Which intraocular tamponade is better for intraocular iatrogenic retinal tear in the posterior zone?

Session Details

Session Title: Free Paper Session 1: Vitreoretinal Surgery I

Session Date/Time: Thursday 07/09/2017 | 09:00-10:30

Paper Time: 10:18

Venue: Room 111

First Author: : Ö.Sever TURKEY

Co Author(s): :                                 

Abstract Details

Purpose:

To evaluate the effectivity of intraocular tamponades for iatrogenic retinal breaks in the posterior zone during pars plana vitrectomy.

Setting:

Retrospective, interventional, comparative study, including a total of 67 eyes of 50 patients operated for diabetic intraocular haemhorrage and diabetic fibrovascular proliferation over a 4-year period in a single centre.

Methods:

Patients who underwent 23-Gauge diabetic vitrectomy complicated with retinal breaks in the posterior zone (Zone 1) were included. Zone 1 is a term to define diseases in premature retinopathies and describes the circle from centre of disc with radius of twice distance from disc to macula. Twenty eyes had tamponade with Air (Air group), 22 eyes C3F8 Gas (Gas group) and 25 eyes received Silicone Oil (Silicone group) as the tamponading agent. Follow up time was 6 months.The primary outcome measures were retinal detachment, retinal rehaemhorrage, interface disease formation, elevated intraoculer pressure (IOP), cataract formation and visual acuity gain. Patients who had vitrectomy beforehand and patients with bad metabolic control (uncontrolled diabetes and hypertension) were excluded.

Results:

Mean number of visits was 2,4 ± 1,4 (2-6) in a month. Mean silicone oil removal time was 4,8 ± 0,86 months (3-6 months). Postoperative 2 week IOP alterations of Silicon group, C3F8 group and Air group were p=0,115, p= 0, 280, p= 0,716, respectively. Postoperative 6 month IOP alterations of Silicon, C3F8 and Air groups were p = 0,176, p = 0,223, p = 0,637, respectively. But intergroup correlations show that Air group has significantly lower IOP rise than both other groups (p< 0,01). Eight patients from Silicone group, 4 patients from Gas group and 2 patients from Air group had cataract at the 6 month control (p=0,189). When air group was compared to Silicone group there was a significant increase in cataract formation (p<0,00). Three patients from each Air and Gas group and 1 patient from Silicone group had rehaemhorrage (p=0,420). Six patiens from Silicone group and 3 patients from Gas group and 1 patient from Air group had epiretinal membrane formation (p=0,289). Only one patient from Air group had retinal detachment at the 1 week control and succesfully reoperated while no other group had retinal detachment. All the groups had significant visual gain (p=0,00).

Conclusions:

The retinal tear closure rate was similar with Air, Silicone oil and C3F8 gas tamponade. However, Air tamponade exhibited a decreased incidence of cataract formation, interface disease and ocular hypertension with shorter tamponade duration. Air may have a role as the tamponading agent for iatrogenic retinal breaks in the posterior retinal zones.

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