Treatment of Retinal Detachment with Giant Tear by Pneumatic Retinopexy

Evaluation of the treatment results in patients with rhegmatogenous retinal detachment treated by pars plana vitrectomy with air: Preliminary results

PURPOSE

The aim of this study was to evaluate the effectiveness of treatment and the restoration of the anatomic conditions (retinal reattachment) in rhegmatogenous retinal detachment treated by pars plana vitrectomy (PPV) using air as endotamponade.

METHODS

Twelve patients (12 eyes) with rhegmatogenous retinal detachment were included in the study. These were eyes with retinal detachment both with and without macular involvement. During the PPV surgery, the peripheral and central part of the vitreous body was excised to eliminate the formation of vitreoretinal traction after surgery, laser therapy was performed peripherally and in retinal openings, and the eyeball was filled with filtered air. Local conditions were evaluated at 1, 7, 14, 30, 90, and 180 days after the procedure.

RESULTS

The result of the patients' examination on the 30 day after surgery showed that 100% of cases achieved retinal reattachment and improved vision (best corrected visual acuity). In the long-term assessment, the final visual acuity was better in 11 patients (91.7%) compared to the initial results. On average, 7 days after the surgery, air in the eyeball occupied about one-fifth of the vitreous chamber and was completely absorbed about 10 to 14 days after surgery.

CONCLUSIONS

In the above-mentioned study, very good results of treatment of open-rooted retinal detachment were achieved. The air was quickly absorbed and visual acuity improved. Owing to the relatively fast absorption time, this method could be used successfully in high altitude patients and people often travelling by airplane.

Giant retinal tears

A giant retinal tear (GRT) is a full-thickness neurosensory retinal break that extends circumferentially around the retina for three or more clock hours in the presence of a posteriorly detached vitreous. Its incidence in large population-based studies has been estimated as 1.5% of rhegmatogenous retinal detachments, with a significant male preponderance, and bilaterality in 12.8%. Most GRTs are idiopathic, with trauma, hereditary vitreoretinopathies and high myopia each being causative in decreasing frequency. The vast majority of GRTs are currently managed with a pars plana vitrectomy; the use of adjunctive circumferential scleral buckling is debated, but no studies have shown a clear anatomical or visual advantage with its use. Similarly, silicone oil tamponade does not influence long-term outcomes when compared with gas. Primary and final retinal reattachment rates are achieved in 88% and 95% of patients, respectively. Even when the retina remains attached, however, visual recovery may be limited. Furthermore, fellow eyes of patients with a GRT are at higher risk of developing retinal tears and retinal detachment. Prophylactic treatment under these circumstances may be considered but there is no firm evidence of its efficacy at the present time.

Pneumatic retinopexy for the repair of retinal detachments: a comprehensive review (1986-2007)

Pneumatic retinopexy has become an important surgical technique in the modern era of retinal surgical management for retinal detachments. It is primarily indicated for uncomplicated retinal detachments with retinal breaks involving the superior 8 clock hours of the fundus, although more complex retinal detachments may be successfully managed with this technique on a selected basis. Qualified candidates must be willing to maintain a specific head posture for five or more days for optimal outcome with pneumatic retinopexy. Basic surgical steps of pneumatic retinopexy include retinopexy of retinal breaks with cryotherapy or laser, intraocular gas injection before or after retinopexy, and maintenance of proper head posture by the patient for the required time period after surgery. Phakic eyes fared better than nonphakic eyes for pneumatic retinopexy, with the single-operation successes of 71-84% for the former and 41-67% for the latter. Despite lower single-operation successes with pneumatic retinopexy in comparison to sclera buckling, the multicenter pneumatic retinopexy trial and other published reports have shown that the final anatomical and visual outcomes are not disadvantaged by the initial pneumatic retinopexy. An extensive discussion of complications associated with pneumatic retinopexy is presented. In addition, a key feature of this review is a comprehensive update in the outcome of pneumatic retinopexy in published reports from 1986 to the present in chronological order not available in the current literature. This comprehensive summary shows updated average surgical outcomes for the 4,138 eyes in the 21-year period to be similar to previous reports: single-operation successes (74.4%), final operation successes (96.1%), new retinal breaks (11.7%), and proliferative vitreoretinopathy (5.2%).