27G limited vitrectomy with gas tamponade (surgical pneumoretinopexy) in the management of rhegmatogenous retinal detachment (RD)

Session Details

Session Title: Free Paper Session 28: Vitreoretinal Surgery VII

Session Date/Time: Sunday 10/09/2017 | 12:00-13:30

Paper Time: 12:18

Venue: Room 116

First Author: : S.Mittal INDIA

Co Author(s): :    K. Madaan   R. Goel                          

Abstract Details

Purpose:

Surgical Pneumoretinopexy can be described as a fixed set of steps comprising of 27G vitrectomy with gas tamponade for the treatment of retinal detachment. In this, central vitrectomy without excision of vitreous base is done. Drainage is done through preexisting break. This is combined by limited laser/cryo and gas tamponade. Scleral buckle is not done. Internal limiting membrane peeling is not done. Triamcinolone is not used to identify posterior hyaloid and induce Posterior Vitreous Detachment. The role of Surgical Pneumoretinopexy in the management of RD is evaluated.

Setting:

Thind Eye Hospital, Jalandhar

Methods:

Retrospective review of 53 consecutive patients of RD (minimum 35 years age) who underwent surgical pneumoretinopexy. Patients with Proliferative Vitreo-Retinopathy, choroidal detachment and Giant Retinal Tears were not included. All patients underwent 27G vitrectomy. Core vitrectomy was performed with removal of vitreous up to the break and excision of the anterior flap if needed. No special attempt to induce PVD or excise vitreous base was made. Fluid-fluid exchange was done through preexisting break to remove thick proteinaceous fluid followed by slow air fluid exchange after making the break dependent. Drainage retinotomy if performed was made at the equator in the same axis/quadrant as the primary break. Posterior Retinotomy to drain remaining fluid was not done. Limited Laser or cryoretinopexy was done around the breaks. Gas tamponade was done using a non-expansile mixture of 14% Perfluoro-OCT-Ane gas. The patients were followed up for 6 months postoperatively. Primary success at 6 months was defined as retinal attachment with single surgery and absence of any tamponade. Secondary success was defined as retinal attachment with more than 1 surgery and absence of any tamponade. Failure at 6 months was defined as retina not attached or attached with presence of tamponade.

Results:

Primary success was achieved in 49/53 (92.45%) eyes. 2 eyes had recurrence of RD after 2 months due to formation of a new break at the edge of previous laser scars. 2 eyes revealed formation of ERM at 3 months of follow-up. Secondary success was achieved in 52/53 (98.11%) eyes. Postoperative best corrected vision ranged from 6/6 to 6/18 (Mean 6/12). 3 eyes had high IOP after 1 week of follow up. 4 eyes had hypotony after 1 day of follow up. Intraoperative time taken was 16-35 minutes (Average 21 minutes). Progression of cataract seen in 11/19 phakic eyes. 3 eyes needed cataract surgery within 6 months of follow up.

Conclusions:

Surgical Pneumoretinopexy is a technique which combines the advantages of pneumoretinopexy and vitrectomy to overcome the limitations of both. It is possible in inferior breaks, large breaks or lattice degenerations. It can also be done in eyes with multiple breaks in multiple quadrants. There is no question of missed breaks in aphakic or pseudophakic patients. Post-op positioning could be more liberal as compared to Pneumoretinopexy. It achieves high success rate with a single procedure. Surgical Pneumoretinopexy could be an effective and faster alternative for the management of RD; though randomized controlled clinical trials with large number of subjects and longer follow up are needed to study complications and recurrences.

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