Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment

Purpose: To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a secondary procedure for recurrent RRD. Methods: We retrospectively analyzed case records of 54 patients (54 eyes) who underwent PR for RRD by injecting 0.3 ml of perfluoropropane (C3F8) in the vitreous cavity and cryopexy to break in the same sitting, followed by positioning. Results: A total 54 eyes of 54 patients aged between 17 and 84 years (mean - 51.3, median - 53 years) were included in the study. Except five eyes, all had breaks in the superior quadrants. The RRD ranged from 1 quadrant to 4 quadrants. Twenty-eight eyes (51.8%) were phakic and 26 (48.1%) were pseudophakic. The follow-up ranged from 6 to 144 months. In 25 eyes (46.2%), PR was the primary intervention and was successful in 15 (60%) eyes with a significant visual improvement (P = 0.023). Twenty-nine eyes (52.7%) with failed scleral buckle or failed pars plana vitrectomy underwent PR with a success rate of 65.5% and significant visual improvement (P = 0.0017). Progression of proliferative vitreoretinopathy changes (40%) was the most common cause of failure. The success rate was higher in phakic eyes, eyes with attached macula, superior breaks, superior RRD, and RRD limited to 3 quadrants or less. Conclusion: PR remains a minimally invasive procedure which can be used primarily or as a salvage procedure in failed surgery with moderately good success rate and minimal complications. One-step procedure reduces patient visits and ensures adequate treatment of the break.

Effect of scleral buckling with intravitreous gas injection for rhegmatogenous retinal detachment and influence on serum amino acids and VEGF / 国际眼科杂志(Guoji Yanke Zazhi)

· AIM:To study the clinical curative effect of scleral buckling (SB) combined with intravitreous gas injection in the treatment of rhegmatogenous retinal detachment (RRD) and the influence on serum levels of amino acids and vascular endothelial growth factor (VEGF).· METHODS:The clinical data of 150 RRD patients (150 eyes) in our hospital were retrospectively analyzed.And 81 patients (81 eyes) treated with scleral buckling alone were included into the non-gas injection group while 69 patients (69 eyes) treated with scleral buckling combined with intravitreous gas injection were included in the gas injection group.The surgical effect,serum levels of amino acids and VEGF before and after surgery were compared between the two groups.· RESULTS:There was no significant difference in retinal reattachment rate between the two groups at different time points after surgery (P＞ 0.05).The intraocular pressure of gas injection group at 3d after surgery was significantly higher than that of non-gas injection group (P＜ 0.05) but there was no significant difference in intraocular pressure between the two groups at 5d after surgery (P＞ 0.05).The uncorrected visual acuity of operative eye of the two groups was improved significantly after surgery (P＜ 0.05).Serum levels of histidine,glutamic acid,phenylalanine and VEGF levels in the two groups significantly decreased at 5d after surgery (P＜0.05),without significant difference between the two groups (P＞0.05).There was no significant difference in serum levels of arginine,leucine,isoleucine and glycine before and after treatment (P＞ 0.05).The total score of visual function related quality of life and scores of different dimensions significantly increased at 1mo after surgery (P＜0.05),without significant differences between the two groups (P＞ 0.05).There was no significant difference in the total incidence of postoperative complications between the gas injection group (7.2％,5/69) and the non-gas injection group (9.9％,8/81;P＞0.05).· CONCLUSION:Scleral buckling combined with intravitreous gas injection can help the early recovery of visual function and intraocular pressure in RRD patients,and reduce the levels of histidine,glutamic acid,phenylalanine and VEGF,and it has high safety.

Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

PURPOSE: To investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole. METHODS: All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF₆ gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam® scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery. RESULTS: Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF₆ gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003). CONCLUSIONS: After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.

Analysis of Ganglion Cell-Inner Plexiform Layer Thickness after Internal Limiting Membrane Peeling

PURPOSE: To evaluate the ganglion cell-inner plexiform layer (GCIPL) thickness after internal limiting membrane (ILM) peeling with or without intravitreal gas injection (IVGI) or surgical induction of posterior vitreous detachment (PVD). METHODS: Eighty patients who were diagnosed with epiretinal membrane (ERM) or macular hole and who received surgical intervention were retrospectively reviewed. Forty patients were treated with ILM peeling and forty patients were treated with ERM removal, but not with ILM peeling. The patients were categorized according to ILM peeling, IVGI, and surgical induction of PVD. The GCIPL thickness was measured using optical coherence tomography, and the average and sectorial thickness of GCIPL were compared. RESULTS: The GCIPL thickness in the ILM peeling group significantly decreased (-13.80 ± 22.63 µm; p < 0.001), but was not significantly different in the ERM removal without ILM peeling group, compared with the preoperative GCIPL thickness (+1.21 ± 22.53 µm; p = 0.546). The difference was statistically significant between the two groups (p = 0.038). In the ILM peeling group, GCIPL thickness was not significantly different in the IVGI group (-17.41 ± 23.92 µm vs. -7.25 ± 19.05 µm; p = 0.109) and was significantly decreased in the surgical induction of the PVD group (-23.06 ± 23.92 µm vs. -7.25 ± 19.05 µm; p = 0.020). On sectorial analysis, reduction of the temporal GCIPL thickness was the largest and was significantly different compared with the nasal GCIPL thickness in ILM peeling group (-19.73 ± 28.55 µm vs. -7.42 ± 19.90 µm; p = 0.005). CONCLUSIONS: ILM peeling and surgical induction of PVD may damage ganglion cells. Therefore, gentle ILM peeling and surgical induction of PVD may be needed to minimize ganglion cell damage, especially when ILM peeling is performed in glaucomatous patients.

Retrograde gas injection under nasal endoscope combined with 5-Fluorouracil for treating lacrimal canalicular rupture / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the operative effect and time effectiveness of the conventional surgery versus retrograde gas injection under nasal endoscope combined 5-Fluorouracil for lacrimal canalicular rupture. ●METHODS:A total of 67 patients (67 eyes) with lower lacrimal canalicular rupture who received surgical treatment by Department of Ophthalmology in Qinhuangdao Haigang Hospital were consecutively recruited between Jan. 2009 and Dec. 2015. They were randomly divided into Group A or Group B. Group A (33 patients, 33 eyes) were treated by conventional surgery, and Group B ( 34 patients, 34 eyes ) were treated by retrograde gas injection under nasal endoscope combined 5-Fluorouracil. Time for finding out the cute end of the lower lacrimal canaliculus and postoperative effect were recorded. Comparisons between the two groups were done with lndependent sample t-test and Mann-Whitney Rank sum test. ●RESULTS: Time for finding out the cute end of the lower lacrimal canaliculus of Group A was (44. 42±10. 66) min, and the time of Group B was ( 30. 06 ± 6. 21 ) min. There was significant difference between the two groups (t=6. 72, P ●CONCLUSION: Compared with conventional surgery, retrograde gas injection under nasal endoscope combined 5-Fluorouracil for lacrimal canalicular rupture can make the operation time shorter and has better effect.

Treatment of primary rhegmatogenous retinaldetachment with cryopexy in combination with intravitravitreal injection of expending gas / 实用医学杂志

Objective To demonstrate the visual results and complications of an cryopexy in combination with intravitreal injection of expending gas in the therapy of primary rhegmatogenous retinaldetachment (RRD). Methods Thirty-two cases (32 eyes) were retrospectively reviewed in this study. The RRD diagnosis was confirmed by best corrected visual acuity,slit-lamp microscope,indirected ophthalmoscope and Goldman three-mirror contact lens. All patients had undergone cryopexy with intravitreal gas injection and assisted by correct body position. Patients were followed for 6 to 24 months. Post-operative BCVA,final anatomical outcome, complications and failed cases were analyzed. Results The reattachment rate of cryopexy with intravitreal gas injection was 81%(26/32 eyes). Four eyes required additional scleral buckling. Two eyes needed additional vitrectomy with intravitreal injection of expending gas (SF6).Final retinal reattachment was achieved in all 32 subjects (100%). Postoperative BCVA was significantly improved (P < 0.01). Conclusion Cryopexy with intravitreal gas injection is a simple,less trauma, lower cost and effective surgery for primary rhegmatogenous retinaldetachment.

The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization

PURPOSE: To presents the effect of triple therapy including C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy on patients with subretinal hemorrhage accompanied by choroidal neovascularization. METHODS: Twelve eyes of 12 patients suffering from subretinal hemorrhage accompanied by choroidal neovascularization with onset of the symptom within a week prior to three-day prone positioning after C3F8 gas injection were included in the present study. Next, intravitreal anti-VEGF injection and photodynamic therapy was performed. Then, within two months, intravitreal bevacizumab or ranibizumab injection was performed. RESULTS: After stabilization of the submacular hemorrhagic lesion, ten eyes of ten patients showed improved visual acuity, one eye showed no improvement, and decreased visual acuity developed in one patient. LogMAR visual acuity improved after the initial treatment from 1.05 +/- 0.43 to 0.74 +/- 0.58 and 0.53 +/- 0.51 at three and six months, respectively. The improvement was considered to be clinically significant. CONCLUSIONS: An appropriate regimen for treating broad submacular hemorrhage accompanied by choroidal neovascularization has not been established. The authors of the patients had obtained positive results from C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy. In the future, additional studies should be conducted.

Treatment of Hypotony Maculopathy Caused by Silicone Oil Removal With Gas Tamponade

PURPOSE: To report a case of hypotony maculopathy after silicon oil removal treated by intravitreal gas injection. CASE SUMMARY: A 35-year-old women presented with decreased visual acuity of the right eye for two weeks. Retinal detachment with peripheral retinal tears was observed in the patient's right eye. Pars plana vitrectomy including lensectomy, endolaser photo-coagulation and silicone oil injection was performed. Silicone oil removal was performed to improve patient's visual acuity two months after the operation. After the silicone oil removal, visual acuity was decreased to hand motion, and intraocular pressure was decreased below 3 mmHg while observing chorioretinal folding in fundus for two months. Intraviteal C3F8 gas injections were performed three times in the two months after silicone oil removal. After three gas injections, gradual reduction of chorioretinal folding was observed. Visual acuity was improved to 0.2 and IOP was maintained at 8 to 10 mmHg for 18 months after the last gas injection. CONCLUSIONS: Intravitreal gas injection offers a safe and effective method for treating hypotony retinopathy after silicon oil removal.

Treatment of Hypotony Retinopathy with Cyclodialysis Cleft by Intravitreal Gas Injection

PURPOSE: We report a case of post-traumatic hypotony retinopathy with cyclodialysis cleft treated by intravitreal gas injection. METHODS: A 38-year-old man presented with decreased visual acuity after blunt trauma to the left eye. Visual acuity of the left eye was 0.06 and intraocular pressure was 1 mmHg. No external wound was found. The anterior chamber showed a microscopic hyphema and, upon funduscopic examination, mild macular edema and striae were seen. The cyclodialysis was identified using gonioscopy. We treated the patient with intravitreal gas (perfluoropropane, C3F8) injection under topical anesthesia and tracked the outcome of this treatment. RESULTS: On the first postoperative day, intraocular pressure fell to the normal range. After 7 days the visual acuity improved to 1.0. During a follow-up period of 10 months, intraocular pressure and visual acuity remained in their normal range. CONCLUSIONS: Intravitreal gas injection offers a safe and effective method of treating hypotony retinopathy with cyclodialysis cleft.

Treatment of Failed Macular Hole after Vitrectomy by Outpatient Gas Injection and Laser Photocoagulation

PURPOSE: This study aimed to assess the effect of gas injection and laser photocoagulation for patients with opened macular holes who had previously undergone trans pars plana vitrectomy. METHODS: A retrospective study for 6 patients (6 eyes) who had opened macular holes after vitrectomy were treated by an outpatient method consisting of laser photocoagulation to the foveal pigment epithelium followed by injection of 100% SF6 gas. Visual acuity, anatomic status of the macular hole, and complications were evaluated. RESULTS: The length of period of gas injection and laser photocoagulation was distributed to 1 month to 8months (mean 3.2 months) and follow up period was distributed to 8 months to 25 months (mean 14.3months). Three of six eyes with gas injection and laser photocoagulation achieved anatomic success and two of them achieved visual improvement by more than two lines. Three eyes among four phakic eyes developed nucleosclerosis of the lens and one eye developed transient elevation of intraocular pressure. CONCLUSIONS: The outpatient gas injection and laser photocoagulation appears to be a safe and cost-effective alternative to repeated surgery for opened macular holes after trans pars plana vitrectomy.

The 2 Cases of Surgical Treatment for Retinal Detachment with Macular Hole after Ocular Trauma

In two patients with macular hole, retinal detachment in the posterior pole and commotio retinae, we performed pars plana vitrectomy, fluid-air exchange, intravitreal injection and removal of 0.04cc autologous serum, and air-gas exchange. These patients absolutely maintained prone position during the two-week postoperative period. As a result, anatomical and functional success about macular hole was accomplished in both cases through a long term of observation over a year. In traumatic macular hole with retinal detachment, we suppose that anatomical and functional success will be accomplished through pars plana vitrectomy, intravitreal injection and removal of autologous serum and gas injection into the vitreous cavity.

Effect of Intravitreal Gas Injection in Retinal Detachment Assiciated with Macular Hole: Long Term Follow-up

In 11(64.7%) of 17 eyes treated by intravitreal gas injection, the retinas were successfully attached during follow-up period that ranged from 12 to 39 months. Group I(detachment limited to the perimaculararea) patients need more frequent gas injection than group II(detachment extending to equator), but success rate of group I(83.3%) is higher than group II(66.7%). Group III(detachment with peripheral retinal break) patients are not successful by gas injection only. In the succesful eyes, macular holes are not visible, but "window defects" are present on FAG. The relative scotomas improve. Recurrent detachment cases(31.3%) are associated with posterior staphyloma, peripheral retinal break and trauma. Time of late recurrences ranged from 4 to 13 months postoperatively(mean: 7 months).

Treatment of Retinal Detachment with Macular Hole: Paracentesis, Subretinal Fluid Drainage and Intravitreal Gas Injection

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.

Treatment of Retinal Detachment with Macular Hole: Paracentesis, Subretinal Fluid Drainage and Intravitreal Gas Injection

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.

Intraocular Pressure Changes After Gas Injection into the Rabbit Vitreous Cavity

A total of 0.3ml of 100% sulfur hexafluoride(SF6) was injected into vitreous cavity with a single shot or two 0.15ml shots, and the time dependent intraocular pressure changes were compared. Intraocular pressure was monitored at 5 minute intervals for 60 minutes after injection. Immediately after a single shot injection, remarkable intraocular pressure elevation(85mmHg, mean)was observed, which returned, however, to normal level within 15 minutes. Intraocular pressure elevation was milder when a smaller bolus of gas(0.15ml)was separately injected twice. No re-elevation of intraocular pressure was noted with either method after the initial return to normal.

Treatment of Retinal Detachment With Macular Hole: drainage of subretinal fluid and intravitreal gas injection

Four cases of retinal detachment with macular hole and no posterior vitreoretinal connections were treated successfully by draining subretinal fluid externally, injecting sulfur hexafluoride gas into the vitreous cavity, and then keeping the patient in a prone position. And in all four cases, the retina remained attached during follow-up periods of 6 months or longer. This approach is simple, easy, and safe. Moreover, it brings good functional success because the macula is preserved. This approach must be the treatment of choice in retinal detachments with macular hole but without other breaks or vitreous adhesion.