Korean J Ophthalmol.  2009 Dec;23(4):253-258. 10.3341/kjo.2009.23.4.253.

The Efficacy of Fluid-Gas Exchange for the Treatment of Postvitrectomy Retinal Detachment

• Jang JH
• Kim YC
• Kim KS

• KMID: 754759
• DOI: http://doi.org/10.3341/kjo.2009.23.4.253

Abstract

PURPOSE
This study was designed to evaluate the efficacy of fluid-gas exchange for the treatment of postvitrectomy retinal detachment.
METHODS
We retrospectively reviewed the records of 33 consecutive patients (35 eyes) who underwent fluid-gas exchange treatment for postvitrectomy retinal detachment using the two-needle pars plana approach technique.
RESULTS
The retinal reattachment rate was 80.0% after complete intravitreal gas disappearance following the fluid-gas exchange; the overall success rate was 65.7%. Visual acuity was improved or stable in 80.0% of cases; a two-line or greater vision improvement or a best-corrected visual acuity of 0.4 or better occurred in 62.9% of cases. The success rates for superior retinal detachments and posterior pole retinal detachments were 76.5% and 85.7%, respectively.
CONCLUSIONS
Fluid-gas exchange represents a simple and cost-effective alternative outpatient procedure for retinal reattachment without reoperation for the treatment of superior and posterior pole retinal detachments.

Keyword

Fluid-gas exchange; Postvitrectomy retinal detachment; Two-needle pars plana approach technique

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Fluorocarbons/*administration & dosage
Follow-Up Studies
Humans
Injections
Laser Coagulation/methods
Male
Middle Aged
Ophthalmoscopy
Postoperative Care/*methods
Retinal Detachment/diagnosis/etiology/*therapy
Retrospective Studies
Sulfur Hexafluoride/*administration & dosage
Time Factors
Treatment Outcome
Visual Acuity
Vitrectomy/*adverse effects
Vitreous Body
Young Adult

Figure

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  Fig. 1 (A) Technique for the pars plana approach to fluid-gas exchange using two 1 mL syringes for retinal detachment in a vitrectomized eye. (B) The gas infusion syringe is inserted in the superotemporal pars plana while the second 1 mL syringe, without a plunger, is inserted in the inferotemporal pars plana.

Reference

1. Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971. 75:813–816.

2. Machemer R. A new concept for vitreous surgery. 2. Surgical technique and complication. Am J Ophthalmol. 1972. 74:1022–1033.

3. Custodis E. Schepens CL, editor. Scleral buckling without excision and with polyviol implant. Importance of Vitreous Body in Retina Surgery with Special Emphasis on Reoperations. 1960. Louis: Mosby;175–182.

4. Heimann H, Krichhof B. Ryan SJ, editor. Primary vitrectomy in rhegmatogenous retinal detachment. Retina. 2006. v. 3:4th ed. St Louis: Mosby;chap. 120.

5. Landers MB III, Robinson D, Olsen KR, Rinkoff J. Slit-lamp fluid-gas exchange and other office procedures following vitreoretinal surgery. Arch Ophthalmol. 1985. 103:967–972.

6. Kleiner RC. A new device for performing fluid-gas exchange. Arch Ophthalmol. 1988. 106:421–422.

7. Miller JA, Chandra SR, Stevens TS. A modified technique for performing outpatient fluid-air exchange following vitrectomy surgery. Am J Ophthalmol. 1986. 101:116–117.

8. Blumenkranz M, Gardner T, Blankenship G. Fluid-gas exchange and photocoagulation after vitrectomy: indications, technique, and results. Arch Ophthalmol. 1986. 104:291–296.

9. Gonin J. Treatment of detached retina by searing the retinal tears. Arch Ophthalmol. 1930. 4:621–625.

10. Rosengren B. Results of treatment of detachment of the retina with diathermy and injection of air into the vitreous. Acta Ophtahlmol. 1938. 16:573–579.

11. Shea M. Cryosurgery of vitreous and retina. Int Ophthalmol Clin. 1967. 7:3–18.

12. Martin DF, McCuen BW II. Efficacy of fluid-air exchange for postvitrectomy diabetic vitreous hemorrhage. Am J Ophthalmol. 1992. 114:457–463.

13. Han NS, Lee SB, Jo YJ. The Results of primary vitrectomy for rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2006. 47:55–61.

14. Park HJ, Seo MS. Clinical analysis according to treatment methods in simple retinal detachment. J Korean Ophthalmol Soc. 2001. 42:1277–1283.

15. Park JL, Kim SD, Yun IH. A clinical study of the rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2002. 43:1015–1024.

16. Chang S. Ryan SJ, Wilkinson CP, editors. Intraocular gases. Retina. 2006. v. 3:4th ed. St Louis: Mosby;chap. 127.

17. Han DP, Murphy ML, Mieler WF, Abrams GW. Outpatient fluid-air exchange for severe postvitrectomy diabetic vitreous hemorrhage. Retina. 1991. 309–314.

18. Lambrou FH, Devenyi RG, Han DP. Fluid-gas exchange after vitrectomy using long-acting gases in an outpatient setting. Arch ophthalmol. 1988. 106:1344.