Intraocular Gas Tamponade Research Articles

Duration of face down positioning following full-thickness macular hole repair: A protocol for a randomized pilot study.

Full-thickness macular holes (FTMH) are defects in the fovea involving all neural retinal layers. They reduce patients' visual acuity (VA) and impact their quality of life. FTMHs are repaired with pars plana vitrectomy (PPV) with intraocular gas tamponade and post-operative face-down positioning (FDP). There is no consensus regarding the ideal positioning requirements following FTMH repair and there lacks clear guidelines on the topic. While analysis of global practice patterns indicates that between 5-7 days is the most common duration suggested by surgeons, there is significant heterogeneity in surgeon preferences. There is, however, biological plausibility to support minimal or even no FDP following surgery and given the disabling nature of FDP for patients, there is a need to better assess key patient outcomes with different FDP durations. As such, this prospective randomized controlled pilot trial will compare 3-days of FDP to 7-days of FDP following PPV for FTMH. This single-centered, parallel-group randomized controlled pilot trial will randomize patients 1:1 following PPV to 3 days or 7 days of FDP. This investigation has been approved by the local ethics board (HiREB # 16100) and has been registered on clinicaltrials.gov (NCT06000111). The primary objective will be focused on assessing the feasibility of a larger trial; this will be determined through an assessment of the recruitment rate, retention rate, completion rate and recruitment time. The secondary outcomes involve assessment of the following patient-important outcomes a) macular hole closure rate, b) best-recorded VA, c) a general quality of life measure and vision-specific quality of life measure, d) patient compliance and e) complication rates. Outcomes will be evaluated at 3 months following surgery. The results of this pilot study will determine the feasibility of a larger-scale trial that will answer a patient important question with clinical equipoise.

In-Office Suprachoroidal Viscopexy for Rhegmatogenous Retinal Detachment Repair

In-office suprachoroidal viscopexy (SCVEXY) is a minimally invasive technique for rhegmatogenous retinal detachment (RRD) repair that can be performed with no incision, no tamponade agent, and no positioning requirements. This technique has the potential to be a step forward in the armamentarium to treat RRDs. To describe in-office SCVEXY for RRD repair. In this single-case report with short follow-up, a man in his 50s with pseudophakia and recent visual loss presented to St Michael's Hospital, Unity Health Toronto, with a fovea-off RRD in the right eye, extending from 6 to 10 o'clock, with no visible causative retinal break. Injection of suprachoroidal sodium hyaluronate, 1%, in the region of the suspected break, using a 30-gauge needle with a custom-made guard that exposed only 1 mm of the needle. Ability to perform in-office SCVEXY and to obtain a visible choroidal indentation. After the procedure, a dome-shaped choroidal convexity was present in the superior temporal area. The patient achieved macular reattachment in less than 24 hours with no postoperative abnormalities, such as outer retinal folds, residual subfoveal fluid, or retinal displacement, with rapid recovery of the outer retinal bands on optical coherence tomography. The optical coherence tomography scans acquired in the area of the choroidal convexity demonstrated the location of the viscoelastic material in the suprachoroidal space. Laser retinopexy was applied in the suspected region of the retinal tear, and the patient was able to resume normal activity immediately after the procedure with no restrictions. Suprachoroidal viscopexy is feasible as an in-office technique to create a temporary choroidal buckle for RRD repair. It is a minimally invasive procedure with the potential to maximize anatomical outcomes of integrity and postoperative functional outcomes in RRD because its mechanism of action does not require drainage of subretinal fluid or intraocular gas tamponade. Nevertheless, this was a single-case report with short follow-up, which limits the ability to determine the procedure's benefits, potential adverse events, failure rates, and best-case selection. Further work is required to refine the procedure and assess its efficacy and safety.

Gestion médicochirurgicale de l’hémorragie intravitréenne chez le patient diabétique

Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.

Surgery for Infectious Retinitis - When Medical Therapy Is Not Sufficient: The Moacyr E. Alvaro Pan-American Lecture 2023

ABSTRACT Background Viral retinitis composes a group of infectious ocular diseases with poor prognoses. With the advent of antivirals and HAART, the treatment of these diseases has evolved and ocular outcomes have improved. However, even with prompt medical treatment, a significant number of patients will experience complications that require surgical intervention. While there has been an abundance of research examining the medical treatment of CMV retinitis and acute retinal necrosis, the research examining surgical outcomes of complications such as retinitis-associated retinal detachment is comparatively limited. Methods Literature review. Results In this review, we discuss the current literature examining treatment of CMV retinitis and acute retinal necrosis, with a focus on surgical management of complications such as retinal detachment. Conclusions Despite significant improvements in the medical treatment of CMV retinitis and ARN over the last three decades, vision-threatening complications such as retinal detachment are relatively common and require surgical management via PPV, laser photocoagulation, and intraocular gas or silicone oil tamponade.

Pars plana vitrectomy and subretinal tissue plasminogen activator for large exudative submacular hemorrhage: a case series

BackgroundTo evaluate anatomical and functional outcomes of patients with large submacular hemorrhage (SMH) who treated by pars plana vitrectomy (PPV) in combination with subretinal tissue plasminogen activator (TPA) injection, intraocular gas tamponade, and with additional post-operative interventions.MethodsMedical records of 9 patients who presented with large SMH secondary to age-related macular degeneration (AMD) and underwent PPV, subretinal TPA injection, and gas tamponade at Chiang Mai university hospital between January 2012 and January 2020 were reviewed. Collected data included preoperative visual acuity (VA), SMH extent and duration, intraoperation and post-operation complications, post-operative anatomical and VA responses, and the need for administer post-operation additional treatments.ResultsOverall, five patients were male and four patients were female with a mean (SD) age of 66.9 (7.7) years and a mean (SD) follow-up of 21.1 (16.1) months. A mean (SD) duration of SMH was 15.1 (10.9) days with a mean (SD) extent of SMH was 6.2 (3.4) disc diameters. At 1-month post-operation, complete SMH displacement was noted in eight (88.9%) patients. The mean (SD) VA significantly improved from LogMAR 1.9 (0.4) to 1.1 (0.4), (P = 0.004). During follow-up, eight patients (88.9%) were given additional therapy (anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy, or in combination). At final follow-up, a mean (SD) LogMAR VA of 0.9 (0.4) was significantly improved compared to baseline (P = 0.004). For intra- and post-operation complications, none developed intraoperative retinal break and retinal detachment.ConclusionsVitrectomy with subretinal TPA injection, intraocular gas tamponade, and additional post-operation treatments provide benefit for anatomical and visual outcomes for patients with large SMH. It may consider as one of effective treatment in this group of patients.

Spotlight on the Internal Limiting Membrane Technique for Macular Holes: Current Perspectives.

Pars plana vitrectomy has become the standard procedure for primary macular holes (MHs) repair, including the removal of the posterior cortical vitreous, the stripping of eventual epiretinal membranes, and finally an intraocular gas tamponade. During this procedure, peeling the internal limiting membrane (ILM) has been proven to increase closure rates and avoid postoperative reopening in several researches. In fact, even in large MHs more than 400 µm, the advantage of peeling off the ILM was highlighted by better anatomical closure rates. Nevertheless, some authors suggested that ILM peeling is not always essential, because it generates various side effects in retinal structure and function. Furthermore, the ideal amount of ILM peeling and the most effective strategies for removing the ILM are still subject of research. Different surgical modifications have been reported as alternatives to traditional peeling in certain clinical settings, including ILM flaps, ILM scraping, and foveal sparing ILM peeling. As regards large MHs, the introduction of ILM inverted flap appeared as a game changer, offering a significantly higher >90% closure rate when compared to traditional ILM peeling. Modifications to inverted ILM flap procedures have been claimed in recent years, in order to define the best area and direction of ILM peeling and its correlation with functional outcomes. Moreover, several innovations saw the light in the setting of recurrent MHs, such as ILM free flap transposition, inverted ILM flap combined autologous blood clot technique, neurosensory retinal flap, and human amniotic membrane (HAM) plug, claiming higher anatomical success rate also in those complex settings. In conclusion, the aim of this review is to report how the success rate of contemporary macular surgery has grown since the turn of the century, especially for big and chronic MHs, analyzing in which way ILM management became a crucial point of this kind of surgery.

Early Removal of Scleral Buckle

Purpose: To study the outcomes of early removal of segmental buckle on visual acuity, retinal status, and astigmatism. Study Design: Interventional case series Place and Duration of Study: Mayo hospital, from February 2018 to July 2018. Methods: Ten patients fulfilling the inclusion criteria were recruited. All the patients underwent segmental radial sponge with cryoretinopexy, with or without drain and intraocular gas tamponade as per need. Post-operative follow ups were at 1st week, 4th week and 6th week. Sponge was removed at 6th week after making sure that the retina was attached. Follow ups after buckle removal were planned at 1st week, 1st month and 3rd month. Improvement in VA, retinal status and astigmatism were noted. The commonest reason for the explant removal was infection followed by pain. Normality was checked through Shapiro-Wilk’s W-test and the normality criteria was met so paired sample t-test was used to assess the significance of astigmatism pre and post-surgery. Results: The average age was 32.30 ± 16.75 years (range, 03 – 61 years). Anatomical success was achieved in 100%. Visual acuity improved in all patients. Moreover, early removal of buckle reduced astigmatism and further improvement in vision was also noted. Pre and post-surgical vision improvement was statistically significant with p-value of 0.000. After removal of buckle, improvement of astigmatism was also statistically significant p-value 0.004. Conclusion: The early removal of scleral explant not only provides symptomatic relief to the patients, but is also associated with marked improvement in visual acuity was noted. Key Words: Visual Acuity, Astigmatism, Retinal Detachment, Segmental Scleral Buckle.

Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole.

PurposeTo summarize current surgical techniques for treating primary macular holes (MHs).MethodsWe reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results.ResultsCurrently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of >90%, even in large MH up to 650 µm. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs.ConclusionSince the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy.

Intraocular endoscopy for the evaluation and treatment of hypotony due to a traumatic cyclodialysis: a case report

BackgroundA cyclodialysis cleft often leads to direct communication between the anterior chamber and the suprachoroidal space. It is a rare condition that is encountered with blunt trauma, and less commonly, after surgery. Hypotony is the major sequelae that may lead to hypotonous maculopathy, optic disc edema, corneal folds, and astigmatism. These may cumulatively lead to visual loss. We describe how endoscopy in a cyclodialysis repair allowed us to accurately locate the cleft and guided its appropriate management avoiding unnecessary cryopexy.Case presentationA 41-year-old male experienced a traumatic cyclodialysis cleft, which resulted in persistent hypotony. Pars plana vitrectomy was performed to treat vitreous hemorrhage. Scleral indentation was attempted to visualize the cyclodialysis cleft. However, the depression distorted the visualization. Intraocular endoscopy was therefore used to evaluate the cleft. Guided by this assessment, only intraocular gas tamponade was used to reposition the ciliary body. The patient’s intraocular pressure was restored to 13 mmHg 3 days after the operation, and OCT confirmed cleft closure 1 month after the operation.ConclusionEndoscopy-assisted repair of cyclodialysis is an approach that enhances visualization and can guard against common causes of persistent cleft and hypotony, as well as reveal the causes of recurrent failure. Hence, it can eliminate unnecessary cryopexy that might worsen the hypotonous state. In our case, intraocular endoscopy was effective for the evaluation of a cyclodialysis cleft and the subsequent selection of an appropriate management technique, gas tamponade, that was more conservative than other approaches initially considered.

Rhegmatogenous retinal detachment and full-thickness macular hole induced by lightning

A 31-year-old gentleman was remotely struck by lightning and complained of blurred vision in his left eye. He was diagnosed with left eye anterior uveitis and full-thickness macular hole (FTMH), and subsequently referred for vitreoretinal intervention. On examination, his left-eye vision was hand movement. Anterior uveitis had resolved with no cells in the anterior chamber. Posterior subcapsular cataract 2+ was noted. There was a FTMH and partial posterior vitreous detachment (PVD) confirmed by optical coherence tomography (OCT). Right eye was normal with 6/6 vision. At one- month follow-up, the macular hole was closed spontaneously but localised rhegmatogenous retinal detachment (RRD) was noted in the inferior retina with macula-on. There were multiple holes in the inferior equatorial region surrounded by hyper- and hypopigmented retinal atrophy. The patient underwent phacoemulsification, intraocular lens implantation, vitrectomy, and gas tamponade (C3F8 14%). At one week postoperative, he had recurrent retinal detachment with multiple new atrophic holes noted. He underwent a second vitrectomy with silicone oil tamponade. Best-corrected visual acuity (BCVA) in his left eye two months after surgery was 6/45 and the retina had reattached.

Spontaneous scleral rupture associated with retinochoroidal coloboma

Abstract We reported a case of ocular hypotony due to spontaneous scleral rupture in retinochoroidal coloboma and the treatment which was performed. This is a prospective case report in which a 21-year-old woman complained of abrupt vision loss in her left eye. Ocular hypotony due to spontaneous scleral rupture in retinochoroidal coloboma was identified through tests. An ultrassonography confirmed the scleral lesion but magnetic resonance imaging and fluorescein angiography have also proven to be useful. Due to the posterior location of the perforation, we opted for a sub-tenon injection of autologous blood and intraocular gas tamponade, which were successful, resulting in improved visual acuity and intraocular pressure. In this case, an alternative to invasive surgical procedure in the treatment of spontaneous scleral perforation and retinochoroidal coloboma was presented.

CLOSURE OF SMALL MACULAR HOLES USING VITRECTOMY SURGERY WITH INTERNAL LIMITING MEMBRANE PEELING WITHOUT THE USE OF INTRAOCULAR GAS TAMPONADE: BROADENING THE UNDERSTANDING OF THE MACULAR HOLE PATHOPHYSIOLOGY.

To determine whether small macular hole closure can be achieved with 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or facedown positioning. 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or positioning was performed on 20 eyes with a small (<400-µm diameter), full-thickness macular hole. In 17 of 20 eyes (85%), the hole had closed. Three holes had closed by Postoperative Day 1, 13 holes by Postoperative Week 1, 16 holes by Postoperative Week 2, and 17 holes by Postoperative Week 6. At Postoperative Month 1, vision improved in 16 of 17 eyes in which the macular hole had closed. One hole that had not closed at the first postoperative week and two holes that had not closed at the third postoperative week required follow-up surgery with intraocular gas tamponade and facedown positioning, after which the hole closed. The mean preoperative visual acuity was 0.626 logMAR (20/85), and the mean postoperative visual acuity after 1 month was 0.392 logMAR (20/50) (P < 0.001). Vitrectomy surgery with internal limiting membrane peeling without the use of gas tamponade or positioning can achieve closure of small macular holes.

Long term results of surgery for idiopathic macular hole

Amaç: İdiopatik makula deliği cerrahisinde 23G sütürsuz vitrektomi ile triamsinolon asetonid kullanılarak iç limitan membran soyulmasını değerlendirmek.Materyal ve Metot: Beyoğlu Göz Eğitim ve Araştırma Hastanesi’nde 2006-2011 yıllarında, makula deliği nedeniyle 23 Gauge pars plana vitrektomi (PPV) ile iç limitan membran (İLM) (triamsinolon asetonid yardımıyla) soyulan ve göz içi gaz tamponadı uygulanan 44 hastanın 49 gözüne ait veriler retrospektif olarak incelendi. Yaş, cinsiyet, makula deliği evresi, en iyi düzeltilmiş görme keskinliği (GK), semptom süresi, cerrahi sonrası fonksiyonel başarı ve optik kohorens tomografi ile anatomik olarak değerlendirildi.Bulgular: Ortalama yaşları 67 ±9,51 olan hastaların 28’i kadın (%57,1) ve 21’i (%42,9) erkekti. Deliklerin 26 tanesi (%53,1) evre 3, 20 tanesi (%40,8) evre 4, 3 tanesi ise (%6,1) evre 2 idi. Hastaların şikayet süresi ortalama 4,14±3,22 ay (1-12 ay) idi. Ortalama 13,81± 9,44 ay (6-58 ay) takip edilen hastaların 44’ünde (%89,8) anatomik başarı elde edildi. Snellen eşeline göre 2 veya daha fazla sıra görme artışı olan hasta oranı %51 (25 göz) oldu. Görme kaybı 6 aydan daha az olan vakaların hem preoperatif en iyi düzeltilmiş GK hem de postoperatif en iyi düzeltilmiş GK’ları daha iyi saptandı. Son vizitteki en iyi düzeltilmiş GK ile deliğin evresi, delik çapı, preoperatif en iyi düzeltilmiş GK ve tamponad çeşiti arasında anlamlı ilişki bulunmadı. Ameliyat sonrası, 33 hastada (%67,3) katarakt, 3 hastada (%6,1) hipotoni gelişti. Sonuç: 23 G sütürsuz PPV ile triamsinolon asetonid kullanılarak İLM soyulması uygulanan idiopatik makula deliği tedavisinin yüksek anatomik ve fonksiyonel başarı ile sonuçlandığı görüldü. Erken dönemde başvuru ve erken cerrahinin sonuç en iyi düzeltilmiş GK’yı etkileyen en önemli faktör olduğu sonucuna varıldı.

Macular perfusion changes assessed with optical coherence tomography angiography after vitrectomy for rhegmatogenous retinal detachment

PurposeTo explore macular perfusion changes in patients with rhegmatogenous retinal detachment (RRD) involved the macula following successful surgery and to evaluate the correlation between macular blood flow density and visual outcomes using optical coherence tomography angiography (OCTA).MethodsThis retrospective study included 14 eyes (14 patients) with macular-off RRD that underwent a standard three-port 23-gauge pars plana vitrectomy (PPV) and intraocular gas tamponade combined with phacoemulsification, aspiration, and intraocular lens implantation. OCTA was used to evaluate the macular perfusion changes throughout postoperative 12 weeks in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillary plexus (CCP). The fellow unaffected eyes were used as controls for comparison.ResultsA significant increase in the superficial capillary plexus flow density (SCPFD) (P = 0.000) was observed over time in RRD eyes with successful PPV, as well as the deep capillary plexus flow density (DCPFD) (P = 0.000) and the choriocapillary plexus flow density (CCPFD) (P = 0.000). Final best-corrected visual acuity (BCVA) was positively associated with CCPFD (r = − 0.577, P = 0.031) and non-correlated with SCPFD and DCPFD (P > 0.05).ConclusionsMacular perfusion gradually recovered following successful RRD repair by PPV. OCTA provided a non-invasive method to explore the underlying reason for different postoperative visual outcomes in macular-off RRD patients.

Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes.

Aim To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury. Methods Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses. Results The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P < 0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C3F8 gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P < 0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P < 0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029). Conclusions Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022)

BackgroundIn mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV. MethodsA total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. ResultsThe panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-naive PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. ConclusionsSix evidence-based recommendations support optimal care for PCV patients’ management.

Circumferential Pupillary Capture by IOL due to Intraocular Gas Tamponade: A Case Report

Circumferential Pupillary Capture by IOL due to Intraocular Gas Tamponade: A Case Report

Efficacy of 23-Gauge Pars Plana Vitrectomy with Intraocular SF6 Gas Tamponade for the Treatment of Intraocular Foreign Body

Background: Penetrating ocular injuries associated with intraocular foreign body (IOFB) can lead to severe visual loss and despite improvement in microsurgical techniques, IOFB removal is one of the most challenging procedures in ophthalmology. Objectives: The aim of this study was to evaluate the treatment outcomes of 23-gauge (23-G) pars plana vitrectomy (PPV) and intraocular SF6 gas tamponade for the management of patients with intraocular foreign body and attached retina with superior full thickness retinal breaks. Methods: In this prospective study, 23-G PPV was performed to manage patients with IOFB and attached retina and with full thickness retinal breaks. In patients with traumatic cataract and ruptured anterior and posterior lens capsule, IOFB was removed through limbal incision, yet in cases with intact lens capsule or without cataract, IOFB was removed through extended sclerotomy. Careful intraoperative barrier laser was performed and the vitreous cavity was filled with SF6 gas. All patients were followed-up for at least six months. Results: Ten eyes of ten patients were included in this study. The IOFB was removed through limbal incision in five eyes and through extended sclerotomy in five eyes. Lensectomy was done in eight eyes, in which primary intraocular lens (IOL) was implanted in seven eyes and secondary IOL (iris claw IOL) was implanted in one eye threemonths later. Visual acuity improved from 1.22±0.36 to 0.26± 0.18 logMAR (P = 0.007). No major intra-operative or post-operative complication, such as retinal detachment or endophthalmitis, occurred. Conclusions: The 23-G PPV with intraocular SF6 gas tamponade was an effective and safe treatment modality for the management of eyes with small IOFBs and attached retina with full thickness retinal break

THE ROLE OF INTRAOCULAR GAS TAMPONADE IN RHEGMATOGENOUS RETINAL DETACHMENT: A Synthesis of the Literature.

To review the literature regarding intraocular gas tamponade after vitrectomy for rhegmatogenous retinal detachment. The history and evolution of the use of gas is described. The theories explaining gas tamponade are discussed, and efficacy and safety studies in human and animal models are covered. A total of 61 articles relating to gas tamponade were cited in this review. Gas tamponade is a frequently used procedure in vitreoretinal surgery. An understanding of its mechanism of action is crucial for its safe use when determining which gas is to be used and at what concentration.

Retinal sensitivity following intraocular silicone oil and gas tamponade for rhegmatogenous retinal detachment.

To investigate whether intraocular silicone oil (SO) tamponade is associated with functional changes in patients with both macula-on and macula-off rhegmatogenous retinal detachments (RRDs). Prospective observational cohort study of patients with RRD treated by vitrectomy with gas or SO tamponade at the University Medical Center Utrecht. Outcome was best-corrected visual acuity (BCVA) and retinal sensitivity on microperimetry 2months after surgery. In total, 40 eyes were included. There are 10 eyes in each of the following groups: macula-on RRD and gas, macula-on RRD and SO, macula-off RRD and gas, and macula-off RRD and SO. Median retinal sensitivity on microperimetry was decreased following SO tamponade compared to gas tamponade for both macula-on and macula-off RRD (p<0.037). Foveal sensitivity was decreased in eyes after SO tamponade compared to gas tamponade. These effects were observed in patients with macula-on as well as macula-off RRD. Although further investigation is warranted to validate our results and to study underlying mechanisms, retinal surgeons need to be aware of these findings after the use of SO tamponade.