Air versus fluorinated gas tamponades in pars plana vitrectomy treatment for primary rhegmatogenous retinal detachment

Abstract

Purpose: To compare the treatment success of air with fluorinated gas (20% SF 6 or 14% C 3 F 8 ) tamponade in pars plana vitrectomy for primary rhegmatogenous retinal detachment. Methods: A retrospective cohort study comprised of 1023 consecutive primary retinal detachment cases between 2014 and 2020. We employed a univariate multivariable binary logistic regression model. Results: We used intraocular gas tamponades in 872 cases with PVR grade B or lower: air tamponade was used in 414 eyes and 458 eyes were treated with a type of fluorinated gas tamponade. There was no significant difference in the type of tamponade with regard to the re-detachment rate (95% CI À1.0% and 4.1%). Additionally, also in the subgroup of rhegmatogenous retinal detachments with inferior located retinal defects we found no significant difference between the two types of tamponade (p = 0.54 Fisher's exact). The multivariable model, which included tamponade, PVR grade, a retinal detachment involving the 6 o'clock position and age as covariates, also showed no significant effect of tamponade choice on treatment success (OR 0.5, 95% 0.2-1.0, p = 0.10). Conclusion:We found no difference in treatment success with air tamponade versus fluorinated gas tamponades in the repair of primary retinal detachments, this also includes inferiorly located retinal tears and detachments.

Air versus Gas Tamponade for Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis

“…In most studies, age, number of breaks, RRD quadrants, and the ratio of macular detachment were comparable between the filtered air and gas groups. In three studies [9, 18, 20], the preoperative quadrants of RRD were larger in the gas group, and the proportion of PVR change was greater in the gas group in one study [21]. In addition, five [11, 12, 18, 21, 22] and four studies [9, 11, 18, 19] investigated the anatomical success of upper and lower break RRDs, respectively.…”

“…Among the observational studies, there was no significant flaw in the intervention classification, deviation from intended interventions, and outcome measurement. However, in the included studies, we found differences in the ratio of PVR and preoperative quadrants of RRD between the filtered air and gas groups [18, 20, 21]. Different surgeons performing the procedures within the studies were also observed in the included studies [19].…”

“…Besides, two included studies [10, 23] did not compare the baseline characteristics between the air and gas groups; thus, potential selection bias between the two groups cannot be ruled out. In the overall bias analysis, five observational studies [11, 18, 19, 22] were rated as having a moderate risk of bias, one observational study [20] with a serious risk of bias, and three observational studies [10, 21, 23] with a critical risk of bias. The detailed risk of bias assessment of the included studies is shown in online supplementary Table S2.…”

Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery

“…However, this could be considered a disadvantage as a vitreous replacement due to its short time effect, especially in case of PVR or complex RDs. In these cases, a clear superiority of longer lasting tamponade effect has been demonstrated [ 119 , 120 , 121 , 122 ]. Another negative aspect of air is its low refractive index, which results in total light reflection and hence poor optical performance [ 123 ].…”

Do Daily Activities Affect Gas Tamponade‒retina Contact After Pars Plana Vitrectomy?

“…5 In fact, gas tamponade reabsorption exposes increasing retinal portions to aqueous that may leak into the subretinal space through yet unsealed retinal tears. 6 Although the gas-fluid interface and the fraction of retinal surface in contact with gas at rest have been thoroughly studied, 7,8 less is known about the extent of retinal surface affected by the sloshing of aqueous because of eye and patients' movements. During daily activities, retinal tears contacting gas under static conditions may temporarily fall under the air-fluid interface, giving aqueous a potential access to the subretinal space thus increasing the risk of recurrent retinal detachment or retinal shifting.…”