1 / 11

PNEUMATIC RETINOPEXY FOR UNCOMPLICATED DETACHMENTS Rationale, Indications, Longterm Results

PNEUMATIC RETINOPEXY FOR UNCOMPLICATED DETACHMENTS Rationale, Indications, Longterm Results LADISLAO PÉREZ BELMONTE VR Fellow Manchester Royal Eye Hospital, UK. HISTORY. 1st intravitreal air injection for RD: Ohm 1911

cora
Download Presentation

PNEUMATIC RETINOPEXY FOR UNCOMPLICATED DETACHMENTS Rationale, Indications, Longterm Results

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

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:Rosengren1938 • SF6 pneumothorax pulmonary tuberculosis. Nontoxic and well tolerated: Swalbach et al1957 • 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

  6. 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 • Unsuitable for inferior breaks* *  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. 2003 Mar;110(3):589-94.   Comment in: Ophthalmology. 2003 Nov;110(11):2260-1; author reply 2261. Ophthalmology. 2003 Nov;110(11):2261; author reply 2261-2. Ophthalmology. 2004 Jul;111(7):1435; author reply 1435. * Holz ER, Mieler WF.View 3: The case for pneumatic retinopexy. Br J Ophthalmol. 2003 Jun;87(6):787-9.  Comment on: Br J Ophthalmol. 2003 Jun;87(6):782.  Pérez Belmonte

  9. CASES IDEALLY SUITED TO PNEUMATIC RETINOPEXY • Posterior breaks • “Fish-mouthing” breaks after buckling • 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 • 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 96:772-783, 1989 Pérez Belmonte

  11. Reattached, no. (%) New retinal Author No. of eyes One operation Reoperations breaks (%) PVR(%) Algvere et al. 35 29 (83) 33 (94) 4 (11) 3 (8.6) Bovey et al. 27 18 (67) 27 (100) 8 (29) 2 (7.4) Brinton and Hilton 70 57 (81) 68 (97) 11 (16) 3 (4.3) Chan and Wessels 38 30 (79) 38 (100) 5 (13) 0 Chen et al. 51 32 (63) -- 11 (22) 5 (9.8) Dominguez et al. 31 29 (94) 30 (97) -- 1 (3.2) Dominguez et al. 43 40 (93) 42 (98) 2 (5) 1 (2.5) Friberg 14 12 (86) 14 (100) -- 0 (0) Gnad et al. 27 24 (89) 27 (100) 1 (4) 0 (0) Hilton and Grizzard 20 18 (90) 20 (100) 2 (10) 1 (5.0) Hilton et al. 100 84 (84) 98 (98) 7 (7) 3 (3) Kelly 268 217 (81) 265 (99) -- -- Liggett 30 16 (53) -- 2 (7) 1 (3.3) Lowe et al. 55 45 (82) 54 (98) 6 (11) 3 (5.5) McAllister et al. 56 40 (71) 56 (100) 11 (20) 1 (1.8) McAllister et al. 4 4 (100) 4 (100) -- 0 (0) Menchini et al. 36 31 (86) -- 0 0 Mortensen and Sjolie 12 10 (83) 11 (92) -- 1 (8.3) Packo 33 27 (82) 33 (100) 9 (27) 0 (0) Poliner and Grand 39 24 (62) 37 (95) 3 (8) 6 (15.3) Tornambe et al. 34 28 (82) 33 (97) 4 (12) 3 (8.8) Tornambe and Hilton 103 83 (81) 102 (99) 24 (23) 3 (2.9) Van Effenterre et al. 60 51 (85) 59 (98) 4 (7) 1 (1.6) Vygantas 12 8 (67) 11 (92) -- -- Zakka 20 16 (80) 19 (95) 2 (10) 1 (5.0) Zegarra et al. 56 40 (71) 56 (100) 9 (16) 1 (1.8) Total (%) 1,274 1,013 (80) 1,137 (98) 125 (13) 40 (4) Pérez Belmonte

More Related