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S.Y. Lesnik-Oberstein, k. Mireskandari, G. Duguid, W.E. Schulenburg; Vitrectomy, Cryotherapy and Air for Primary Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2990.
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Purpose: To assess the primary reattachment rate when using air as a tamponading agent in selected cases of primary retinal detachment treated by vitrectomy and cryotherapy. Air has a half life of approximatly 1.6 days in the eye. Therefore if there is a complete air fill, 25% (ie more than one quadrant) of the retina should still be tamponaded after 5 days. Retinal adhesion by cryotherapy is believed to be effective within 2-5 days post-operatively. Air tamponade should therefore have sufficient duration to be effective, whilst offering several advantages of being of shorter duration than SF6 (earlier rehabilitation and air travel and possibly less cataract) Methods: All consecutive patients who underwent primary vitrectomy and cryotherapy with air as a tamponading agent between January 2002 and July 2002 were assessed retrospectively. All patients had full ophthalmic examinations before surgery using a standard work up. The extent of the retinal detachment and the location of the retinal breaks was determined by indirect ophthalmoscopy and during surgery. Air was chosen as the tamponade agent if the tears were within the same quadrant. The primary outcome measure was reattachment of the retina. Results: 25 eyes in 24 patients were identified to have undergone vitrectomy with cryotherapy and air. The average age of the patients was 66.6 years (range 47-70). All patients were phakic. Vision at presentation varied from 6/6 to perception of light. 9 eyes had macula off retinal detachments and 16 were macula on. The tears were between 10 and 2 o'clock in 22 of the patients. The primary reattachment rate was 90% and 84% of eyes had a post-operative visual acuity of 6/9 or better. This is similar to primary reattachment rates for vitrectomy with long acting gas. Conclusions: We conclude that air is a safe and effective tamponade agent in cases of primary retinal detachment, if the breaks are within the same quadrant and in a position to allow tamponade by posturing. As air resorbs more quickly than SF6 or C3F8 this promotes patient visual rehabilitation and may decrease the incidence of cataract and secondary retinal breaks due to persisting intraocular gas. It also allows earlier travel at altitude.
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