Routine Use of Air Tamponade in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Abstract

<b><i>Purpose:</i></b> The aim of this study is to establish if air can be considered as a safe substitute for long-lasting tamponade agents for primary rhegmatogenous retinal detachment (RRD) treatment, regardless of the position or the number of retinal breaks. <b><i>Methods:</i></b> In this study, 230 consecutive patients (236 eyes) who underwent a pars plana vitrectomy (PPV) for primary RRD with air or SF<sub>6</sub> tamponade from January 2014 till March 2020 were analyzed. The main outcome measure was the rate of an anatomically attached retina without the presence of any tamponade agent for at least 3 months postoperatively. <b><i>Results:</i></b> Our overall success rate in treating RRD with PPV in cases involving superior, inferior, and also multiple breaks is 88.5% (146/165 eyes) with air tamponade and 80.3% (57/71 eyes) with SF<sub>6</sub> 20% tamponade. Preoperative characteristics were almost similar between the two groups. <b><i>Conclusion:</i></b> Our study shows encouraging results for RRD treated with air tamponade, not only for superior breaks but also for inferior and multiple breaks. Thorough removal of vitreous traction, aspiration of subretinal fluid, and sealing of all the retinal breaks are mandatory elements to treat RRD. After this is accomplished, air tamponade seems to be a safe and effective agent for primary RRD. In order to clarify the use of intravitreal gases or air in the treatment of primary RRD with PPV, a randomized controlled prospective study should be realized in the future.

Air versus Gas Tamponade for Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis

“…Different surgeons performing the procedures within the studies were also observed in the included studies [19]. Besides, two included studies [10, 23] did not compare the baseline characteristics between the air and gas groups; thus, potential selection bias between the two groups cannot be ruled out. In the overall bias analysis, five observational studies [11, 18, 19, 22] were rated as having a moderate risk of bias, one observational study [20] with a serious risk of bias, and three observational studies [10, 21, 23] with a critical risk of bias.…”

“…Besides, two included studies [10, 23] did not compare the baseline characteristics between the air and gas groups; thus, potential selection bias between the two groups cannot be ruled out. In the overall bias analysis, five observational studies [11, 18, 19, 22] were rated as having a moderate risk of bias, one observational study [20] with a serious risk of bias, and three observational studies [10, 21, 23] with a critical risk of bias. The detailed risk of bias assessment of the included studies is shown in online supplementary Table S2.…”

“…First, only one included study was an RCT, whereas the others were non-randomized studies; thus, it is not known whether air tamponade cases were highly selected ones. For example, in several studies [9, 11, 12, 18, 20, 21, 23], the eyes with a lower break or relatively more complicated RRD cases (i.e., RRD cases with PVR change, foveal detachment, and with more quadrant involvement) tended to be allocated to the gas group, possibly causing overestimation of the effectiveness of the efficacy of air tamponade after PPV. Hence, the conclusion should be interpreted with caution given inevitable bias.…”

“…There are two commonly used methods for RRD repair: one is laser photocoagulation, and the other is cryotherapy. Among studies included in this metaanalysis, six studies [10,11,[18][19][20]23] used laser photocoagulation, one study [12] used cryotherapy, and the other three studies [9,21,22] used either laser photocoagulation or cryotherapy to create retinal adhesion. In an experimental retinal detachment study by Yoon et al [27], retinal tissues undergoing laser photocoagulation had increased adhesive strength to 128% of the normal retina within 24 h after surgery and remained to be twice the normal value from 3 days to 4 weeks postoperatively.…”

Efficacy of Vitrectomy with Air Tamponade for Rhegmatogenous Retinal Detachment: A Prospective Study

“…Preoperative characteristics were almost similar between the two groups. They reported that PPV with air tamponade was effective for RRD regardless of the location of the retinal breaks 13 . The present study prospectively evaluated the primary success rate based on the location of retinal breaks (i.e., upper and lower breaks).…”