Management of Giant Retinal Tears Using Transscleral Diode Laser Retinopexy and Short-Term Postoperative Tamponade With Perfluoro-N-Octane

Abstract

Purpose: To determine the results of pars plana vitrectomy for giant retinal tear detachments using transscleral diode laser retinopexy and short-term postoperative tamponade with perfluoro-n-octane (PFnO). Methods: Twenty consecutive patients with fresh giant retinal tears were enrolled in a single-arm prospective study. One case was withdrawn for technical reasons. The remainder all underwent pars plana vitrectomy, PFnO injection, transscleral diode laser retinopexy to the edge of the giant retinal tear, and short-term postoperative heavy liquid tamponade. None of the cases had scleral buckling or lensectomy. Results: Nineteen cases (18 male and 1 female) with a mean age of 41 years (range 10–69 years) were followed up for a period of 6 months. Postoperative tamponade with PFnO was maintained for a mean of 7.6 days (range 4–21 days), after which it was exchanged for sulfur hexafluoride (SF6), perfluoropropane (C3F8) gas, or balanced salt solution. Final reattachment rate was 100%, with 3 (15.7%) patients requiring additional surgery. Best-corrected visual acuity at final follow-up was 20/40 or better in 11 eyes (58%), between 20/60 and 20/200 in 7 (37%), and 20/400 in 1 (5%). Conclusion: In this series of acute giant retinal tears, transscleral diode laser retinopexy together with the use of PFnO for short-term postoperative tamponade achieved excellent anatomical and visual results.

Giant Retinal Tears: A Review With a Focus on Trauma

“…Retinopexy is typically performed with endolaser or cryotherapy, but transscleral diode laser has also been described. 2,11,77,78 While comparisons of endolaser and cryotherapy are limited, Bonnet et al 79 reviewed PVR development between the 2 retinopexy techniques. Considering all GRTs, there was no difference in postoperative PVR development with cryopexy (33%) and laser photocoagulation (16%).…”

“…After flattening the retina and careful vitrectomy, retinopexy can be performed under perfluorocarbon. Retinopexy is typically performed with endolaser or cryotherapy, but transscleral diode laser has also been described 2,11,77,78 . While comparisons of endolaser and cryotherapy are limited, Bonnet et al 79 reviewed PVR development between the 2 retinopexy techniques.…”

“…This is advocated to minimize retinal slippage associated with fluid air exchange intraoperatively while avoiding the use of silicone oil. Bhardwaj et al 77 report 20 cases using 4 to 8 days of PFO as tamponade with appropriate positioning for heavy tamponade during that time. The PFO was exchanged for a gas tamponade agent in a secondary surgery.…”

Traumatic Retinal Tears and Retinal Detachment

“…Diod lazer, kriyoterapiye göre daha az inflamasyon yaratmakta ve hızlı retinopeksi sağlamaktadır. [46] Psödofak olgularda diod ve argon lazer benzer başarı sağlarken, fakik ve perifer retina görüntülenmesi zor olgularda, diod lazer daha işlevsel olabilmektedir.…”

A Novel Technique of Suturing Sclerotomy in Pars Plana Vitrectomy

“…Post-operative tamponade is achieved by silicon oil, gas or air. [1][2][3][4] Introduction of small gauge vitrectomy has revolutionized the technique. 23-gauge pars plana vitrectomy is most commonly performed small gauge vitrectomy these days.…”