Efficacy of preoperative intravitreal injection of gas as an adjunct to pars plana vitrectomy for rhegmatogenous retinal detachment repair
What:
Paper Presentation | Présentation d'article
When:
4:15 PM, Saturday 2 Jun 2018
(10 minutes)
Where:
How:
Authors: Rachel Trussart, Tina Felfeli, Efrem D. Mandelcorn
Author Disclosure Block: R. Trussart: None. T. Felfeli: None. E.D. Mandelcorn: None.
Abstract Body:
Purpose: To evaluate the success rate and complications of preoperative intravitreal injection of gas (PIG) with or without laser retinopexy (LR) combined with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair.
Study Design: Prospective nonrandomized interventional case series
Methods: Consecutive cases of RRD requiring surgical repair using PPV who were eligible to receive PIG from April to September 2017 at Toronto Western Hospital were included in this case series. All patients were followed for a minimum of 3 months postoperatively. They were excluded in cases of proliferative vitreoretinopathy grade C or D, contraindication to intraocular gas due to travel plans and inability to maintain the required postoperative head position. The primary outcome measure was anatomical retinal reattachment. Secondary outcome measures included postoperative visual acuity (VA), ease of surgical repair and postoperative complications.
Results: A total of 21 eyes were included in this case series. Of the treated eyes, 52% were macula off and 29% had at least one inferior retinal break. Sixty-two percent of cases had multiple retinal breaks with 69% not clustered in the same quadrant. Two patients had a history of recent ocular trauma and seven patients initially presented with moderate vitreous haemorrhage. Seven patients were high myopes (≥6D). Presence of lattice degeneration was observed in 52% of eyes. Three patients had previous RRD repair in the same eye. All eyes (100%) achieved retinal reattachment. The mean VA improved significantly from 0.77±0.69 LogMAR preoperatively to 0.39±0.31 (p=0.01) at the final follow-up postoperatively. Thirty-eight percent of cases required pneumatic retinopexy only. Sixty-two percent of eyes underwent a PIG with or without LR followed by single PPV and gas tamponade to successfully reattach the retina. Of the PPV patients, none required perfluorocarbon (PFC) heavy liquid or unnecessary posterior retinotomy. In the macula-on group, no patients were observed to develop intraoperative macular detachment. Postoperative complications included transient increased intraocular pressure (14%), cataract formation in 18% of the eleven phakic patients, cystoid macular edema (5%), epiretinal membrane (5%) and persistent subretinal fluid (10%).
Conclusions: PIG is valuable whether eyes reattach with pneumatic retinopexy alone or if PPV is required. This adjunctive intervention to PPV not only showed a high success rate (100%) but also may simplify PPV without the need for PFC or posterior retinotomy, which may ultimately improve final visual outcomes.
Author Disclosure Block: R. Trussart: None. T. Felfeli: None. E.D. Mandelcorn: None.
Abstract Body:
Purpose: To evaluate the success rate and complications of preoperative intravitreal injection of gas (PIG) with or without laser retinopexy (LR) combined with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair.
Study Design: Prospective nonrandomized interventional case series
Methods: Consecutive cases of RRD requiring surgical repair using PPV who were eligible to receive PIG from April to September 2017 at Toronto Western Hospital were included in this case series. All patients were followed for a minimum of 3 months postoperatively. They were excluded in cases of proliferative vitreoretinopathy grade C or D, contraindication to intraocular gas due to travel plans and inability to maintain the required postoperative head position. The primary outcome measure was anatomical retinal reattachment. Secondary outcome measures included postoperative visual acuity (VA), ease of surgical repair and postoperative complications.
Results: A total of 21 eyes were included in this case series. Of the treated eyes, 52% were macula off and 29% had at least one inferior retinal break. Sixty-two percent of cases had multiple retinal breaks with 69% not clustered in the same quadrant. Two patients had a history of recent ocular trauma and seven patients initially presented with moderate vitreous haemorrhage. Seven patients were high myopes (≥6D). Presence of lattice degeneration was observed in 52% of eyes. Three patients had previous RRD repair in the same eye. All eyes (100%) achieved retinal reattachment. The mean VA improved significantly from 0.77±0.69 LogMAR preoperatively to 0.39±0.31 (p=0.01) at the final follow-up postoperatively. Thirty-eight percent of cases required pneumatic retinopexy only. Sixty-two percent of eyes underwent a PIG with or without LR followed by single PPV and gas tamponade to successfully reattach the retina. Of the PPV patients, none required perfluorocarbon (PFC) heavy liquid or unnecessary posterior retinotomy. In the macula-on group, no patients were observed to develop intraoperative macular detachment. Postoperative complications included transient increased intraocular pressure (14%), cataract formation in 18% of the eleven phakic patients, cystoid macular edema (5%), epiretinal membrane (5%) and persistent subretinal fluid (10%).
Conclusions: PIG is valuable whether eyes reattach with pneumatic retinopexy alone or if PPV is required. This adjunctive intervention to PPV not only showed a high success rate (100%) but also may simplify PPV without the need for PFC or posterior retinotomy, which may ultimately improve final visual outcomes.
