Induced posterior vitreous detachment by intravitreal sulfur hexafluoride (SF6) injection in patients with nonproliferative diabetic retinopathy

Abstract

ABSTRACT.Purpose: To induce posterior vitreous detachment (PVD) in patients with nonproliferative diabetic retinopathy (NPDR) by injecting an intravitreal gas bubble of SF6 and to compare the evolution of the diabetic retinopathy between eyes with gas induced PVD and non-injected eyes without PVD. Methods: An intravitreal gas bubble of SF6 was injected via the pars plana in twelve eyes of twelve patients with NPDR and no previous PVD. Subsequent clinical, ultrasonographic and angiographic controls were performed to evaluate the development of PVD and progression of the disease. Results: All gas-injected eyes developed PVD. All eyes with induced PVD (treatment group) remained stable without progression of the retinopathy after 2 years of follow up. In the control group (contralateral eyes without PVD), two eyes (16.6%) progressed to proliferative diabetic retinopathy (PDR) (pΩ 0.23); five (41.6%) showed progression to more severe stages of NPDR (pΩ 0.01) and another 41.6% of such eyes remained stable. Conclusions: Intravitreal SF6 injection induced PVD in all eyes of our study without undesirable side effects. Further studies are necessary to make conclusions regarding the correlation between the presence of induced PVD and the progression of diabetic retinopathy.Key words: posterior vitreous detachment (PVD) -sulfur hexafluoride (SF6) -intravitreal gas bubble -diabetic retinopathy.

Intravitreal Tissue Plasminogen Activator to Treat Refractory Diabetic Macular Edema by Induction of Posterior Vitreous Detachment

“…Previous studies 3,13 have suggested that induction of PVD concurrent with vitrectomy and removal of traction on the macula can lead to improvement in macular edema. For these reasons, ophthalmologists have been exploring methods other than surgery for induction of PVD, and pharmacologic vitreolysis represents a major and important goal of vitreoretinal surgeons.…”

“…Concurrent with vitrectomy, intravitreal injection of varying materials, including hyaluronidase, tissue plasminogen activator (TPA), plasmin, and sulfur hexafluoride, has been used to induce PVD. 13,14 The purpose of this study was to evaluate the role of intravitreal injection of TPA for the treatment of DME refractory to standard treatment in patients with nonproliferative diabetic retinopathy.…”

Pneumatic release of focal vitreomacular traction

“…All treated eyes developed a PVD. 20,21 Efficacy of pneumatic VMT release, as reported in studies so far, seems higher than that of ocriplasmin. 2,4,11,19 The observed weak and nonsignificant effect of ocriplasmin on pseudophakic eyes (13.4% in the ocriplasmin group vs 3.8% in the placebo group) 11 makes the traction release in all three of our pseudophakic cases all the more interesting.…”

“…On the basis of these studies, intravitreal gas injection may offer a minimally invasive, easily accessible, and low-cost alternative treatment for patients with VMT. 2,[16][17][18][19][20][21] In addition, the safety profile of intravitreal gas injection has been well established in pneumatic retinopexy in retinal detachments 22,23 and pneumatic displacement of submacular hemorrhages. 24,25 We report a case series of 20 eyes in 17 patients that were treated with an intravitreal gas injection to release VMT.…”

State of the art und Zukunft der Vitrektomie – Techniken und Instrumente

“…Neben der chirurgischen Lösung der VMT und der eventuellen Entfernung von epiretinalen Membranen mittels Vitrektomie besteht seit 2012 die Möglichkeit der enzymatischen Vitreolyse [16][17][18][19]. Obwohl schon vor Jahren die Induktion einer Glaskörperabhebung durch intravitreale Gasapplikation gezeigt wurde, hat diese Methode erst in den letzten Jahren bei der VMT ein vielversprechendes Indikationsgebiet gefunden [20][21][22].…”