Pars plana vitrectomy with partial tamponade of filtered air in Rhegmatogenous retinal detachment caused by superior retinal breaks

Air tamponade in vitrectomies for primary rhegmatogenous retinal detachment caused by superior breaks

The effectiveness of filtered air tamponade for superior retinal breaks was well established. This study was performed to compare the treatment efficacy of pars plana vitrectomies (PPV) with filtered air and silicone oil (SO) for patients with rhegmatogenous retinal detachment (RRD) caused by superior breaks with no or mild proliferative vitreoretinopathy. Patients of RRD with superior breaks who underwent PPV with filtered air (Group A) and SO (Group S) tamponade were reviewed retrospectively. Age, gender, laterality, lens status, duration of symptoms, macular status, proliferative vitreoretinopathy grade, use of perfluorocarbon liquid, early and late postoperative complications, follow-up duration were acquired. The primary anatomic reattachment after the first surgery and the final rate of successful reattachment was compared as the main outcome. Secondary outcomes were long-term postoperative best-corrected visual acuity (BCVA), rate of deferred cataract removal, surgical complications and total surgery number. The primary anatomic success rate was 88% (14/16 eyes) in Group A and 100% (16/16 eyes) in group S, which was not significantly different (P = .484). Both groups achieved 100% final anatomic success. The rate of cataract removal was 57.1% and 100% (P = .016), and the duration from first surgery to cataract surgery was 231.38 ± 241.23 and 156.36 ± 110.09 days (P = .428) for group A and group S, respectively. The rate of postoperative epiretinal membrane was 21.4% vs 25.0% (P = 1.000). Postoperative BCVA was associated with preoperative BCVA after multiple linear analysis. The primary and final anatomic success rate for PPV with air tamponade and SO in treating RRD with superior breaks were not statistically different. The rate of deferred cataract removal was higher in patients with SO as tamponade.

The use of fluorinated gases and quantification of carbon emission for common vitreoretinal procedures

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".

Advances in Polysaccharide- and Synthetic Polymer-Based Vitreous Substitutes

The vitreous humour is a gel-like structure that composes the majority of each eye. It functions to provide passage of light, be a viscoelastic dampener, and hold the retina in place. Vitreous liquefaction causes retinal detachment and retinal tears requiring pars plana vitrectomy for vitreous substitution. An ideal vitreous substitute should display similar mechanical, chemical, and rheological properties to the natural vitreous. Currently used vitreous substitutes such as silicone oil, perfluorocarbon liquids, and gases cannot be used long-term due to adverse effects such as poor retention time, cytotoxicity, and cataract formation. Long-term, experimental vitreous substitutes composed of natural, modified and synthetic polymers are currently being studied. This review discusses current long- and short-term vitreous substitutes and the disadvantages of these that have highlighted the need for an ideal vitreous substitute. The review subsequently focuses specifically on currently used polysaccharide- and synthetic polymer-based vitreous substitutes, which may be modified or functionalised, or employed as the derivative, and discusses experimental vitreous substitutes in these classes. The advantages and challenges associated with the use of polymeric substitutes are discussed. Innovative approaches to vitreous substitution, namely a novel foldable capsular vitreous body, are presented, as well as future perspectives related to the advancement of this field.

25-Gauge pars plana vitrectomy combined with air tamponade for primary rhegmatogenous retinal detachment

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.

Retinal surgery quality indicators for uncomplicated primary rhegmatogenous retinal detachment without a national registry

PURPOSE

The objective of this study was to evaluate the possibility of analysing quality indicators for uncomplicated primary rhegmatogenous retinal detachment in a hospital department of ophthalmology without the support of a national registry or need to collect data from referring ophthalmological centres.

METHODS

In 2014, we operated 231 consecutive eyes with uncomplicated retinal detachment. Our quality indicators were primary anatomical success, final anatomical success and postoperative endophthalmitis. We reviewed medical records in our university surgical department retrospectively and compared them with medical records from the regional hospitals that had referred most of the operated patients and done their own postoperative examination. Our hypothesis was that any retinal re-detachment and/or serious postoperative complication would be reported back.

RESULTS

The medical records at the surgical department revealed primary anatomic success for 91.3% of eyes and final anatomical success of 99.6%. The data from the regional hospitals confirmed that our hypothesis was correct. All patients with adverse outcomes were referred back for reoperation. Patients who were not referred again had an attached retina and showed no signs of endophthalmitis.

CONCLUSION

Our hypothesis that data in the surgical department's medical records would closely reflect those in referring hospitals was borne out. This supports, under current conditions, an effective strategy for analysing chosen quality indicators without relying on a national registry or reviewing records from regional hospitals.

Comparison between air and gas as tamponade in 25-gauge pars plana vitrectomy for primary superior rhegmatogenous retinal detachment

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.

Outcomes of 25-gauge pars plana vitrectomy alone with air tamponade for the management of rhegmatogenous retinal detachment with inferior breaks

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.

Air Tamponade for Rhegmatogenous Retinal Detachment With Inferior Breaks After 25-Gauge Pars Plana Vitrectomy: Technique and Outcome

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.

Environmental effect of air versus gas tamponade in the management of rhegmatogenous retinal detachment VR surgery: A multicentre study of 3,239 patients

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.

Retinal Detachment Repair With Vitrectomy: Air Tamponade Integration to a Vitreoretinal Service, Comparison With Gas Tamponade, and Literature Review

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.].

PATCHING RETINAL BREAKS WITH HEALAFLOW IN 27-GAUGE VITRECTOMY FOR THE TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT

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.

Efficacy of PPV Combined with Air Tamponade for Treatment of Inferior Retinal Breaks

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.

Vitrectomy with air tamponade and cryotherapy for retinal detachment repair without perfluorocarbon use: A UK 12-month prospective case series

INTRODUCTION

Rhegmatogenous retinal detachment (RRD) is commonly managed by pars plana vitrectomy (PPV). Gas tamponade has significant clinical and quality of life factors that affect the patient. Using shorter acting air tamponade, intuitively leads to surgical concern for higher rate of primary detachment. To circumvent this, surgeons advocate the use of perfluorocarbon to maximise sub-retinal-fluid drainage when using air tamponade and/or avoid using cryotherapy due to longer duration for scar formation relative to laser. These steps are a deviation from traditional technique for otherwise routine primary RRD repair and discourages popularisation of using air tamponade despite the benefits to patients.

METHOD

Prospective 12-month, single centre, single surgeon, consecutive study from January to December 2019. Inclusion criteria was as per based on the pneumatic retinopexy versus vitrectomy for retinal detachment: (i) single retinal break or group of breaks, no larger than 1-clock-hour (30°), in detached retina; (ii) all breaks in detached retina lie above the 8 to 4 o'clock meridian; and (iii) breaks or lattice degeneration in attached retina at any location. We excluded PVR formation and RRD in the inferior 4 o'clock hours.

RESULTS

We report primary and final success rate of 96% and 100%, respectively in 23 eyes (22 macular-on and one macular-off) with RRD eyes in a 12-month period. Cryopexy was utilised in 65% patients and in isolation in 23% with no perfluorocarbon use in all eyes.

CONCLUSION

We show cryotherapy can be used safely in AT-RRD without PFCL in RRD fulfilling PIVOT trial criteria with minimal cataract formation and IOP spikes and faster post-operative visual rehabilitation.

Vitrectomy with air tamponade for surgical repair of rhegmatogenous retinal detachment by eye position guided fluid-air exchange

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.

SURGICAL OUTCOMES OF 25-GAUGE PARS PLANA VITRECTOMY USING AIR AS AN INTERNAL TAMPONADE FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT

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.

The comparison of the surgical outcome of 27-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment between air and SF6 gas tamponade

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.

Complications Associated with the Use of Expandable Gases in Vitrectomy

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.

Air tamponade and without heavy liquid usage in pars plana vitrectomy for rhegmatogenous retinal detachment repair

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.