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Loiudice P, Pintor ES, Tronci C, Tatti F, Casini G, Figus M, Demarinis G, Peiretti E. Safety and efficacy of cryopexy during pars Plana vitrectomy in rhegmatogenous retinal detachment. Eur J Ophthalmol 2023; 33:2285-2289. [PMID: 36987589 DOI: 10.1177/11206721231166976] [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: 03/30/2023]
Abstract
PURPOSE To evaluate efficacy and safety of intraoperative cryoretinopexy in cases of rhegmatogenous retinal detachment (RRD). METHODS In this retrospective, interventional case series, we review the medical records of 85 consecutive cases of RRD treated with pars plana vitrectomy and gas tamponade, without the use of perfluorocarbon liquids. Baseline best-corrected visual acuity, intraocular pressure, number and location of retinal breaks, location and extension of retinal detachment, duration of symptoms, macula status, presence, and grade of proliferative vitreoretinopathy (PVR) were registered. Follow-up visits were at 1 day, 15 days, 1 month and 3 months. Anatomical and functional outcomes and any adverse event were recorded. RESULTS Primary anatomical success was obtained in 82/85 patients (96%). During the postoperative period, PVR was observed in 4/85 cases (4.7%), 3 of whom developed recurrence of retinal detachment. 7/85 (8.2%) patients developed ocular hypertension. We built a model of logistic regression including age, sex, lens status, macula status, number of quadrants involved, number of ruptures and duration of symptoms. None of the variables considered was found to be a predictor of postoperative PVR development. Symptom's duration (β = 0.429; 95% CI = 0.009-0.023; P < 0.001) and preoperative BCVA (β = 0.273; 95% CI = 0.034-0.184; P = 0.005) were predictors for final BCVA. CONCLUSION These findings emphasize the safety and efficacy of the use of intraoperative cryotherapy, associated with PPV and gas tamponade, for the management of uncomplicated RRDs.
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Affiliation(s)
- Pasquale Loiudice
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Claudia Tronci
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Giamberto Casini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Demarinis
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
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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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Huang N, Gao XY, Li JP, Lu X, Zhu HM, Dong K. Expression levels of ROS and Atg proteins in the vitreous in rhegmatogenous retinal detachment. Int J Ophthalmol 2023; 16:348-353. [PMID: 36935782 PMCID: PMC10009606 DOI: 10.18240/ijo.2023.03.03] [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: 02/19/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023] Open
Abstract
AIM To detect the concentrations of reactive oxygen species (ROS), transient receptor potential mucin-1 (TRPML1), and autophagy-related (Atg) proteins (LC3-I, LC3-II, and Beclin1) in vitreous humor of patients with simple rhegmatogenous retinal detachment (RRD). METHODS RRD patients enrolled as the RRD group, and patients with idiopathic macular hole (IMH) and idiopathic macular epiretinal membrane (IMEM) were enrolled as control group. The levels of ROS, TRPML1, LC3-I, LC3-II, and Beclin1 in vitreous humor of patients in the RRD and control groups were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS The RRD group included 28 eyes 28 patients and had a higher concentration of ROS in vitreous humor (631.86±18.05 vs 436.34±108.22 IU/mL, P<0.05). The ROS level in patients with a wide retinal detachment (RD) extent (RD range ≥1/2) was higher than that with a narrow RD extent (RD range<1/2, P<0.05). ROS concentration was negatively correlated with RD time (r=-0.46, P=0.01). The expression levels of LC3-I and Beclin1 significantly decreased in RRD (P<0.05), but there were no correlations with the RD time, RD extent, or macular involvement. CONCLUSION In eyes with RRD, the concentration of ROS in vitreous humor increases and the expression levels of Atg proteins decrease, reflecting possibly that autophagy is inhibited.
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Affiliation(s)
- Nan Huang
- Department of Ophthalmology, Xiaoxian People's Hospital, Suzhou 234000, Anhui Province, China
| | - Xue-Yan Gao
- Graduate School of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Jin-Ping Li
- Department of Ophthalmology, Eye Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Xing Lu
- Graduate School of Anhui Medical University, Hefei 230001, Anhui Province, China
| | - Hua-Mei Zhu
- Hefei Aier Eye Hospital, Hefei 230001, Anhui Province, China
| | - Kai Dong
- Department of Ophthalmology, Eye Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
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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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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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Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment. J Ophthalmol 2021; 2021:5588479. [PMID: 33996150 PMCID: PMC8081592 DOI: 10.1155/2021/5588479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022] Open
Abstract
Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.
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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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