Supplemental gas tamponade after conventional scleral buckling surgery--a simple alternative to surgical revision.

Abstract

Supplemental intravitreal gas injection was used in the early postoperative period in an attempt to achieve long term retinal reattachment in 11 cases of failed scleral buckling surgery. Success was dependent on the presence of a correctly placed scleral buckle underlying all breaks. Surgical revision was thereby avoided in these patients. However, when the scleral buckle was inadequate the technique failed.The incidence of failure of retinal detachment surgery is 5-10%.' Failure of the primary surgical procedure may have several unfavourable consequences, most notably the development of proliferative vitreoretinopathy (PVR), which is the main reason for long term failure of reattachment.2 Surgical revision increases the risk of complications, lengthens morbidity, and is itself implicated in the genesis of PVR.A simple method of restoring retinal attachment following failure in the early postoperative period may avoid surgical revision, lessen the risk of PVR, and should therefore improve the success rate for long term retinal reattachment.Intravitreal gas injection is a widely used method of retinal break tamponade. 'Pneumatic retinopexy' is considered an alternative to scleral buckling surgery and may be used in the management of established failure of scleral buckling surgery.3 Bedside intravitreal air injection has been successfully used for persistent subretinal fluid (SRF) in seven patients after non-drainage scleral buckling procedures. 4 We have reviewed our use of a technique of supplemental intravitreal gas injection for redetachment in the early postoperative period after scleral buckling surgery. Our aim was to reattach the retina by the simplest effective method as soon as progressive redetachment was observed.Patients and method

Pneumatic retinopexy as supplemental therapy for persistent retinal detachment after scleral buckling operation

“…They reported successful reattachment in all of the 10 eyes included in the series. Worsley & Grey (1991) injected gas in 11 eyes with primary failure of scleral buckling, in 10 of them within 1 week from the operation. The retina was reattached only in 7 of the eyes, all of them had a correctly positioned buckle supporting the retinal breaks.…”

Outcomes of Combined Scleral Buckling Plus Pneumatic Retinopexy Vs. Scleral Buckling for Primary Rhegmatogenous Retinal Detachment

“…When scleral buckling alone may not achieve the surgical goals additional gas tamponade may be applied to seal the retinal tears; this combined procedure has been termed pneumatic buckling. [4][5][6] Intraocular gas tamponade following scleral buckling failure can be considered an adjuvant procedure.…”

Management of a rhegmatogenous retinal detachment in a low-resource setting: treatment options when there is no vitreoretinal surgeon

“…There were no statistically significant differences in final visual acuity between groups 25. However, if using air as the tamponade agent it is challenging to ensure sufficient intravitreal volumes and it may have insufficient longevity 26. Repeated injections may be required.…”