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PNEUMATIC RETINOPEXY FOR UNCOMPLICATED DETACHMENTS Rationale, Indications, Longterm Results LADISLAO PÉREZ BELMONTE VR Fellow Manchester Royal Eye Hospital,

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Presentation on theme: "PNEUMATIC RETINOPEXY FOR UNCOMPLICATED DETACHMENTS Rationale, Indications, Longterm Results LADISLAO PÉREZ BELMONTE VR Fellow Manchester Royal Eye Hospital,"— Presentation transcript:

1 PNEUMATIC RETINOPEXY FOR UNCOMPLICATED DETACHMENTS Rationale, Indications, Longterm Results LADISLAO PÉREZ BELMONTE VR Fellow Manchester Royal Eye Hospital, UK

2 HISTORY –1st intravitreal air injection for RD: Ohm 1911 –1st scientific use of intravitreal air in a large series of RD: Rosengren 1938 –SF6  pneumothorax  pulmonary tuberculosis. Nontoxic and well tolerated: Swalbach et al 1957 –Expanding-gas operation: Kreissig 1979 –Pneumatic retinopexy: Domínguez 1985, Hilton & Grizzard 1986 Pérez Belmonte

3 RATIONALE Pneumatic retinopexy –Internal temporary tamponade – Cryopexy or laser – Retinal adhesion around the break Head position for one week Pérez Belmonte

4 RATIONALE Intraocular gas bubble flattens  internal tamponade If the bubble > than the break  surface tension of the gas prevents it from passing through the break. Gas bubble positioned against the break  passage of fluid blocked  subretinal fluid resorbed through the REP and choroid. Pérez Belmonte

5 GASES Non - ExpansilesExpansiles Air Oxygen Nitrogen Carbon dioxide Nitrous oxide Argon Krypton Radon Helium Neon Xenon Sulfur hexafluoride (SF6) Octafluorocyclobutane (C4F10) Perfluoromethane (CF4) Perfluoroethane (C2F6) Perfluoropropane (C3F8) Perfluoro-butane (C4F10)

6 Gases 100% VolumenExpansion (24-36h) SF60.5 mlx 2 C2F60.4 mlx 3 C3F80.3 mlx 4 Pérez Belmonte

7 SURGICAL TECHNIQUE –Office-Theatre (Anesthesia) –Reduce IOP –Antiseptic agents –Drape –Speculum –Cryotherapy - injection of gas (PP, 3,5-4mm) - appropriate postoperative positioning - laser. –CRA. Control IOP, AB Pérez Belmonte

8 INDICATIONS –Breaks in the superior 2/3 of the retina Pérez Belmonte * Friberg TR, Eller AW. Pneumatic repair of primary and secondary retinal detachments using a binocular indirect ophthalmoscope laser delivery system. Ophthalmology 1988;95:187–93. * Chang TS, Pelzek CD, Nguyen RL, Purohit SS, Scott GR, Hay D. Inverted pneumatic retinopexy: a method of treating retinal detachmentsassociated with inferior retinal breaks. Ophthalmology Mar;110(3): Comment in: Ophthalmology Nov;110(11):2260-1; author reply Ophthalmology Nov;110(11):2261; author reply Ophthalmology Jul;111(7):1435; author reply * Holz ER, Mieler WF. View 3: The case for pneumatic retinopexy. Br J Ophthalmol Jun;87(6): Comment on: Br J Ophthalmol Jun;87(6):782. –Unsuitable for inferior breaks*

9 CASES IDEALLY SUITED TO PNEUMATIC RETINOPEXY 1.Posterior breaks 2.“Fish-mouthing” breaks after buckling 3.Tears under the superior rectus 4.Contraindications to GA * Based on George F. Hilton, M.D.Daniel A. Brinton, M.D. CHAPTER 130 Pneumatic retinopexy and alternative techniques. Ryan- Retina 2nd Edition Volumen III. Pérez Belmonte

10 EXCLUSION CRITERIA FOR THE MCT 1.Breaks > than one clock hour or multiple breaks extending > one clock hour 2.Breaks in the inferior four clock hours 3.PVR grade C or D (Retina Society Terminology Committee, 1983) 4.Patient’s unsuitability 5.Glaucoma 6.Cloudy media *Tornambe, PE, Hilton, GF, and the Retinal Detachment Study Group: Pneumatic retinopexy, A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling, Ophthalmology 96: , 1989 Pérez Belmonte

11 Reattached, no. (%) New retinal AuthorNo. of eyesOne operation Reoperations breaks (%) PVR(%) Algvere et al.3529 (83)33 (94)4 (11)3 (8.6) Bovey et al.2718 (67)27 (100)8 (29)2 (7.4) Brinton and Hilton7057 (81)68 (97)11 (16)3 (4.3) Chan and Wessels3830 (79)38 (100)5 (13)0 Chen et al.5132 (63)-- 11 (22)5 (9.8) Dominguez et al.3129 (94)30 (97)-- 1 (3.2) Dominguez et al.4340 (93)42 (98)2 (5)1 (2.5) Friberg1412 (86)14 (100)-- 0 (0) Gnad et al.2724 (89)27 (100)1 (4)0 (0) Hilton and Grizzard2018 (90)20 (100)2 (10)1 (5.0) Hilton et al (84)98 (98)7 (7)3 (3) Kelly (81)265 (99)-- -- Liggett3016 (53)-- 2 (7)1 (3.3) Lowe et al.5545 (82)54 (98)6 (11)3 (5.5) McAllister et al.5640 (71)56 (100)11 (20)1 (1.8) McAllister et al.44 (100)4 (100)-- 0 (0) Menchini et al.3631 (86) Mortensen and Sjolie1210 (83)11 (92)-- 1 (8.3) Packo3327 (82)33 (100)9 (27)0 (0) Poliner and Grand3924 (62)37 (95)3 (8)6 (15.3) Tornambe et al.3428 (82)33 (97)4 (12)3 (8.8) Tornambe and Hilton10383 (81)102 (99)24 (23)3 (2.9) Van Effenterre et al.6051 (85)59 (98)4 (7)1 (1.6) Vygantas128 (67)11 (92)-- -- Zakka2016 (80)19 (95)2 (10)1 (5.0) Zegarra et al.5640 (71)56 (100) 9 (16)1 (1.8) Total (%)1,2741,013 (80)1,137 (98)125 (13)40 (4) Pérez Belmonte


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