Efficacy and impacts of air tamponade combined with vitrectomy in the treatment of rhegmatogenous retinal detachment_Chinese Journal of Ocular Fundus Diseases

Authors：

Yu Ying , Zeng Lun , Yang Zhongkai , Zhu Rongrong , Xue Shengding ,  Chen Hui

Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, China;
Zeng Lun, graduate students, is working on the Department of Ophthalmology, Wuxi Ninth People's Hospital, Wuxi 214062, China; Yang Zhongkai, visiting scholar, is working on the Department of ENT, Karamay People's Hospital, Karamay 830054, China;

Corresponding author：

Chen Hui, Email: chenhuieye@126.com

Keywords：

Retinal detachment/surgery; Vitrectomy; Air; Root cause analysis

DOI：

10.3760/cma.j.cn511434-20200211-00049

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Objective To evaluate the efficacy and impacts of air tamponadein treating rhegmatogenous retinal detachments (RRD) including inferior breaks after 25G pars plana vitrectomy (PPV).Methods A prospective non-randomized study. From November 2016 to December 2018, 110 RRD patients receiving PPV in the Ophthalmology Department of Affiliated Hospital of Nantong University were included in the study. All the patients choose the operation mode voluntarily after fully understand the condition and operation mode. There were 90 eyes in the air filling group and 20 eyes in the silicone oil filling group. There was no difference of age (t=－0.082), sex ratio (χ²=1.538), left or right eye (χ²=0.839), average course of disease (Z=－0.276), intraocular pressure (t=3.669), axial length (t=0.765), grade of proliferative vitreous retinopathy (Z=－2.101), high myopia (χ²=0.013), lens state (χ²=1.275), logMAR BCVA (t=－0.681), the scope of retinal detachment (t=0.970), the site (χ²=0.108) and numbers (t=0.158) of the retinal holes, whether involving macula (χ²=1.791) between the two groups (P＞0.05). At 1, 3, and 6 months after surgery, the first retinal reduction rate, BCVA increase rate, visual recovery rate, intraocular pressure, fovea retinal thickness (CFT), ellipsoid and cross sectional area, and the occurrence of postoperative complications in the two groups were observed and compared. Independent sample t test and Chi-squared test, Mann-Whitney U test, and ANOVA were used for data comparision.Results After the first operation, retinal reattachmnents were achieved in 87 eyes (96.6%) in the air group and 19 eyes (95.0%) in the silicone oil group (χ²=0.130, P＞0.05). In the air group and the silicone oil group, there were 7 and 2 eyes with subretinal holes, whose retinal reattachmnents were achieved. At 6 months after surgery, logMAR BCVA of the eyes in the air group and the silicone oil group were 0.23±0.23 and 0.37±0.23, respectively. All of them were higher than that before operation (t=－2.410, P＜0.001). BCVA in the air group was superior to that in the silicone oil group (P＜0.05). The increase rate of BCVA of the eyes in the air group and the silicone oil group were 0.69±0.28 and 0.48±0.30 logMAR units, respectively (t=－3.225, P＜0.05). The CFT of the eyes in the air group and the silicone oil group were 226.87±42.30 μm and 234.83±36.10 μm, respectively (t=－0.448, P=0.657). In the air group and silicone oil group, posterior cataract was observed in 15 and 4 eyes, subretinal residual fluid in 1 and 2 eyes, and visual object deformation in 3 eyes respectively. In the air group and silicone oil group, posterior cataract was observed in 15 and 4 eyes, subretinal residual fluid in 1 and 2 eyes, and visual object deformation in 3 eyes respectively.Conclusions Air filling combined with PPV can effectively treat RRD, which is suitable for both superior and inferior holes. The visual acuity recovered well and the complication is less. The time of retinal detachment (especially the time of macular detachment) is an important factor affecting the prognosis.

Citation： Yu Ying, Zeng Lun, Yang Zhongkai, Zhu Rongrong, Xue Shengding, Chen Hui. Efficacy and impacts of air tamponade combined with vitrectomy in the treatment of rhegmatogenous retinal detachment. Chinese Journal of Ocular Fundus Diseases, 2020, 36(8): 605-610. doi: 10.3760/cma.j.cn511434-20200211-00049 Copy

1.	Tetsumoto A, Imai H, Hayashida M, et al. The comparison of the surgical outcome of 27-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment between air and SF₆ gas tamponade[J]. Eye, 2020, 34(2): 299-306. DOI: 10.1038/s41433-019-0726-2.
2.	Zhou C, Qiu Q, Zheng Z, et al. Air versus gas tamponade in rhegmatogenous retinal detachment with inferior breaks after 23-gauge pars plana vitrectomy: a prospective, randomized comparative interventional study[J]. Retina, 2015, 35(5): 886-891. DOI: 10.1097/IAE.0000000000000416.
3.	Holladay JT. Visual acuity measurements[J]. J Cataract Refract Surg, 2004, 30(2): 287-290. DOI: 10.1016/j.jcrs.2004.01.014.
4.	Wong R, De Luca M, Shunmugam M, et al. Visual outcome after removal of silicone oil in patients undergoing retinectomy for complex retinal detachment[J]. Int J Ophthalmol, 2016, 9(1): 108-110. DOI: 10.18240/ijo.2016.01.18.
5.	Shah R, Byanju R, Pradhan S. Outcomes of silicone oil removal in complex retinal detachment[J]. Nepal J Ophthalmol, 2018, 10(20): 124-129. DOI: 10.3126/nepjoph.v10i2.23012.
6.	Al-Jazzaf AM, Netland PA,Charles S. Incidence and management of elevated intraocular pressure after silicone oil injection[J]. J Glaucoma, 2005, 14(1): 40-46. DOI: 10.1097/01.ijg.0000145811.62095.fa.
7.	Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vitrectomy and silicone oil injection[J]. Ophthalmologica, 2018, 240(3): 129-134. DOI: 10.1159/000489792.
8.	Ni Y, Fang H, Zhang X, et al. Analysis of the causative factors related to earlier emulsification of silicone oil[J]. Int J Ophthalmol, 2019, 18, 12(3): 517-519. DOI: 10.18240/ijo.2019.03.25.
9.	Karimi S, Entezari M, Nikkhah H, et al. Effects of intravitreal silicone oil on subfoveal choroidal thickness[J]. Ophthalmologica, 2018, 239(2-3): 159-166. DOI: 10.1159/000485851.
10.	Tan HS, Oberstein SY, Mura M, et al. Air versus gas tamponade in retinal detachment surgery[J]. Br J Ophthalmol, 2013, 97(1): 80-82. DOI: 10.1136/bjophthalmol-2012-302140.
11.	Chen QY, Tang YX, He YQ, et al. Air tamponade in retinal detachment surgery followed by ultra-widefeld fundus imaging system[J]. Int J Ophthalmol, 2018, 18, 11(7): 1198-1203. DOI: 10.18240/ijo.2018.07.20.
12.	Cleary PE, Leaver PK. Macular abnormalities in the reattached retina[J]. Br J Ophthaimol, 1978, 62(9): 595-603. DOI: 10.1136/bjo.62.9.595.
13.	Delolme MP, Dugas B, Nicot F, et al. Anatomical and functional macular changes after rhegmatogenous retinal detachment with macula off[J]. Am J Ophthalmol, 2012, 153(1): 128-136. DOI: 10.1016/j.ajo.2011.06.010.
14.	Kominami A, Ucon S, Kominami T, et al. Restoration of cone interdigitation zone associated with improvement of focal macular ERG after fovea-off rhegmatogenous retinal reattachment[J]. Invest Ophthalmol Vis Sci, 2016, 57(4): 1604-1611. DOI: 10.1167/iovs.15-19030.
15.	Karacorlu M, Sayman Muslubas I, Hocaoglu M, et al. Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: prognostic factors in rhegmatogenous retinal detachment[J]. Int Ophthalmol, 2018, 38(3): 1275-1283. DOI: 10.1007/s10792-017-0591-6.
16.	Kobayashi M, Lwase T, Yamamoto K, et al. Perioperative factors that are significantly correlated with final visual acuity in eyes after successful rhegmatogenous retinal detachment surgery[J/OL]. PLoS One, 2017, 13, 12(9): 0184783[2017-09-13]. https://doi.org/10.1371/journal.pone.0184783. DOI: 10.1371/journal.pone.0184783.
17.	Hassan TS, Sarrafizadeh R, Ruby AJ, et al. The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments[J]. Ophthalmology, 2002, 109(1): 146-152. DOI: 10.1016/s0161-6420(01)00886-7.
18.	Frings A, Markau N, Katz T, et al. Visual recovery after retinal detachment with macula-off: is surgery within the first 72h better than after?[J]. Br J Ophthalmol, 2016, 100(11): 1466-1469. DOI: 10.1136/bjophthalmol-2015-308153.
19.	Kim JD, Pham HH, Lai MM, et al. Effect of symptom duration on outcomes following vitrectomy repair of primary macula-off retinal detachments[J]. Retina, 2013, 33(9): 1931-1937. DOI: 10.1097/IAE.0b013e3182877a27.

1. Tetsumoto A, Imai H, Hayashida M, et al. The comparison of the surgical outcome of 27-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment between air and SF₆ gas tamponade[J]. Eye, 2020, 34(2): 299-306. DOI: 10.1038/s41433-019-0726-2.
2. Zhou C, Qiu Q, Zheng Z, et al. Air versus gas tamponade in rhegmatogenous retinal detachment with inferior breaks after 23-gauge pars plana vitrectomy: a prospective, randomized comparative interventional study[J]. Retina, 2015, 35(5): 886-891. DOI: 10.1097/IAE.0000000000000416.
3. Holladay JT. Visual acuity measurements[J]. J Cataract Refract Surg, 2004, 30(2): 287-290. DOI: 10.1016/j.jcrs.2004.01.014.
4. Wong R, De Luca M, Shunmugam M, et al. Visual outcome after removal of silicone oil in patients undergoing retinectomy for complex retinal detachment[J]. Int J Ophthalmol, 2016, 9(1): 108-110. DOI: 10.18240/ijo.2016.01.18.
5. Shah R, Byanju R, Pradhan S. Outcomes of silicone oil removal in complex retinal detachment[J]. Nepal J Ophthalmol, 2018, 10(20): 124-129. DOI: 10.3126/nepjoph.v10i2.23012.
6. Al-Jazzaf AM, Netland PA,Charles S. Incidence and management of elevated intraocular pressure after silicone oil injection[J]. J Glaucoma, 2005, 14(1): 40-46. DOI: 10.1097/01.ijg.0000145811.62095.fa.
7. Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vitrectomy and silicone oil injection[J]. Ophthalmologica, 2018, 240(3): 129-134. DOI: 10.1159/000489792.
8. Ni Y, Fang H, Zhang X, et al. Analysis of the causative factors related to earlier emulsification of silicone oil[J]. Int J Ophthalmol, 2019, 18, 12(3): 517-519. DOI: 10.18240/ijo.2019.03.25.
9. Karimi S, Entezari M, Nikkhah H, et al. Effects of intravitreal silicone oil on subfoveal choroidal thickness[J]. Ophthalmologica, 2018, 239(2-3): 159-166. DOI: 10.1159/000485851.
10. Tan HS, Oberstein SY, Mura M, et al. Air versus gas tamponade in retinal detachment surgery[J]. Br J Ophthalmol, 2013, 97(1): 80-82. DOI: 10.1136/bjophthalmol-2012-302140.
11. Chen QY, Tang YX, He YQ, et al. Air tamponade in retinal detachment surgery followed by ultra-widefeld fundus imaging system[J]. Int J Ophthalmol, 2018, 18, 11(7): 1198-1203. DOI: 10.18240/ijo.2018.07.20.
12. Cleary PE, Leaver PK. Macular abnormalities in the reattached retina[J]. Br J Ophthaimol, 1978, 62(9): 595-603. DOI: 10.1136/bjo.62.9.595.
13. Delolme MP, Dugas B, Nicot F, et al. Anatomical and functional macular changes after rhegmatogenous retinal detachment with macula off[J]. Am J Ophthalmol, 2012, 153(1): 128-136. DOI: 10.1016/j.ajo.2011.06.010.
14. Kominami A, Ucon S, Kominami T, et al. Restoration of cone interdigitation zone associated with improvement of focal macular ERG after fovea-off rhegmatogenous retinal reattachment[J]. Invest Ophthalmol Vis Sci, 2016, 57(4): 1604-1611. DOI: 10.1167/iovs.15-19030.
15. Karacorlu M, Sayman Muslubas I, Hocaoglu M, et al. Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: prognostic factors in rhegmatogenous retinal detachment[J]. Int Ophthalmol, 2018, 38(3): 1275-1283. DOI: 10.1007/s10792-017-0591-6.
16. Kobayashi M, Lwase T, Yamamoto K, et al. Perioperative factors that are significantly correlated with final visual acuity in eyes after successful rhegmatogenous retinal detachment surgery[J/OL]. PLoS One, 2017, 13, 12(9): 0184783[2017-09-13]. https://doi.org/10.1371/journal.pone.0184783. DOI: 10.1371/journal.pone.0184783.
17. Hassan TS, Sarrafizadeh R, Ruby AJ, et al. The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments[J]. Ophthalmology, 2002, 109(1): 146-152. DOI: 10.1016/s0161-6420(01)00886-7.
18. Frings A, Markau N, Katz T, et al. Visual recovery after retinal detachment with macula-off: is surgery within the first 72h better than after?[J]. Br J Ophthalmol, 2016, 100(11): 1466-1469. DOI: 10.1136/bjophthalmol-2015-308153.
19. Kim JD, Pham HH, Lai MM, et al. Effect of symptom duration on outcomes following vitrectomy repair of primary macula-off retinal detachments[J]. Retina, 2013, 33(9): 1931-1937. DOI: 10.1097/IAE.0b013e3182877a27.

Chinese Journal of Ocular Fundus Diseases

Efficacy and impacts of air tamponade combined with vitrectomy in the treatment of rhegmatogenous retinal detachment

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