C3F8 Gas Injection Research Articles

Using a commercial fibrin sealant (TISSEEL) as an adjuvant for full-thickness macular hole closure surgery: A case series

A retrospective interventional case series was performed to evaluate the anatomical and visual outcomes of macular hole surgery aided with TISEEL commercial fibrin sealant. Seven eyes of seven patients were included: three with a recurrent macular hole, one with a traumatic macular hole, and three with primary macular holes. All eyes underwent vitrectomy, internal limiting membrane peeling, fluid air exchange, instillation of 1–2 drops of the commercial fibrin sealant on the hole, and C3F8 gas injection. The macular hole was closed in all seven patients; they showed significant improvement in visual acuity and no ocular or systemic complications.

Risk Factors and Outcomes of Postoperative Macular Hole Formation after Vitrectomy for Myopic Traction Maculopathy: SCHISIS Report No. 2

To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM). Multicenter, interventional, retrospective case series. Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up. We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery. Incidence, risk factors, and anatomic and visual outcomes of postoperative MH. We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P= 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P= 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P= 0.022) as significant risk factors for postoperative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P= 0.096), because 1 eye still developed MH. Postoperative MHs were treated by observation (6 eyes), in-office octafluoropropane (C3F8) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after C3F8 gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 ± 0.43 vs. 0.68 ± 0.46; P= 0.002). Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in relatively favorable anatomic closure but unfavorable visual outcomes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Closure of idiopathic full-thickness macular hole after intravitreal C3F8 injection without vitreomacular traction release: A case report and review of literature.

To describe a successful closure of macular hole without release of vitreomacular traction (VMT) after intravitreal perfluoropropane (C3F8) gas injection. A 54-year-old woman was referred to our clinic with the history of declined vision after a period of distorted vision in her right eye. After dilated fundus examination and performing optical coherence tomography (OCT), a V-shaped VMT complicated by full-thickness macular hole was diagnosed and she underwent pneumatic vitreolysis using intravitreal C3F8 gas injection. After 12 weeks, her visual acuity was significantly improved and fundus examination and OCT revealed that the macular hole was completely resolved despite persisted VMT. Intravitreal gas injection would be a promising option to manage idiopathic macular holes not only by releasing the vitreous traction on the macula, but also through some not proven or even unknown mechanisms.

Comparison of macular buckling and vitrectomy for the treatment of macular schisis and associated macular detachment in high myopia: a randomized clinical trial.

ObjectiveTo compare the efficacy and safety of macular buckling and vitrectomy for myopic traction maculopathy showing macular schisis (MS) and associated macular detachment (MD) but without full‐thickness macular hole (FTMH).DesignProspective, randomized, parallel, open‐label study.MethodsPatients were randomly assigned to either buckling or vitrectomy group. Macular buckling and intravitreal C3F8 gas injection were performed in the buckling group. Small gauge vitrectomy, internal limiting membrane peeling (ILMP) and C3F8 gas tamponade were performed in the vitrectomy group. The patients were followed for 12 months.Main outcome measuresBest‐corrected visual acuity (BCVA) at 12 months.ResultsA total of 85 patients were randomized, 80 eyes were included (41 receiving buckling, 39 received vitrectomy), and 78 patients completed the study. There were less eyes determined as surgical failure and required a second surgery in the buckling group than vitrectomy the group (2.4% versus 18.4%, p = 0.021). After surgery, macular buckling achieved more improvement in BCVA (+21.7 versus +4.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, p = 0.002). FTMH development was observed in only 1 (2.4%) eye, after removing of the implant due to recurrent conjunctival erosion, in the buckling group and 10 (26.3%) eyes (seven with‐, three without MD) in the vitrectomy group (p < 0.001). More eyes developed cataracts in the vitrectomy group than did in the buckling group (28.9% versus 7.5%, p = 0.014). Macular buckling‐associated strabismus (esotropia), binocular diplopia and implant exposure were observed in limited cases.Conclusions and relevanceMacular buckling is superior to vitrectomy with ILM peeling plus gas injection for surgical treatment of MS and associated MD in high myopia.

Effect of intravitreal C3F8 gas in patients with vitreomacular traction: Aretrospective case series.

SummaryBackgroundWe aimed to assess the efficacy of a single intravitreal perfluoropropane (C3F8) gas injection for the treatment of vitreomacular traction with or without a macular hole.MethodsIn this retrospective case series, seven eyes of six patients with symptomatic vitreomacular traction documented on optical coherence tomography, one with a macular hole additionally, received a single intravitreal C3F8 gas injection of up to 0.3 ml. The primary endpoint was vitreomacular traction release at 1 month after injection. Secondary endpoints included resolution of vitreomacular adhesion within 6 months, nonsurgical closure of macular holes, and change in central foveal thickness and best-corrected visual acuity.ResultsOverall, on optical coherence tomography, six of seven eyes (85.7%) had release of vitreomacular traction during the entire study duration: three within 1 month of injection and the other three within 6 months. Of the latter group, two of the three eyes showed a concurrent epiretinal membrane and one concurrent diabetic retino- and maculopathy. The patient with a macular hole had resolution of vitreomacular traction within 1 month but had to undergo vitrectomy because of nonclosure of the macular hole. Associated adverse events were macular edema with a consequent lamellar hole after injection in one patient, and another patient developed retinal detachment.ConclusionIntravitreal C3F8gas injection is an inexpensive and promising minimally invasive option for the treatment of symptomatic and persistent vitreomacular traction with or without a macular hole. Further larger studies, especially comparing C3F8 gas injection with other treatment options, are needed.

Pneumatic Vitreolysis for Management of Symptomatic Focal Vitreomacular Traction.

Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale.

Microbubble in the hole: a rare cause of failed macular hole surgery?

To present a failed macular hole surgery with gas microbubble retention within the hole. A 68-year-old female patient with a Stage 2 macular hole underwent vitrectomy with removal of posterior hyaloid and 12% C3F8 gas injection. Because the macular hole was Stage 2 and posterior hyaloid was observed to be firmly attached over the macular area, no attempt was made for peeling of internal limiting membrane. Postoperatively, the patient was instructed to keep a facedown posture for 1 week. At 1-month visit, ophthalmoscopy revealed a tiny gas bubble filling the macular hole that failed to close. The patient underwent a repeat vitrectomy in which internal limiting membrane was peeled, and the eye was filled with 20% SF6. At 2-week follow-up visit, the hole was observed to be closed. The reason for the macular hole nonclosure in this case may be the lack of internal limiting membrane peeling in the first operation. However, the authors believe that microbubble localized within the hole might have contributed to the failure.

Can retinal microtrauma by internal limiting membrane peeling cause retinal angiomatosis proliferans?

A 32-year-old male presented with decreased vision in right eye since 1 month following trauma with plastic ball. Best-corrected visual acuity (BCVA) was 20/160 in right eye and 20/20 in left. Right eye examination revealed angle recession, choroidal rupture, and macular hole. He underwent vitrectomy, internal limiting membrane (ILM) peeling, and 14% C3F8 gas injection. After 6 weeks, BCVA was 20/30; fundus showed macular hole closure. Six months after surgery, fundus revealed retinal vascular lesions suggestive of stage I RAP-like lesions; vision was maintained. Clinical findings were confirmed on Video ICGA, FFA, and OCT. The patient was periodically reviewed and lesions were nonprogressive until last follow-up, 13 months after surgery. It seems quite probable that ILM peeling may have caused retinal microtrauma leading to the formation of RAP-like lesions. What factors lead to such an event is as yet not clearly understood. Hence, larger studies with a longer follow-up are warranted to better understand these findings.

Intraocular Foreign Body of a Vitreous Cutter Tip Fragment

Purpose: To report a case of intraocular foreign body of a vitreous cutter tip fragment. Case summary: A 60-year-old women was referred by her ophthalmologist with a two-day history of visual disturbance in her right eye. She had undergone pars plana vitrectomy, barrier laser and C3F8 gas injection due to pseudophakic rhegmatogenous retinal detachment in our retinal service center four months previously. Slit-lamp biomicroscopy of her right eye showed cornea stromal edema with Descemet membrane folding. Gonioscopic examination revealed a metallic foreign body in the direction of the 6-o ’clock anterior chamber angle. Anterior chamber irrigation with successful removal of the metallic foreign body using intraocular foreign body forceps was performed. The removed intraocular foreign body was a vitrectomy cutter tip fragment 20 gauge in size and 3 mm in length. After surgery, the corneal stromal edema disappeared and her visual acuity in the right eye recovered. Conclusions: Intraoperative breakage of vitreous cutter tips can occur and cause toxic ocular tissue reaction. Care should be taken against vitreous cutter tip breakage during vitrectomy. J Korean Ophthalmol Soc 2010;51(1):141-144

Gas Injection versus Vitrectomy with Gas for Treating Retinal Detachment Owing to Macular Hole in High Myopes

To compare the efficacy between intravitreal gas injection alone and pars plana vitrectomy (PPV) with intraocular gas tamponade in treating retinal detachment due to macular hole in high myopes. Prospective, randomized controlled, multicenter study. We included 231 eyes of 231 patients with retinal detachment owing to myopic macular hole from 14 study sites in China. The patients were randomly assigned to undergo intravitreal perfluoropropane (C3F8) gas injection (group A) or vitrectomy with intraocular C3F8 gas tamponade (group B). Complete ocular examination included best-corrected visual acuity, applanation tonometry, slit-lamp biomicroscopy, color fundus photography, ultrasound examination, and optical coherence tomography at baseline and every 3 months after the surgery. At 12 months after surgery, the retinal reattachment rates was 59.8% (52 eyes) in group A, which was significantly lower than group B (79 eyes, 74.5%; P = 0.029). Logistic regression showed that PPV (P<0.001) and low height of retinal detachment at baseline (P = 0.068) were associated with a greater retinal reattachment rate. Subgroup analysis revealed that in group B, concomitant internal limiting membrane (ILM) peeling showed a slightly higher anatomic success rate (79.2%) than no ILM peeling (70.0%). The postoperative best-corrected visual acuity of the eyes with attached retina between group A and B was not significantly different (P>0.05). Pars plana vitrectomy with C3F8 endotamponade resulted in a higher anatomic success rate than intravitreal C3F8 gas injection alone in treating retinal detachment owing to macular hole in high myopes. The authors have no proprietary or commercial interest in any materials discussed in the article.

Management of optic disk pit-associated macular detachment with tisseel fibrin sealant.

Optic disk pit-associated macular detachment is a challenging condition to treat. Many surgical methods have been used to treat this condition with varying degrees of success. We managed optic disk pit-associated macular detachment in three cases with pars plana vitrectomy, fluid-air exchange, drainage of subretinal fluid through the optic disk pit, application of Tisseel fibrin sealant (Baxter Healthcare Corporation, CA) to the optic disk pit, C3F8 gas injection, and postoperative prone positioning. All three patients maintained flat maculae and had improved vision. Patient 3 had postoperative macular hole formation. This was managed successfully with pars plana vitrectomy, internal limiting membrane peeling, fluid-air exchange, and C3F8 gas injection. Our case series suggest that Tisseel fibrin sealant in conjunction with pars plana vitrectomy can be used successfully for management of optic pit disk-associated macular detachments.