A possible strategic role of air during pars plana vitrectomy for macula-involving rhegmatogenous retinal detachment

Frisina, Rino; Gius, Irene; Frascogna, Giuseppe; Pizzolon, Tobia; Greggio, Angelo; Tozzi, Luigi; Midena, Edoardo

doi:10.1007/s10792-020-01591-2

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…In addition, the trans-scleral fiber-optic-assisted SB is widely used as it permits an easy identification and treatment of retinal breaks using a non-contact wide-angle PPV-style viewing apparatus [ 21 – 23 ]. Similarly, several alternative procedures may be performed during PPV, such as 360° endolaser, lens removal (regardless of its opacity), and ILM peeling [ 24 , 25 ]. In addition, many surgeons still prefer the PPV/SB procedure because it theoretically offers the advantages of both PPV and SB and has been shown to produce excellent anatomic results [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

et al. 2023

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Background To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD). Methods Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD “pending foveal detachment” subgroup. Results Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6). Conclusions The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

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Section: Discussionmentioning

confidence: 99%

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

et al. 2023

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“…C 8 F 18 , F 4 H 5 ) [2,3] and gases (e.g. SF 6 , air) [4][5][6][7] are utilized as tamponading fillers after the removal of the native vitreous. Current clinically used endotamponades are effective in promoting retinal reattachment, but deviate from the hydrophilicity, refractive index and density of human vitreous, leading to complications such as emulsification, prolonged inflammation, blurred vision, raised intraocular pressure, cataract formation or the need for revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Novel vitreous substitutes: the next frontier in vitreoretinal surgery

Schulz

Januschowski

Szurman

2021

Current Opinion in Ophthalmology

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Purpose of reviewAfter removing the native vitreous during vitreoretinal surgery, an adequate substitute is required to ensure homeostasis of the eye. Current clinically used endotamponades (silicone oil, gases, semifluorinated alkanes) are effective in promoting retinal reattachment, but lead to complications such as emulsification, prolonged inflammation, blurred vision, raised intraocular pressure, cataract formation or the need for revision surgery. The aim of this review is to provide an update on novel vitreous substitutes with a focus on polymer-based systems. Recent findingsPolymeric hydrogels provide favourable properties such as high water content, optical transparency, suitable refractive indices and densities, adjustable rheological properties, injectability, biocompatibility and their ability to tamponade the retina via viscosity and swelling pressure, comparable to the native human vitreous body. Here, vitreous replacement strategies can be divided into chemically or physically crosslinked hydrogel systems that are applied as preformed or in-situ gelling matrices. SummarySeveral hydrogel-based vitreous substitutes have already been positively evaluated in preclinical tests and have the potential to enter the clinical phase soon.

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“…Due to improvements in surgical instruments and methods, the anatomical reattachment rate is high, and patients' visual acuity postoperatively can be restored [ 2 , 3 ]. Some alternative techniques, such as microscope-assisted ab externo surgery and vitrectomy under air, could further reduce postoperative complications [ 4 , 5 ]. However, metamorphopsia is a prevalent and persistent symptom identified by patients, especially those with macula-off RRD [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Metamorphopsia and Morphological Changes in the Macula after Scleral Buckling Surgery for Macula-Off Rhegmatogenous Retinal Detachment

Ling

Kong

et al. 2021

Journal of Ophthalmology

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Purpose. To observe the changes in metamorphopsia after scleral buckling (SB) surgery for macula-off rhegmatogenous retinal detachment (RRD) and its association with morphological changes in the macula. Methods. This prospective study included 20 eyes of 20 patients. Before surgery and 1, 3, 6, and 12 months after surgery, metamorphopsia measured by M-charts and best-corrected visual acuity (BCVA) and macular microstructures assessed using optical coherence tomography were recorded. Results. Both the vertical and horizontal M-scores improved significantly after SB surgery. BCVA also improved gradually. The mean M-score in the eyes with a continuous external limiting membrane (ELM) was smaller than that in the eyes with a disrupted ELM ( P = 0.008 ). Preoperative and postoperative BCVA did not correlate with the mean M-score at any time point. The other studied parameters, namely, the duration of RRD, the height of retinal detachment, central foveal thickness, inner nuclear layer thickness, and continuation of the ellipsoid zone, were also not relevant. Conclusions. The continuation of the ELM may be a critical factor in determining the severity of metamorphopsia after SB surgery for macula-off RRD.

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A possible strategic role of air during pars plana vitrectomy for macula-involving rhegmatogenous retinal detachment

Cited by 5 publications

References 36 publications

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

Novel vitreous substitutes: the next frontier in vitreoretinal surgery

Metamorphopsia and Morphological Changes in the Macula after Scleral Buckling Surgery for Macula-Off Rhegmatogenous Retinal Detachment

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