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E.M. Pitchon, H.V. Tran, T.J. Wolfensberger; Pars Plana Vitrectomy With 1cc of Pure SF6 in the Treatment of Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4221.
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© ARVO (1962-2015); The Authors (2016-present)
Intraocular injection of small amounts of pure gas has been widely used for pneumatic retinopexy. Injection of larger amounts of pure gas carries a risk of acute intraocular pressure (IOP) elevation and possible retinal vascular occlusion due to the important expansion the bubble’s initial volume. We present a novel technique of injection of a large bubble of 1 cc of pure SF6 associated with vitrectomy for retinal detachment (RD) due to superior retinal breaks.
In a retrospective study, we analyzed a series of 46 eyes (45 patients) with RD due to superior breaks. 51% of the eyes were pseudophakic. The mean pre–operative IOP was 13.5± 3mmHg. 39% of eyes had a macula–off RD. All patients underwent pars plana vitrectomy, retinopexy, withdrawal of 1 cc of intraocular fluid and injection of 1 cc of pure SF6 through the pars plana. Six hours post–operatively all patients received 500 mg of Acetazolamide per os. During the first 24 hours after surgery patients were kept in a half–supine position allowing the spontaneous resorption of residual subretinal fluid. Patients were followed–up for 6 months.
At day 1 post–operatively, mean IOP was 17±4 mmHg (range: 10–30 mmHg), 11% of eyes receiving a topical pressure–lowering treatment. At 1 month the mean IOP was 16±4 mmHg and topical treatment was needed in 10.3% of cases. At 6 months mean IOP was 15.5±2 mmHg and 6% of patients needed a topical antiglaucomatous treatment. No patient needed surgical treatment for elevated IOP, and no central retinal artery or vein occlusion was observed during the follow–up. Primary retinal attachment rate was 91.5%. Best corrected mean Snellen visual acuity was 0.35±0.3 at 1 week, 0.6±0.3 at 1 month and 0.7±0.25 at 6 months.
Vitrectomy with injection of 1cc of pure SF6 is a safe and effective treatment for superior RD. Post–operative IOP elevation– if present–is transient and well controlled by medical therapy. This technique obviates the need to dilute the gas before injection, and allows a rapid post–operative visual rehabilitation of the patient since the gas bubble does not obstruct the visual axis.
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