University Hospital Coventry Warwickshire, Coventry, UK.
Eur J Ophthalmol. 2021 May;31(3):1475-1478. doi: 10.1177/1120672120978884. Epub 2020 Dec 18.
Rhegmatogenous retinal detachment (RRD) is commonly managed by pars plana vitrectomy (PPV). Gas tamponade has significant clinical and quality of life factors that affect the patient. Using shorter acting air tamponade, intuitively leads to surgical concern for higher rate of primary detachment. To circumvent this, surgeons advocate the use of perfluorocarbon to maximise sub-retinal-fluid drainage when using air tamponade and/or avoid using cryotherapy due to longer duration for scar formation relative to laser. These steps are a deviation from traditional technique for otherwise routine primary RRD repair and discourages popularisation of using air tamponade despite the benefits to patients.
Prospective 12-month, single centre, single surgeon, consecutive study from January to December 2019. Inclusion criteria was as per based on the pneumatic retinopexy versus vitrectomy for retinal detachment: (i) single retinal break or group of breaks, no larger than 1-clock-hour (30°), in detached retina; (ii) all breaks in detached retina lie above the 8 to 4 o'clock meridian; and (iii) breaks or lattice degeneration in attached retina at any location. We excluded PVR formation and RRD in the inferior 4 o'clock hours.
We report primary and final success rate of 96% and 100%, respectively in 23 eyes (22 macular-on and one macular-off) with RRD eyes in a 12-month period. Cryopexy was utilised in 65% patients and in isolation in 23% with no perfluorocarbon use in all eyes.
We show cryotherapy can be used safely in AT-RRD without PFCL in RRD fulfilling PIVOT trial criteria with minimal cataract formation and IOP spikes and faster post-operative visual rehabilitation.
孔源性视网膜脱离（RRD）通常通过玻璃体切除术（PPV）治疗。气体填充具有重要的临床和生活质量因素，会影响患者。使用作用时间更短的空气填充，会直觉地导致更高的原发性脱离率。为了避免这种情况，外科医生提倡使用全氟碳来最大程度地引流视网膜下液，当使用空气填充时，以及/或者避免使用冷冻疗法，因为与激光相比，冷冻疗法形成瘢痕的时间更长。这些步骤偏离了常规原发性 RRD 修复的传统技术，尽管对患者有益，但仍不鼓励使用空气填充。
前瞻性、12 个月、单中心、单外科医生连续研究，时间为 2019 年 1 月至 12 月。纳入标准基于充气性视网膜固定术与玻璃体切除术治疗视网膜脱离的研究（i）单一视网膜裂孔或一组裂孔，脱离视网膜中的裂孔不大于 1 时钟小时（30°）；（ii）所有脱离视网膜中的裂孔均位于 8 点至 4 点子午线上方；以及（iii）任何位置的附着视网膜中的裂孔或格子样变性。我们排除了 PVR 形成和 4 点下方的 RRD。
在 12 个月期间，我们报告了 23 只 RRD 眼的原发性和最终成功率分别为 96%和 100%，其中 22 只为黄斑上型，1 只为黄斑下型。65%的患者使用了冷冻疗法，23%的患者单独使用了冷冻疗法，所有患者均未使用全氟碳。
我们证明，在符合 PIVOT 试验标准的 RRD 中，在不使用 PFCL 的情况下，RRD 中可以安全地使用冷冻疗法，术后白内障形成和眼压升高的风险最小，术后视力恢复更快。
