Fluid air exchange in vitreo retinal surgery

Abstract

This study evaluates the efficiency of fluid-air exchange on the reattachment of the retina and clarifies the possibility that a posterior retinotomy is a cause for intra- and postoperative complications. A consecutive series of 211 eyes with retinal detachments due to P.V.R. (47%), diabetic traction, perforating trauma, macular hole or giant tears is presented. All eyes underwent pars plana vitrectomy, fluid-air exchange, internal drainage of subretinal fluid, laser endophotocoagulation and scleral buckling of the tears; 56% of the eyes were phakic and 55% underwent a posterior retinotomy, 54% underwent tamponade with C3F8 and 46% with silicone oil. Intraoperatively the retina was completely flattened in 91% cases. The causes of incomplete reattachment were residual membranes (6.6%), poor visualization (1.4%) and suprachoroidal hemorrhage (1%). These complications were isolated as being the cause of the bad final results (p < 0.001). Postoperatively, the retina remained attached in 66% of cases after the first procedure and with further surgery in 81% (mean follow up 16 months). Best corrected visual acuity was improved in 73% of eyes, unchanged in 17%, and worse in 10%. Complications were retraction of the retinotomy site in 3 cases and peripheral choroidal hemorrhage in 4 cases. We concluded that fluid air exchange with internal subretinal fluid drainage was an efficient and safe technique even if a posterior retinotomy was necessary.

Comparison of Repeated Fluid-Air Exchange and Passive Drainage for Removing Residual Emulsified Silicone Oil Droplets

“…During SO removal, after the main bulk of SO was removed, the first 2 mL of washout fluid after was collected and FA exchange or PD were performed. FA exchange was performed by triple FA exchange as previously described [20], and then, air was replaced with the fluid. For PD, a 23-gauge back flute needle was inserted into the vitreous cavity, and the fluid was drained for 15 min at a pressure of 25 mmHg (Constellation 5000 Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA).…”

How to Avoid Giant Retinal Tear Slippage: New Surgical Approach

“…According to some authors, the visualization of the PFCL meniscus at the end of the exchange can be difficult under the air bubble, hence the risk of leaving small bubbles of PFCL, but another return to aspirate PFCL allows very often to remove it completely (Figures 8, 9). The passage of PFCL bubbles by the tear under the retina is a complication described in the literature [16,17]. Often favored by a handling of PFCL in the presence of an undissected VR P leaving the retina retracted.…”

“…In our series, we did not notice this complication. The risk of retinal slipping is linked to an imbalance of forces between the re-application force of PFCL which becomes insufficient to resist the anteroposterior air pressure aggravated by the persistence of liquid under the retina and insufficient aspiration of the liquid interface between the air and PFCL [16]. This step of the PFCL-Air exchange is crucial.…”

Silicone oil in vitreoretinal surgery: indications, complications, new developments and alternative long‐term tamponade agents

“…This raises the need to develop novel strategies that more effectively remove emulsified SO droplets, including the non‐visible ones. Various authors have advocated triple‐fluid/air exchange to maximize emulsification removal (Berrod et al 1994; Bopp & Kellner 2019). However, emulsified droplets can typically still be detected in the anterior chamber and within the retina, even in the optic nerve after removal by this technique (Grzybowski et al 2014).…”