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Aranzazu Mateo Montoya, Marc D. de Smet; Air as Tamponade for Retinal Detachments. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5793.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether air can be used as a reliable tamponade agent after pars plana vitrectomy in selected cases of primary retinal detachment (RD).
A retrospective analysis of patients over a 6-month postoperative period was performed. Exclusion criteria were presence of fibrosis, fixed folds, proliferative vitreoretinopathy of grade C or greater, and giant retinal tears. The number, location, and types of breaks (horseshoe tear, operculum), peripheral retinal degeneration, extension of the RD, and whether or not the macula was attached were documented preoperatively. A 25-gauge 3-port pars plana vitrectomy was carried out in all patients. Central and peripheral vitreous was removed to eliminate all vitreous traction around the retinal tears and relieve tractional forces provoked by the air bubble injected at the end of surgery. Argon endolaser retinopexy, or cryotherapy, was applied around all breaks after fluid-air exchange. Filtered air was used as an internal tamponade. Patients were followed up at 24 hours, 1 week, and 1, 3 and 6 months postoperatively.
Twelve eyes (11 patients; 5 women and 6 men) were included. Patients were aged 38 to 97 years (mean: 63.18 years). Seven patients were pseudophakic, 3 had a cataract that was removed during the surgery and 2 had a transparent lens. The average size of the air bubble on postoperative day 1 was 60% (range: 40-80%), and it took 10.7 days (range: 7-15 days) to resolve completely. Visual acuity (VA) improved from 1.35 ± 1.21 logMAR preoperatively to 0.99 ± 0.92 postoperatively on week 1, 0.33 ± 0.30 on month 1, 0.16 ± 0.21 on month 3, and 0.13 ± 0.19 after a follow-up time of 6 months. There were 2 cases of increased intraocular pressure both on day 7 that resolved with treatment. We achieved a primary postoperative success rate of 100% at 1 month, and 91.6% at both 3 and 6 months.
We achieved a good success rate with air tamponade and a minimalistic laser treatment applied on areas around tears only. This approach provides for quicker VA recovery associated with a rapid disappearance of intraocular air, which can allow patients who live at higher altitudes to earlier regain their home after intraocular surgery. The results obtained are encouraging, and if reproducible in a larger series, might convince surgeons to use air tamponade instead of classic intraocular gases in selected RD.
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