliation(s)
- Madoka Nakamura
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Katsuhiro Nishi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
- Correspondence: Koichi Nishitsuka, Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan, Tel +81 23-628-5374, Fax + 81 23-528-5377, Email
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26
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Vurallı D, Gönç N, Özön A, Ekinci S, Doğan HS, Tekgül S, Alikaşifoğlu A. Feminizing Adrenocortical Tumors as a Rare Etiology of Isosexual/Contrasexual Pseudopuberty. J Clin Res Pediatr Endocrinol 2022; 14:17-28. [PMID: 34380293 PMCID: PMC8900075 DOI: 10.4274/jcrpe.galenos.2021.2021.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Estrogen-secreting adrenocortical tumors (ACTs) are quite rare with feminizing adrenocortical tumors (FATs) accounting for 0.37-2% of all ACTs. The aim was to evaluate clinical and hormonal characteristics of FATS as well as treatment options and follow-up in the pediatric age group. METHODS Medical records of children with ACTs presenting to a single center in the last two decades were reviewed. Literature review within Pubmed revealed 34 pediatric patients (22 boys) with FAT among 192 articles. RESULTS Among the 25 children presenting with ACTs in the last two decades, two new pediatric cases of FAT were identified, one benign and the other malignant, in two genders with different clinical presentations. Literature review showed that FATs are extremely rare tumors that are most commonly seen in men and boys presenting with gynecomastia. FATs are more common in children ≤8 years of age, with a median age at diagnosis of six years. While boys present with contrasexual pseudopuberty signs, girls present with isosexual pseudopuberty. A high estrogen level strongly supports diagnosis, while elevations in other adrenal hormones may be seen. FATs are usually malignant in adults and prognosis is generally very poor. However, in children approximately half are benign although assessment of malignant potential depends on clinical behavior of the tumor. FATs are very unpredictable so even after surgery long-term follow-up is required. FATs presenting in childhood may have a better prognosis than adult presentation tumors as most FATs in children are followed without recurrence of tumor. CONCLUSION FATs are more common in children ≤8 years of age, with a median age at diagnosis of six years. FATs in childhood may have a better prognosis than in adult males.
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Affiliation(s)
- Doğuş Vurallı
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey Phone: +90 312 305 11 24 E-mail:
| | - Nazlı Gönç
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
| | - Alev Özön
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
| | - Saniye Ekinci
- Hacettepe University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - H. Serkan Doğan
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey
| | - Serdar Tekgül
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey
| | - Ayfer Alikaşifoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
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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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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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Songur MS, Citirik M. Evaluation of the Usefulness of YouTube Videos on Retinal Detachment Surgery. Cureus 2021; 13:e19457. [PMID: 34912603 PMCID: PMC8664355 DOI: 10.7759/cureus.19457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction The aim of this study is to evaluate the usefulness of YouTube videos about retinal detachment surgery as a resource. Methods The first 100 videos were evaluated when they were scanned by typing "retinal detachment surgery " in the YouTube search engine. These videos were also analyzed and scored using DISCERN, Journal of the American Medical Association (JAMA), and Global Quality (GQ) scoring systems. Results The DISCERN score of the evaluated videos was 39.5±8.4; JAMA score was 1.9±0.5; and the GQ score was 2.1±0.5. According to the results, retinal detachment surgery videos, DISCERN score is medium; The JAMA score was evaluated as low quality and poor quality in the GQ score. Conclusion Although there are enough videos on YouTube with retinal detachment surgery, its usefulness as a resource is low, and its quality is poor.
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Affiliation(s)
| | - Mehmet Citirik
- Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, TUR
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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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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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Kusaba K, Tsuboi K, Handa T, Shiraki Y, Kataoka T, Kmaei M. Primary rhegmatogenous retinal detachment: evaluation of a minimally restricted face-down positioning after pars plana vitrectomy and gas tamponade. Int J Ophthalmol 2021; 14:936-939. [PMID: 34150551 DOI: 10.18240/ijo.2021.06.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the safety and efficacy of a minimally restricted face-down postoperative positioning following pars plana vitrectomy (PPV) with gas tamponade for primary rhegmatogenous retinal detachment (RRD). METHODS Patients with primary RRD treated with PPV and gas tamponade and followed up for at least 6mo were selected for the study. All phakic eyes underwent simultaneous cataract surgery. The patients were required to be in a postoperative position that prevented downward flow of retinal tears. Patients with macular detachment were positioned face-down for only a couple of hours. The patients were assessed for preoperative and postoperative best-corrected visual acuity (BCVA), anatomical retinal reattachment rate, and postoperative complications. RESULTS In total, 40 eyes of 39 patients with primary RRD were included in the study. A single tear was present in 30 eyes (75.0%), multiple retinal tears were present in nine eyes (22.5%), and oral dialysis was present in one eye (2.5%). The anatomical success rate was 90.0% (36 cases) after the primary surgery, and the final anatomical success rate was 100%. The BCVA improved significantly (P<0.001) from 0.75 logarithm angle of resolution (logMAR) preoperatively to 0.12 logMAR at the final visit. Postoperative complications included intraocular pressure elevation (≥25 mm Hg) in 11 patients (27.5%), fibrin formation in two patients (5.0%), pupillary capture of the intraocular lens in two patients (5.0%), and posterior synechia in one patient (2.5%). CONCLUSION A minimally restricted face-down and flexible postoperative positioning after PPV and gas tamponade for primary RRD is effective and safe.
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Affiliation(s)
- Kiichiro Kusaba
- Department of Ophthalmology, Aichi Medical University, Tazako, Nagakute-city, Aichi 480-1195, Japan
| | - Kotaro Tsuboi
- Department of Ophthalmology, Aichi Medical University, Tazako, Nagakute-city, Aichi 480-1195, Japan
| | - Tsuneaki Handa
- Department of Ophthalmology, Aichi Medical University, Tazako, Nagakute-city, Aichi 480-1195, Japan
| | - Yukihiko Shiraki
- Department of Ophthalmology, Aichi Medical University, Tazako, Nagakute-city, Aichi 480-1195, Japan
| | - Takuya Kataoka
- Department of Ophthalmology, Aichi Medical University, Tazako, Nagakute-city, Aichi 480-1195, Japan
| | - Motohiro Kmaei
- Department of Ophthalmology, Aichi Medical University, Tazako, Nagakute-city, Aichi 480-1195, Japan
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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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Mondelo-García C, Bandín-Vilar E, García-Quintanilla L, Castro-Balado A, Del Amo EM, Gil-Martínez M, Blanco-Teijeiro MJ, González-Barcia M, Zarra-Ferro I, Fernández-Ferreiro A, Otero-Espinar FJ. Current Situation and Challenges in Vitreous Substitutes. Macromol Biosci 2021; 21:e2100066. [PMID: 33987966 DOI: 10.1002/mabi.202100066] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Indexed: 12/11/2022]
Abstract
Vitreo-retinal disorders constitute a significant portion of treatable ocular diseases. These pathologies often require vitreo-retinal surgery and, as a consequence, the use of vitreous substitutes. Nowadays, the vitreous substitutes that are used in clinical practice are mainly divided into gases (air, SF6 , C2 F6 , C3 F8 ) and liquids (perfluorocarbon liquids, silicone oils, and heavy silicone oils). There are specific advantages and drawbacks to each of these, which determine their clinical indications. However, developing the ideal biomaterial for vitreous substitution continues to be one of the most important challenges in ophthalmology, and a multidisciplinary approach is required. In this sense, recent research has focused on the development of biocompatible, biodegradable, and injectable hydrogels (natural, synthetic, and smart), which also act as medium and long-term internal tamponade agents. This comprehensive review aims to cover the main characteristics and indications for use of the extensive range of vitreous substitutes that are currently used in clinical practice, before going on to describe the hydrogels that have been developed recently and which have emerged as promising biomaterials for vitreous substitution.
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Affiliation(s)
- Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Enrique Bandín-Vilar
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Laura García-Quintanilla
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Ana Castro-Balado
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Eva M Del Amo
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, 70211, Finland
| | - María Gil-Martínez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain
| | - María José Blanco-Teijeiro
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, 15706, Spain.,Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, 15706, Spain
| | - Francisco J Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, 15782, Spain
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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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Baker AEG, Cui H, Ballios BG, Ing S, Yan P, Wolfer J, Wright T, Dang M, Gan NY, Cooke MJ, Ortín-Martínez A, Wallace VA, van der Kooy D, Devenyi R, Shoichet MS. Stable oxime-crosslinked hyaluronan-based hydrogel as a biomimetic vitreous substitute. Biomaterials 2021; 271:120750. [PMID: 33725584 DOI: 10.1016/j.biomaterials.2021.120750] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
Vitreous substitutes are clinically used to maintain retinal apposition and preserve retinal function; yet the most used substitutes are gases and oils which have disadvantages including strict face-down positioning post-surgery and the need for subsequent surgical removal, respectively. We have engineered a vitreous substitute comprised of a novel hyaluronan-oxime crosslinked hydrogel. Hyaluronan, which is naturally abundant in the vitreous of the eye, is chemically modified to crosslink with poly(ethylene glycol)-tetraoxyamine via oxime chemistry to produce a vitreous substitute that has similar physical properties to the native vitreous including refractive index, density and transparency. The oxime hydrogel is cytocompatible in vitro with photoreceptors from mouse retinal explants and biocompatible in rabbit eyes as determined by histology of the inner nuclear layer and photoreceptors in the outer nuclear layer. The ocular pressure in the rabbit eyes was consistent over 56 d, demonstrating limited to no swelling. Our vitreous substitute was stable in vivo over 28 d after which it began to degrade, with approximately 50% loss by day 56. We confirmed that the implanted hydrogel did not impact retina function using electroretinography over 90 days versus eyes injected with balanced saline solution. This new oxime hydrogel provides a significant improvement over the status quo as a vitreous substitute.
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Affiliation(s)
- Alexander E G Baker
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada; Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada
| | - Hong Cui
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada
| | - Brian G Ballios
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada
| | - Sonja Ing
- Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada
| | - Peng Yan
- Kensington Eye Institute, 340 College St, Toronto, ON, M5T 3A9, Canada
| | - Joe Wolfer
- Toronto Animal Eye Clinic, 150 Norseman St, Etobicoke, ON, M8Z 2R4, Canada
| | - Thomas Wright
- Kensington Eye Institute, 340 College St, Toronto, ON, M5T 3A9, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada
| | - Mickael Dang
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada
| | - Nicola Y Gan
- Department of Ophthalmology, Tock Seng Hospital, National Healthcare Group Eye Institute, 11 Jln Tan Tock Seng, 308433, Singapore
| | - Michael J Cooke
- Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada
| | - Arturo Ortín-Martínez
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Valerie A Wallace
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada; Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada
| | - Derek van der Kooy
- Department of Molecular Genetics, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada
| | - Robert Devenyi
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St, Toronto, ON, L0J 1C0, Canada; Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada; Toronto Western Hospital, 399 Bathurst St, Room 6 E W 438, Toronto, ON, M5T 2S8, Canada
| | - Molly S Shoichet
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada; Institute of Biomedical Engineering, University of Toronto, 160 College St, Toronto, ON, M5S 3E1, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, ON, M5S 1A8, Canada.
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Iwase T, Tomita R, Ra E, Iwase C, Terasaki H. Investigation of causative factors for unusual shape of macula in eyes with macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol 2021; 65:363-371. [PMID: 33423136 DOI: 10.1007/s10384-020-00810-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the factors significantly associated with anterior protrusion of the macula in eyes with a macula-off rhegmatogenous retinal detachment (RRD) and to determine the relationship between the intraretinal cystoid cavities (ICCs) and the anterior protrusion and function of the fovea. STUDY DESIGN Retrospective cross-sectional study. METHODS Sixty-nine eyes of 69 patients with successfully reattached macula-off RRD were retrospectively analyzed. Six radial spectral-domain optical coherence tomographic (OCT) images were used to evaluate the effects of the ICCs on detached macula and to measure the angle of the retina at the macula as a parameter to evaluate the anterior protrusion of the detached retina. The findings were compared to other parameters. RESULTS The mean angle of the retina at the macula was 143.1 ± 15.9° with a range of 108 to 172°. Preoperatively, 51 eyes (74%) had ICCs in the inner nuclear layer and/or the outer plexiform layer and Henle fiber layer complex, but none was present after surgery. Multivariate regression analyses revealed that the angle of the retina was significantly associated with the presence of ICCs (β = -0.637, P<0.001) and the height of subretinal fluid (β = -0.256, P = 0.005). Eyes with ICCs had poorer preoperative vision (P<0.001), narrower angle of the retina (P<0.001), and thicker subretinal fluid (P<0.001) than eyes without cavities. CONCLUSIONS The anterior protrusion in eyes with macula-off RRD is associated with the presence of ICCs. The presence of ICCs can affect preoperative function and morphology but does not affect postoperative function and morphology.
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Affiliation(s)
- Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan. .,Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondou, Akita, Akita, 010-8543, Japan.
| | - Ryo Tomita
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eimei Ra
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Polymeric hydrogels as a vitreous replacement strategy in the eye. Biomaterials 2020; 268:120547. [PMID: 33307366 DOI: 10.1016/j.biomaterials.2020.120547] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
Vitreous endo-tamponades are commonly used in the treatment of retinal detachments and tears. They function by providing a tamponading force to support the retina after retina surgery. Current clinical vitreous endo-tamponades include expansile gases (such as sulfur hexafluoride (SF6) and perfluoropropane (C3F8)) and also sislicone oil (SiO). They are effective in promoting recovery but are disadvantaged by their lower refractive indices and lower densities as compared to the native vitreous, resulting in immediate blurred vision after surgery and necessitating patients to assume prolonged face-down positioning respectively. While the gas implants diffuse out over time, the SiO implants are non-biodegradable and require surgical removal. Therefore, there is much demand to develop an ideal vitreous endo-tamponade that can combine therapeutic effectiveness with patient comfort. Polymeric hydrogels have since attracted much attention due to their favourable properties such as high water content, high clarity, suitable refractive indices, suitable density, tuneable rheological properties, injectability, and biocompatibility. Many design strategies have been employed to design polymeric hydrogel-based vitreous endo-tamponades and they can be classified into four main strategies. This review seeks to analyse these various strategies and evaluate their effectiveness and also propose the key criteria to design successful polymeric hydrogel vitreous endo-tamponades.
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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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Lee JJ, Kwon HJ, Lee SM, Byon IS, Lee JE, Park SW. Duration of room air tamponade after vitrectomy. Jpn J Ophthalmol 2020; 64:216-222. [DOI: 10.1007/s10384-020-00714-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
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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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Park SH, Yang SC, Lee JJ, Kwon H, Park SW, Lee JE. Fortified Barrier Laser On The Vitreous Base In Vitrectomy For Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2019; 13:2127-2133. [PMID: 31802842 PMCID: PMC6827521 DOI: 10.2147/opth.s223415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the efficacy of fortified barrier laser (FBL) on the vitreous base in vitrectomy for rhegmatogenous retinal detachment (RRD). Patients and methods This was a retrospective study of patients who underwent vitrectomy for RRD without proliferative vitreoretinopathy. Barrier laser was applied as 3-4 rows surrounding the break at the end of fluid-air exchange. For the FBL, 3-4 rows of laser burn were additionally made about 0.5 clock-hour long adjacent to the break along the posterior border of the vitreous base. The primary outcome was single surgery success rate (SSSR) between two groups: FBL and conventional barrier laser (CBL) groups. Results Overall, 118 eyes were included; 50 eyes in the FBL group and 68 eyes in the CBL group. SSSR was 100% (50/50) in the FBL group and 91.2% (62/68) in the CBL group with a significant difference (p=0.038). Four eyes of the recurrent cases in the CBL group were related to reopening of the break. All eyes achieved reattachment, and no differences were found in postoperative visual acuity at 6 months. Conclusion FBL on the vitreous base was efficacious in improving the anatomical success rate of vitrectomy.
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Affiliation(s)
- Sun Ho Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sang Cheol Yang
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jae Jung Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hanjo Kwon
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Correlation between preoperative factors and final visual acuity after successful rhegmatogenous retinal reattachment. Sci Rep 2019; 9:3217. [PMID: 30824755 PMCID: PMC6397257 DOI: 10.1038/s41598-019-39839-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/31/2019] [Indexed: 11/08/2022] Open
Abstract
We evaluated the preoperative optical coherence tomographic (OCT) findings in eyes with macula-off rhegmatogenous retinal detachment (RRD) and determined the factors that were significantly correlated with the postoperative best-corrected visual acuity (BCVA). The length of the preoperative photoreceptors was defined as the distance between the external limiting membrane (ELM) and the outer end of the outer segments of the photoreceptors in the OCT images. The mean length of the photoreceptors was 102.8 ± 28.7 µm with a range of 20 to 159 µm in eyes with RRD. The length of the preoperative photoreceptors was not significantly correlated with the preoperative BCVA but it was significantly correlated with the postoperative BCVA (r = -0.353, P = 0.003). Multivariate regression analyses revealed that the length of the photoreceptors (β = -0.388, P = 0.001) and the preoperative BCVA (β = 0.274, P = 0.021) were the only independent factors that were significantly associated with the postoperative BCVA. The length of the preoperative photoreceptors was significantly correlated with the postoperative photoreceptor length (r = 0.486, P < 0.001). Longer preoperative photoreceptors were significantly correlated with longer postoperative photoreceptors and better BCVA after successful reattachment. These results suggest that the preoperative length of the photoreceptors can be good factor to use for predicting the final BCVA following successful reattachment of macula-off RRD.
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Singh SR, Dogra M, Dogra MR. Comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment. Indian J Ophthalmol 2018; 67:185. [PMID: 30574952 PMCID: PMC6324131 DOI: 10.4103/ijo.ijo_1107_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Simar Rajan Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat Ram Dogra
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh SR, Dhurandhar D, Chhablani J. Response to comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment. Indian J Ophthalmol 2018; 67:185-186. [PMID: 30574953 PMCID: PMC6324141 DOI: 10.4103/ijo.ijo_1290_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sumit Randhir Singh
- Academy for Eye Care Education, LV Prasad Eye Institute; Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Deven Dhurandhar
- Academy for Eye Care Education, LV Prasad Eye Institute; Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Academy for Eye Care Education, LV Prasad Eye Institute; Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
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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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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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COMPLETE SUBRETINAL FLUID DRAINAGE IS NOT NECESSARY DURING VITRECTOMY SURGERY FOR MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT WITH PERIPHERAL BREAKS: A Prospective, Nonrandomized Comparative Interventional Study. Retina 2017; 37:487-493. [PMID: 27429377 DOI: 10.1097/iae.0000000000001180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments managed by surgical protocols, the result in either complete (CSFD) or partial subretinal fluid drainage (PSFD). METHODS Fifty-four eyes with macula-off rhegmatogenous retinal detachments with peripheral retinal breaks of 54 patients were assigned prospectively to one of the two surgical designs (PSFD or CSFD, 2:1) in a sequence. Patients were treated with 25-gauge plus vitrectomy, either CSFD (n = 18) or PSFD (n = 36), and 14% C3F8 was used for intraocular tamponade. Anatomical and visual outcomes as well as intraoperative and postoperative complications of the two groups were compared. RESULTS The single-operation success rates were 16/18 (88.9%) and 33/36 (91.6%), respectively, for the CSFD and the PSFD groups (P = 1.00). The mean BCVA improvement (Early Treatment Diabetic Retinopathy Study letters) at the 6-month postoperative was not significantly different between the two groups (26.50 ± 15.43 in CSFD group vs. 22.64 ± 15.43 in PSFD group, P = 0.43). CONCLUSION Partial subretinal fluid drainage procedure during vitrectomy for the repair of macula-off rhegmatogenous retinal detachments revealed comparable results with CSFD in terms of anatomical and visual outcomes. Complete subretinal fluid drainage during vitrectomy seems to be unnecessary for all RRD reattachment surgical procedures.
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