Management of non-inferior rhegmatognous retinal detachment with vitrectomy and air tamponade_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhang Ye , Chen Fang , Zhu Jun , Du Wei , Gan Chunlan , Tong Jun , Chen Xi ,  Xie Zhenggao

Department of Ophthalmology, Subei People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China;
Xie Zhenggao is working on the Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China;

Corresponding author：

Xie Zhenggao, Email: zgxie87@163.com

Keywords：

Retinal perforations; Vitrectomy; Air

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.011

Video：

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Objective To observe the outcomes of 23G pars plana vitrectomy (PPV) and air tamponade for non-inferior rhegmatognous retinal detachment (RRD).Methods A prospective case series study. From August 2017 to April 2018, 39 consecutive RRD patients (39 eyes) in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. There were 20 males (20 eyes) and 19 females (19 eyes), 23 right eyes and 16 left eyes, with the mean age of 55±11 years. There were 30 eyes with lens and 9 eyes without lens or IOL. There were 21, 14 and 4 eyes with 1, 2 and equal or greater than 3 retinal tear respectively. All patients underwent 23G PPV which performed preretinal proliferative membranes and vitreous cortex removal, photocoagulation around the breaks with 3-5 rows, and filtered air tamponade. The follow-up was more than 2 months. The retinal reattachment, visual acuity and complications were observed. Pearson correlation analysis was used to analyze the correlation between BCVA and disease course. Chi-square test was performed for comparison among retinal reattachment rate and different clinical factors before operation.Results At 2 months after the PPV, 35 eyes’ retina reattached, the rate of reattachment was 89.8%. In 2-3 weeks, 4 eyes were re-detached, all of them performed silicone oil tamponade. One eye was secondary to pre-macular membrane. The logMAR BCVA before and after PPV were 1.15±0.78 and 0.41±0.31, respectively (t=6.589, P=0.0001). Correlation analysis results showed that BCVA after surgery was positively correlated with BCVA before surgery (r=0.544, P=0.001). Twelve of 30 eyes with crystalline lens suffered cataract. The rate of reattachment vary in the number of the breaks (χ²=9.181, P=0.010).Conclusion PPV with air tamponade may be an optimal treatment of non-inferior RRD with better success rate and security.

Citation： Zhang Ye, Chen Fang, Zhu Jun, Du Wei, Gan Chunlan, Tong Jun, Chen Xi, Xie Zhenggao. Management of non-inferior rhegmatognous retinal detachment with vitrectomy and air tamponade. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 576-579. doi: 10.3760/cma.j.issn.1005-1015.2019.06.011 Copy

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1. Machemer R. The development of pars plana vitrectomy: a personal account[J]. Graefe's Arch Clin Exp Ophthalmol, 1995, 233(8): 453-468. DOI: 10.1007/bf00183425.
2. Cho GE, Kim SW, Kang SW, et al. Changing trends in surgery for retinal detachment in Korea[J]. Korean J Ophthalmol, 2014, 28(6): 451-459. DOI: 10.3341/kjo.2014.28.6.451.
3. Schwartz SG, Mieler W. Management of primary rhegmatogenous retinal detachment[J]. Comp Ophthalmol Update, 2004, 5: 285-294.
4. Stein JD, Zacks DN, Grossman D, et al. Adverse events after pars plana vitrectomy among medicare beneficiaries[J]. Arch Ophthalmol, 2009, 127(12): 1656-1663. DOI: 10.1001/archophthalmol.2009.300.
5. Folk JC, Sneed SR, Folberg R, et al. Early retinal adhesion from laser photocoagulation[J]. Ophthalmology, 1989, 96(10): 1523-1525. DOI: 10.1016/s0161-6420(89)32696-0.
6. Mateo-Montoya A, de Smet MD. Air as tamponade for retinal detachments[J]. Eur J Ophthalmol, 2014, 24(2): 242-246. DOI: 10.5301/ejo.5000373.
7. Kreissig I, Lincoff H. Mechanism of retinal attachment after cryosurgery[J]. Trans Ophthalmol Soc UK, 1975, 95: 148-157.
8. Donati S, Caprani SM, Airaghi G, et al. Vitreous substitutes: the present and the future[J/OL]. Biomed Res Int, 2014, 2014: 351804[2014-05-04]. http://dx.doi.org/10.1155/2014/351804. DOI: 10.1155/2014/351804.
9. Barca F, Caporossi T, Rizzo S, et al. Silicone oil: different physical proprieties and clinical applications[J/OL]. Biomed Res Int, 2014, 2014: 502143[2014-06-11]. http://dx.doi.org/10.1155/2014/502143. DOI: 10.1155/2014/502143.
10. de Juan E Jr, McCuen B, Tiedeman J. Intraocular tamponade and surface tension[J]. Surv Ophthalmol, 1985, 30(1): 47-51. DOI: 10.1016/0039-6257(85)90088-8.
11. Pastor JC. Proliferative vitreoretinopathy: an overview[J]. Surv Ophthalmol, 1998, 43(1): 3-18. DOI: 10.1016/S0039-6257(98)00023-X.
12. Rachal WF, Burton TC. Changing concepts of failures after retinal detachment surgery[J]. Arch Ophthalmol, 1979, 97(3): 480-483. DOI: 10.1001/archopht.1979.01020010230008.
13. Machemer R, Aaberg TM, Freeman HM, et al. An updated classification of retinal detachment with proliferative vitreoretinopathy[J]. Am J Ophthalmol, 1991, 112: 159-165. DOI: 10.1016/s0002-9394(14)76695-4.
14. Lee E, El Housseini Z, Steel DH, et al. An analysis of the outcomes for patients with failed primary vitrectomy for rhegmatogenous retinal detachment[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(11): 1711-1716. DOI: 10.1007/s00417-014-2610-x.

Chinese Journal of Ocular Fundus Diseases

Management of non-inferior rhegmatognous retinal detachment with vitrectomy and air tamponade

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