Exclusive Use of Air as Gas Tamponade in Rhegmatogenous Retinal Detachment

Purpose. To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. Methods. This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. Results. The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p=0.951). BCVA was significantly better in the air group at 1 month (p=0.021) but not at 3 months postoperatively (p=0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p=0.041). Conclusions. In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358.

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Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment

European Journal of Ophthalmology ◽

10.1177/1120672120940209 ◽

2020 ◽

pp. 112067212094020

Author(s):

Paolo Radice ◽

Elisa Carini ◽

Patrizio Seidenari ◽

Andrea Govetto

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Vision Loss ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Full Thickness Macular Hole ◽

Air Tamponade ◽

Subretinal Fluid Drainage ◽

Anatomical Success

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.

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Endoillumination aided scleral buckling combined with intravitreal injection of hyaluronate for treatment of rhegmatogenous retinal detachment

10.21203/rs.2.156/v1 ◽

2019 ◽

Author(s):

Tong Zhao ◽

Zhijun Wang

Keyword(s):

Intraocular Pressure ◽

Retinal Detachment ◽

Intravitreal Injection ◽

Rhegmatogenous Retinal Detachment ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Wide Angle ◽

Corrected Visual Acuity ◽

Significant Difference ◽

Subretinal Fluid Drainage

Abstract Background: To evaluate the efficiency and safety of 25-gauge illumination aided scleral buckling surgery combined with intravitreal injection of hyaluronate for treatment of rhegmatogenous retinal detachment Methods: This study was undertaken in a prospective, nonrandomized, and uncontrolled manner. Patients of rhegmatogenous retinal detachment were performed scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. Hyaluronate was injected into the vitreous cavity to maintain intraocular pressure stable after subretinal fluid drainage through the external sclerotomy when necessary. Best corrected visual acuity(BCVA), intraocular pressure, fundus examination and complications were observed and recorded. Results: Twenty-eight consecutive patients (28 eyes) were enrolled. Subretinal fluid drainage and hyaluronate injection was performed in 12 eyes. The final reattachment ratio was 100%. BCVA increased after operation (P<0.001) and no significant difference was observed between preoperative and postoperative intraocular pressure (P=0.149). No iatrogenic retinal break, choroidal hemorrhage or endophthalmitis were observed. Conclusions: Endoillumination aided buckling surgery combined with intravitreal injection of hyaluronate could be an option for treatment of rhegmatogenous retinal detachment especially for the cases of highly elevated retina. Trial registration: ChiCTR1800020055. Retrospectively registered on December 12, 2018. Key words: Rhegmatogenous retinal detachment, scleral buckling, noncontact wide-angle viewing system, endoillumination, intravitreal injection of hyaluronate.

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Comparison of the parameters of retinal sensitivity after vitrectomy due to rhegmatogenous retinal detachment

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-349-354 ◽

2021 ◽

pp. 349-354

Author(s):

R.R. Fayzrakhmanov ◽

◽

A.V. Sukhanova ◽

O.A. Pavlovsky ◽

E.D. Bosov ◽

...

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Light Sensitivity ◽

Control Group ◽

Strong Positive Correlation ◽

Gas Tamponade ◽

Group I ◽

Silicone Oil Tamponade ◽

Group Ii

Purpose. To compare the parameters of a light sensitivity (LS) of the central zone of a retina after vitrectomy due to reghmatogenous retinal detachment (RRD) with a silicone oil tamponade (SOT) and gas tamponade (GT). Material and methods. The study included 20 eyes after pars plana vitrectomy due to macula-off rhegmatogenous retinal detachment (RRD) by 25G. All patients were divided in 2 groups depending on the choice of the tamponade. The group I (10 eyes) included cases with the silicone oil tamponade (SOT) (1300 cSt), in the group II (10 eyes) – the gas tamponade (GT) (C2F6). The control group included contralateral eyes without ophthalmic pathology. All patients underwent standard ophthalmological examination and fundus- microperimetry (FMP) on the 30th day after removal of the SOT for the group I, or on the 30th day after the C2F6 tamponade for the group II. Results. According to FMP data, the parameter of average light sensitivity (LS) in the group I was significantly reduced, both in comparison with the group II (p=0.007) and the control group (p=0.003). Differentiation by zones in the group I revealed a decrease in each analyzed parameter in comparison with the control group (p<0.05) and a decrease in the 2nd zone (p=0.031) and the 4th zone (p=0.038) in comparison with the group II. In the 1st zone of the group I the formation of a relative scotoma was revealed in 4 cases out of 10 (40%). The parameters of light sensitivity (LS) in comparison with the control in the group II were significantly reduced when analyzed in each zone (p<0.05). A strong positive correlation was found between the Best Corrected Visual Acuity (BCVA) and the average LS in the group II (r=0.87). Conclusion. There is a decrease in the functional parameters of the retina with SOT compared with GT in the form of a decrease in the LS parameter in the 10° zone according to FMP data. Key words: retinal detachment, photosensitivity, microperimetry, silicone tamponade.

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25-gauge vitrectomy with gas tamponade for rhegmatogenous retinal detachment: experienced vs. inexperienced surgeons

10.21203/rs.3.rs-53301/v2 ◽

2020 ◽

Author(s):

Martin Pencak ◽

Miroslav Veith ◽

Zbynek Stranak ◽

Jakub Dite ◽

Jana Vranova ◽

...

Keyword(s):

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Functional Results ◽

Complication Rates ◽

Gas Tamponade ◽

Single Operation ◽

Case Series Study ◽

The Mean

Abstract Introduction: To compare the results and complication rates of a 25-gauge pars plana vitrectomy (25g PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD) between experienced and inexperienced surgeons.Materials and Methods: This is a retrospective comparative consecutive case series study of patients with uncomplicated RRD treated with 25g PPV with gas tamponade. Patients were divided into 2 groups: In Group 1 (ESG) the procedure was performed by an experienced vitreoretinal surgeon and in Group 2 (ISG) the procedure was performed by 2 inexperienced surgeons. Anatomical and functional results and complication rates were compared between the two groups.Results: 216 eyes were included in the study. In the ESG (106 eyes), the single operation success rate was 94.3%, and the final success rate was 100%. The mean best-corrected visual acuity (BCVA) improved from 0.38 decimal to 0.73 decimal. In the ISG (110 eyes), the single operation success rate was 93.6%, and the final success rate was 100.0%. The mean BCVA improved from 0.33 decimal to 0.74 decimal. The differences between groups were not statistically significant. There was no difference in complication rates between groups.Conclusions: A 25g PPV with gas tamponade for treatment of RRD yields excellent anatomical results and improvement in BCVA. With good technique and use of modern vitrectomy machines and instruments, even inexperienced surgeons can achieve high single operation success rate, suggesting a short learning curve. The complication rate is comparable between experienced and inexperienced surgeons.

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Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311787 ◽

2018 ◽

Vol 103 (4) ◽

pp. 481-487 ◽

Cited By ~ 1

Author(s):

Viviana Cacioppo ◽

Andrea Govetto ◽

Paolo Radice ◽

Gianni Virgili ◽

Antonio Scialdone

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Key Factor ◽

Subretinal Fluid Drainage ◽

Functional Deterioration

PurposeTo investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone.MethodsThis institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography images were reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed.ResultsNinety-two patients with a mean age of 56±13 years completed the 6 months follow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 months and 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047).ConclusionThe incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.

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Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series*

Journal of International Medical Research ◽

10.1177/0300060517724931 ◽

2017 ◽

Vol 46 (1) ◽

pp. 316-325 ◽

Cited By ~ 3

Author(s):

Chuandi Zhou ◽

Qiurong Lin ◽

Yuxin Wang ◽

Qinghua Qiu

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Success Rates ◽

Pneumatic Retinopexy ◽

The Mean ◽

Final Operation

Objective To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD). Methods Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA). Results In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40. Conclusions Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

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Outcome of scleral buckling with or without gas tamponade for recurrent retinal detachment in post-vitrectomy eyes

BMC Ophthalmology ◽

10.1186/s12886-021-01873-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jun-Xing Bai ◽

Xiao-Jian Zhang ◽

An-Li Duan ◽

Xiao-Yan Peng

Keyword(s):

Retinal Detachment ◽

Functional Outcomes ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Intraoperative Complications ◽

Scleral Buckling ◽

Gas Tamponade ◽

Pars Plana ◽

Air Tamponade

Abstract Background Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once. Methods We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed. Results The original PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2–5 operations. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160 ± 20/63 at baseline to 20/80 ± 20/50 at the last visit in the 13 successfully treated eyes (P = 0.025). Conclusions SB can be effective for re-RD after PPV in specific cases.

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Human amniotic membrane grafts for retinal breaks in diabetic tractional retinal detachment and combined tractional and rhegmatogenous retinal detachment

Scientific Reports ◽

10.1038/s41598-021-86804-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yen-Chih Chen ◽

San-Ni Chen

Keyword(s):

Retinal Detachment ◽

Tissue Regeneration ◽

Amniotic Membrane ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Control Group ◽

Human Amniotic Membrane ◽

Ellipsoid Zone ◽

Retinal Breaks ◽

Additional Surgery

AbstractTo describe the surgical outcomes of using human amniotic membrane (hAM) grafts in the management of retinal breaks in diabetic tractional detachment (TRD) and combined tractional and rhegmatogenous retinal detachment (CTRRD). A retrospective case series of 10 eyes with TRD or CTRRD receiving pars plana vitrectomy with hAM grafts implantation, compared with 13 controls receiving the same surgery without hAM grafts. Best-corrected visual acuity (BCVA) and re-detachment rate were compared between two groups. Postoperatively, all eyes in the hAM group had retina attachment without recurrence, while 9 eyes in the control group had retina re-detachment and required additional surgery (0% vs 69.2%, p = 0.003). The BCVA significantly improved in the hAM group (from 1.96 ± 0.95 to 1.44 ± 0.77 in log MAR, p = 0.03), but not improved in control group (p = 0.20). Postoperative optical coherence tomography of the eyes receiving hAM grafts demonstrated glial tissue regeneration and restoration of ellipsoid zone. In diabetic TRD or CTRRD, hAM grafts could be an effective method, with promising outcome. Compared to standard surgery, it could result in higher retina reattachment rate and significant visual improvement. Moreover, it may offer the adjunctive benefit in tissue regeneration and fasten ellipsoid zone restoration.

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Outcome of Scleral Buckling With or Without Gas Tamponade for Recurrent Retinal Detachment in Post-vitrectomy Eyes

10.21203/rs.3.rs-117837/v1 ◽

2020 ◽

Author(s):

Jun-Xing Bai ◽

Xiao-Jian Zhang ◽

An-Li Duan ◽

Xiao-Yan Peng

Keyword(s):

Retinal Detachment ◽

Functional Outcomes ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Intraoperative Complications ◽

Scleral Buckling ◽

Gas Tamponade ◽

Pars Plana ◽

Air Tamponade

Abstract Background: Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once.Methods: We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed.Results: The first PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2–5 operations. The re-RD involved the fovea in 7 (50%) eyes. There was no break detected in 2 eyes, suspected break in 5 eyes, 1 break in 4 eyes, 2 breaks in 2 eyes, and 3 breaks in 1 eye. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160±20/63 at baseline to 20/80±20/50 at the last visit in the 13 successfully treated eyes (P=0.025).Conclusions: SB can be effective for re-RD after PPV in specific cases.

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25-gauge vitrectomy with gas tamponade for rhegmatogenous retinal detachment: experienced vs. inexperienced surgeons

10.21203/rs.3.rs-53301/v1 ◽

2020 ◽

Author(s):

Martin Pencak ◽

Miroslav Veith ◽

Zbynek Stranak ◽

Jakub Dite ◽

Jana Vranova ◽

...

Keyword(s):

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Functional Results ◽

Complication Rates ◽

Gas Tamponade ◽

Single Operation ◽

Case Series Study ◽

The Mean

Abstract Background: To compare the results and complication rates of a 25-gauge pars plana vitrectomy (25 g PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD) between experienced and inexperienced surgeons.Methods: This is a retrospective comparative consecutive case series study of patients with uncomplicated RRD treated with 25 g PPV with gas tamponade. Patients were divided into 2 groups: In Group 1 (ESG) the procedure was performed by an experienced vitreoretinal surgeon and in Group 2 (ISG) the procedure was performed by 2 inexperienced surgeons. Anatomical and functional results and complication rates were compared between the two groups.Results: 216 eyes were included in the study. In the ESG (106 eyes), the single operation success rate was 94.3%, and the final success rate was 100%. The mean best-corrected visual acuity (BCVA) improved from 0.38 decimal to 0.73 decimal. In the ISG (110 eyes), the single operation success rate was 93.6%, and the final success rate was 100.0%. The mean BCVA improved from 0.33 decimal to 0.74 decimal. The differences between groups were not statistically significant. There was no difference in complication rates between groups.Conclusions: A 25 g PPV with gas tamponade for uncomplicated RRD renders excellent functional and anatomical results even when performed by an inexperienced surgeon. The complication rate was comparable between experienced and inexperienced surgeons.

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