Morphological changes in the optic disc after vitrectomy and fluid–air exchange

Ohashi, Hirokazu; Kasuga, Yuzo; Hata, Naruhiko; Manabe, Shin-ichi; Takashima, Yasuyuki; Lee, Seiki; Yamakawa, Ryoji

doi:10.1007/s00417-004-0877-z

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…Ohashi et al [27] detected morphological changes in the optic disc for significant periods following vitrectomy for macular hole, with no concomitant functional changes. This was attributed to fluid-air exchange.…”

Section: Discussionmentioning

confidence: 99%

Scleral Buckling versus Vitrectomy for Retinal Detachment Repair: Comparison of Visual Fields and Nerve Fiber Layer Thickness

Koutsandrea

Kanakis²,

Papaconstantinou³

et al. 2015

Ophthalmologica

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Purpose: To compare visual field loss and retinal nerve fiber layer (RNFL) defects in cases of rhegmatogenous retinal detachment (RRD) treated with scleral buckle (SB) versus pars plana vitrectomy (PPV) and C₃F₈ injection. Methods: This was a prospective, comparative interventional study of 50 eyes with primary RRD, treated with PPV (25 eyes) or SB (25 eyes). All measurements took place at least 9 months following successful and uncomplicated surgical treatment. The visual field total deviation (TD) values for preoperative attached and detached areas were calculated and compared separately. The optic nerve head morphology was studied with Heidelberg retinal tomography (HRT), and the RNFL using spectral-domain optical coherence tomography. Results: The preoperative detached areas demonstrated more affected TD values (in dB) compared to the preoperative attached areas (-6.9 ± 5.2 vs. -4.3 ± 3.3 for the SB group and -9.6 ± 5.2 vs. -7.8 ± 5.1 for the PPV group; p = 0.001) in both groups. The preoperative attached areas of the SB group showed better TD values (calculated mean values) compared to the preoperative attached areas of the PPV group (-4.3 ± 3.3 vs. -7.8 ± 5.1, p = 0.007). The RNFL and HRT values showed no statistically significant difference between the two groups. Conclusions: It seems that the preoperative detached retina, despite successful reattachment, suffers permanent damage as a result of the detachment, irrespective of the method of treatment. In the PPV group, the postoperative functionality of the preoperative attached areas was detected to be worse compared to the postoperative functionality of the preoperative attached areas of the SB group. We postulate that this fact could be attributed to an additional traumatizing factor (possibly fluid-air exchange or gas injection) in patients with RRD treated with PPV.

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Section: Discussionmentioning

confidence: 99%

Scleral Buckling versus Vitrectomy for Retinal Detachment Repair: Comparison of Visual Fields and Nerve Fiber Layer Thickness

Koutsandrea

Kanakis²,

Papaconstantinou³

et al. 2015

Ophthalmologica

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“…28,29,31,43 However, fluid-air exchanges are not without risk because several reports have cited damage to the retina or optic nerve resulting in decreased retinal ganglion cell activity, visual field defects, or morphologic changes in the optic disk after fluid-air exchange. [44][45][46][47] The objective of this study was to prospectively evaluate whether a difference in intraocular pressure (IOP) or hypotony rate exists between eyes randomized to fluid fill versus those randomized to air fill after 25-gauge and 23-gauge vitrectomy through beveled incisions. We are unaware of any prospective randomized study evaluating the effect of these parameters in small-gauge transconjunctival PPV.…”

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confidence: 99%

Study of Intraocular Pressure After 23-Gauge and 25-Gauge Pars Plana Vitrectomy Randomized to Fluid Versus Air Fill

Garretson

Ranchod

et al. 2011

Retina

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“…[3, 5, 6, 11, 12,14,15,16,17,18]]. Visual field defects may be induced by either damaging the optic nerve fiber layers or the underlying ganglion cells.…”

Section: Discussionmentioning

confidence: 99%

“…Visual field defects are a serious complication that may occur after vitreous surgery [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. After the first report of this unwanted symptom by Melberg and Thomas in 1995 [11], much work has been done to find out its causes.…”

Section: Introductionmentioning

confidence: 99%

“…Electron microscopic studies have shown a sharp demarcation between damaged and undamaged retina, indicating a mechanical damage by the pressurized airflow from the infusion cannula [5]. More detailed histological analysis revealed that not only ganglion cells but also inner retinal structures and the optic disc have been damaged and that decreasing the pressure of infused air also decreases the risk of retinal damage [5, 6, 16, 18]. Another prevention of airflow-induced retinal damage is limited cortical vitreous removal [3].…”

Section: Introductionmentioning

confidence: 99%

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Intraocular Fluid-Air Exchange Reduces Retinal Ganglion Cell Activity

Schanze

Hesse²

2006

Ophthalmologica

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Aim: To demonstrate the influence of intraocular fluid-air exchange on retinal ganglion cell activity. Methods: In two cats lensectomy and vitrectomy were performed in a two-step approach 2 weeks prior to recording experiments. To measure retinal activity, up to two fiber microelectrodes were inserted via a scleral port. Precise micromanipulator positioning of the electrodes’ tips onto the inner retinal surface were verified by ophthalmoscopy and simultaneous electrical recording. Neuronal activity of the retina was continuously recorded with or without visual stimulation. We maintained the intraocular pressure constant at 29 mm Hg. Fluid-air exchange and fluid refill were performed with an infusion tube integrated in the manipulator and slowly to avoid direct mechanical/stream-based damage of the retina. Results: We found that fluid-air exchange leads to a rapid reduction of spontaneous as well as visually evoked retinal ganglion cell activity. The activity started to diminish within few minutes, and then it halved approximately every 3 min. Even 1 h after eye fluid refill, the retinal activity recovered only partially. Conclusion: Decrease in retinal activity after fluid-air exchange can be explained by mechanical stress-induced drying of the inner retinal surface and by potential changes of extracellular ion concentration. Since even moderate airstream-based fluid-air exchanges can lead to retinal damage, the surgeon should minimize the quantity of air passing open sclerotomy sites until a better understanding of the retinal effects of this essential technique in modern vitrectomy is available.

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Morphological changes in the optic disc after vitrectomy and fluid–air exchange

Abstract: Whereas no visual field loss is observed, vitrectomy with F-A exchange induces morphological changes in the optic disc for significant periods following surgery.

Cited by 6 publications

References 19 publications

Scleral Buckling versus Vitrectomy for Retinal Detachment Repair: Comparison of Visual Fields and Nerve Fiber Layer Thickness

Scleral Buckling versus Vitrectomy for Retinal Detachment Repair: Comparison of Visual Fields and Nerve Fiber Layer Thickness

Study of Intraocular Pressure After 23-Gauge and 25-Gauge Pars Plana Vitrectomy Randomized to Fluid Versus Air Fill

Intraocular Fluid-Air Exchange Reduces Retinal Ganglion Cell Activity

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