Primary 23 Gauge Transconjunctival Sutureless Vitrectomy With Air Tamponade for Simple Rhegmatogenous Retinal Detachment

Oh Jae Kim; Tae Gon Lee; Sung Jin Na

doi:10.3341/jkos.2011.52.2.190

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Kim, Lee, and Na: Primary 23 Gauge Transconjunctival Sutureless Vitrectomy With Air Tamponade for Simple Rhegmatogenous Retinal Detachment

Original Article

J Korean Ophthalmol Soc 2011;52(2):190-196.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.2.190

Primary 23 Gauge Transconjunctival Sutureless Vitrectomy With Air Tamponade for Simple Rhegmatogenous Retinal Detachment

Oh Jae Kim, MD, Tae Gon Lee, MD, Sung Jin Na, MD

Department of Ophthalmology, Konyang University Hospital, Daejeon, Korea

Address reprint requests to Sung Jin Na, MD Department of Ophthalmology, Konyang University Hospital #685 Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea Tel: 82-42-600-9258, Fax: 82-42-600-9176, E-mail: said8@hanmail.net

Received 13 August 201029 August 2010 Accepted 13 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the surgical outcomes of primary 23-gauge (23G) transconjunctival sutureless vitrectomy (TSV) with air tamponade in patients with idiopathic simple rhegmatogenous retinal detachment (RRD).

Methods

A chart review of 38 eyes with idiopathic simple RRD which underwent primary 23G TSV with air tamponade and without prone positioning by a single vitreoretinal surgeon was retrospectively performed. All cases were followed up for a minimum of 3 months after the operation.

Results

The primary anatomical success rate was 94.7% (36/38 eyes). Preoperative mean logMAR (Snellen) best corrected visual acuity (BCVA) was 0.81 ± 0.13 and improved to 0.63 ± 0.37 and 0.48 ± 0.37 at postoperative 1 week and 3 months (p < 0.05), respectively. The mean 21.35% amount of air bubble remained in the vitreous cavity at postoperative 1 week and the residual air bubble was completely absorbed at postoperative 2 weeks. Complications were sclerotomy site leakage (1 eye), cataract (3 eyes), vitreous hemorrhage (1 eye), epiretinal membrane (2 eyes) and increased intraocular pressure (3 eyes).

Conclusions

The use of 23G TSV with air tamponade in cases with idiopathic simple RRD may be an effective and safe surgical technique.

Keywords: Air tamponade, Primary vitrectomy, Retinal detachment, 23-Gauge transconjunctival sutureless vitrectomy

References

1. Escoffery RF, Olk RJ, Grand MG, Boniuk I. Vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment. Am J Ophthalmol. 1985; 99:275–81.

2. Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1993; 231:344–6.

3. Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand. 2005; 83:293–7.

4. Heimann H, Zou X, Jandeck C, et al. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol. 2006; 244:69–78.

5. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25:208–11.

6. Fine HF, Iranmanesh R, Iturralde D, Spaide RF. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology. 2007; 114:1197–200.

7. Han JI, Cho SW, Lee TG, et al. The clinical results of sutureless vitrectomy using 23-gauge surgical system. J Korean Ophthalmol Soc. 2008; 49:911–6.

8. Rosengren B. Cases of retinal detachment treated with diathermy and injection of air into vitreous body. Acta Ophthalmol. 1938; 16:573–9.

9. Vygantas CM, Peyman GA, Daily MJ, Ericson ES. Octafluorocy- clobutane and other gases for vitreous replacement. Arch Ophthalmol. 1973; 90:235–6.

10. Cibis PA, Becker B, Okun E, Canaan S. The use of liquid silicone in retinal detachment surgery. Arch Ophthalmol. 1962; 68:590–9.

11. Chang S, Ozmert E, Zimmerman NJ. Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy. Am J Ophthalmol. 1988; 106:668–74.

12. Chang S, Reppucci V, Zimmerman NJ, et al. Perfluorocarbon liquids in the management of traumatic retinal detachments. Ophthalmology. 1989; 96:785–91.

13. Uemoto R, Saito Y, Sato S, et al. Better success of retinal reattachment with long-standing gas tamponade in highly myopic eyes. Graefes Arch Clin Exp Ophthalmol. 2003; 241:792–6.

14. Martínez-Castillo V, Verdugo A, Boixadera A, et al. Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air. Arch Ophthalmol. 2005; 123:1078–81.

15. Gonin J. The treatment of detached retina by searing the retinal tears. Arch Ophthalmol. 1930; 4:621–5.

16. Gartry DS, Chignell AH, Franks WA, Wong D. Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy. Br J Ophthalmol. 1993; 77:199–203.

17. Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments. Ophthalmology. 1999; 106:1811–5.

18. Woon WH, Burdon MA, Green WT, Chignell AH. Comparison of pars plana vitrectomy and scleral buckling for uncomplicated rhegmatogenous retinal detachment. Curr Opin Ophthalmol. 1995; 6:76–9.

19. Newman DK, Burton RL. Primary vitrectomy for pseudophakic and aphakic retinal detachments. Eye. 1999; 13:635–9.

20. Bartz-Schmidt KU, Kirchhof B, Heimann K. Primary vitrectomy for pseudophakic retinal detachment. Br J Ophthalmol. 1996; 80:346–9.

21. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109:1807–12.

22. Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month followup results of a single operation – report no. 1. Ophthalmology. 2005; 112:1421–9.

23. Brazitikos PD, Androudi S, Christen WG, Stangos NT. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: A randomized clinical trial. Retina. 2005; 25:957–64.

24. Stangos AN, Petropoulos IK, Brozou CG, et al. Pars plana vitrectomy alone versus vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment. Am J Ophthalmol. 2004; 138:952–8.

25. Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month followup results of a single operation–report no. 1. Ophthalmology. 2005; 112:1421–9.

26. Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegma togenous retinal detachment. Acta Ophthalmol Scand. 2007; 85:540–5.

27. Heimann H, Bornfeld N, Friedrichs W, et al. Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1996; 234:561–8.

28. Kang SW, Min JP. Vitrectomy without scleral buckling for the treatment of primary rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 1997; 38:227–35.

29. Oshima Y, Emi K, Motokura M, Yamanishi S. Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachments. Jpn J Ophthalmol. 1999; 43:120–6.

30. Han NS, Lee SB, Kim YB, Jo YJ. Results of triple surgery: cataract extraction, intraocular lens implantation and vitrectomy for retinal detachment. J Korean Ophthalmol Soc. 2004; 45:2041–6.

31. Thompson JT. The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol. 2004; 137:250–7.

32. Michels RG, Gilbert HD. Surgical management of macular pucker after retinal reattachment surgery. Am J Ophthalmol. 1979; 88:925–9.

33. Uemura A, Ideta H, Nagasaki H, et al. Epiretinal membrane after retinal detachment surgery. Ophthalmic Surg. 1992; 23:116–9.

34. Cox MS, Azen SP, Barr CC, et al. Epiretinal membrane after successful surgery for proliferative vitreoretinopathy. Ophthalmology. 1995; 102:1884–91.

35. Shea M. The surgical management of macular pucker in rhegmatogenous retinal detachment. Ophthalmology. 1980; 87:70–4.

36. Hagler WS, Aturaliya U. Macular puckers after detachment surgery. Br J Ophthalmol. 1971; 55:451–7.

37. Martínez-Castillo V, Boixadera A, Verdugo A, García-Arumí J. Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position. Ophthalmology. 2005; 112:1222–6.

38. Martínez-Castillo V, Zapata MA, Boixadera A, et al. Pars plana vitrectomy, laser retinopexy, and aqueous tamponade for pseudophakic rhegmatogenous retinal detachment. Ophthalmology. 2007; 114:297–302.

39. Yoon YH, Marmor MF. Rapid enhancement of retinal adhesion by laser photocoagulation. Ophthalmology. 1988; 95:1385–8.

40. Folk JC, Sneed SR, Folberg R, et al. Early retinal adhesion from laser photocoagulation. Ophthalmology. 1989; 96:1523–5.

41. Kita M, Negi A, Kawano S, Honda Y. Photothermal, cryogenic, and diathermic effects of retinal adhesive force in vivo. Retina. 1991; 11:441–4.

42. Thompson JT. Kinetics of intraocular gases. Disappearance of air, sulfur hexafluoride, and perfluoropropane after pars plana vitrectomy. Arch Ophthalmol. 1989; 107:687–91.

Figure 1.

Postoperative residual amount of air bubble.

Table 1.

General characteristics of 38 patients (eyes)

	No. (%)
Male	22 (57.9)
Female	16 (42.1)
Mean age ± SD (yr)	54.4 ± 9.4
Mean follow up ± SD (mon)	6.3 ± 1.2

Table 2.

Surgical characteristics of 38 patients (eyes)

Characteristics	No. (%)
Macula status (%)
On	11 (28.9)
Off	27 (71.1)
Preoperative lens status (%)
Phakic	25 (65.8)
Pseudophakic	13 (34.2)
Mean Extent of RD^∗ (clock hours)	6.45 ± 4.2
Number of breaks (%)
1	22 (57.9)
2	12 (31.6)
3	4 (10.5)
Location of break (%)
Superior half (9∼3 o'clock)	29 (76.3)
Inferior half (4∼8 o'clock)	9 (23.7)

^∗ Retinal detachment.

Table 3.

Mean value of visual acuity and improvement

	V/A^∗ (preoperative)	V/A^∗ (1 wk)	V/A^∗ (3 mon)
Macula on	0.19 ± 0.24	0.29 ± 0.28	0.18 ± 0.15
	(0.67 ± 0.18)	(0.52 ± 0.34)	(0.62 ± 0.23)
Macula off	0.95 ± 0.14	0.75 ± 0.20^†	0.64 ± 0.17^†
	(0.11 ± 0.13)	(0.14 ± 0.24)	(0.23 ± 0.28)
Total	0.81 ± 0.13	0.63 ± 0.37	0.48 ± 0.37^†
	(0.15 ± 0.21)	(0.24 ± 0.27)	(0.34 ± 0.17)

^∗ logMAR (Snellen) visual acuity;

^† p<0.05, by Wilcoxon's signed rank test.

Table 4.

Intraoperative and postoperative complications

Complications	Number of eyes
Sclerotomy site leakage	1
Iatrogenic tear	0
Choroidal detachment	0
Hypotony	0
Increased IOP^∗	3
Cataract progression	3
Vitreous hemorrhage	1
Epiretinal membrane	2
Redetachment	2

^∗ IOP = intraocular pressure.

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