Author: Birgit Govers (Netherlands)
Co-authors: M.P.M. Lamers, B.J. Klevering, S. Keijser
Purpose
In the Radboud University Medical Center, Nijmegen, the use of 20% SF6 and 14% C3F8 gas has gradually been replaced by filtered-air tamponade between 2014 and 2020. We have compared treatment success of filtered-air versus other gas tamponades in pars plana vitrectomy treatment of primary rhegmatogenous retinal detachments (RRDs), and analyzed whether the choice of tamponade affects treatment success in inferior located retinal tears.
Setting/Venue
This retrospective cohort study was conducted with all consecutive rhegmatogenous retinal detachment cases treated at the tertiary referral center, the Radboud University Medical Center, Nijmegen, the Netherlands, between June 2014 and May 2020.
Methods
We identified 1272 patients searching for ‘RRD’ in our vitreoretinal surgery database treated by a single vitreoretinal surgeon. Cases were excluded in which no pars plana vitrectomy was used, or a retinal re-detachment was treated. We defined an inferior located retinal tear as a defect involving clock hours 4, 5, 6, 7, and/or 8. Primary treatment success was defined as a retinal reattachment without re-detachment within six months after initial treatment. We built a univariate multivariable binary logistic regression model to analyze the effect of tamponade choice on treatment success. The model-building process was executed using the ‘purposeful selection method’ approach.
Results
Pars plana vitrectomy was in 1023 eyes indicated for a primary rhegmatogenous retinal detachment. We used intraocular gas tamponades in 872 cases with PVR grade B or lower: 414 eyes were treated with filtered-air tamponade and 458 eyes with 20% SF6 or 14% C3F8 gas tamponade. The first years, we primarily chose filtered-air tamponade in superior located retinal tears. Gradually, retinal detachments with defects at 4 and 8 o’clock were also treated with filtered-air tamponade. In 2020, filtered-air tamponade was the only type of gas tamponade used. Primary treatment success was achieved in 96.9% (n=845). We found no significant difference in re-detachment rate between filtered-air and other gas tamponades (risk difference; 95% confidence interval -1.0% and 4.1%). Additionally, the subgroup of RRDs with retinal defects located inferiorly showed no significant difference in primary treatment success between tamponade groups (p=0.54 Fisher's exact). Candidate variables for the univariate multivariable binary logistic regression model were tamponade and all parameters that were univariably associated with treatment success. The final multivariable model included tamponade, PVR grade, a retinal detachment involving clock hour six and age as covariates, and showed no significant effect of tamponade choice on treatment success (OR 0.5, 95% 0.2-1.0, p=0.10).
Conlusions
We found no significant difference in pars plana vitrectomy treatment success between filtered-air and SF6 or C3F8 gas tamponades in primary rhegmatogenous retinal detachments with a PVR grade B or lower. Filtered-air tamponade also resulted in similar treatment success compared to other gas tamponades in inferior located retinal tears.
Financial Disclosure
None
Comments
-
