Minimal Gas Vitrectomy with Scleral Buckle to Minimize Retinal Displacement in Rhegmatogenous Retinal Detachment with Inferior Breaks
Author: Rajeev Muni (Canada)
Co-authors: Aditya Bansal, Wei Wei Lee, Luis C Escaf
Recent evidence has demonstrated a high risk of a low integrity retinal attachment (LIRA) with pars plana vitrectomy for rhegmatogenous retinal detachment repair. This is thought to occur because of a stretch of the retina, often inferiorly, induced by the flow of subretinal fluid under the thin elastic retina at the completion of vitrectomy when the patients changes their head position. Retinal displacement has been associated with worse functional outcomes including metamorphopsia and aniseikonia. We have previously described a modification to standard vitrectomy (Minimal Gas Vitrectomy) to minimize the risk of retinal displacement for patients with superior breaks. We now present a novel technique, Minimal Gas Vitrectomy with Scleral Buckle (MGV-SB), as a means of potentially minimizing retinal displacement compared to standard vitrectomy or vitrectomy/scleral buckle for patients with inferior breaks in detached retina.
Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto
A patient with a right macula off retinal detachment and retinal breaks at 7 o’clock and 10 o’clock underwent a 23-gauge pars plana vitrectomy, localization and cryopexy of the breaks along with an inferior temporal segmental scleral buckle. No air-fluid exchange was performed. Suturing of sclerotomies, anterior chamber paracentesis of 0.3 ml and an intravitreal injection of 0.6 mL of pure sulfur hexafluoride were then performed. The patient was advised to perform the steamroller maneuver with initial log-roll to face down positioning for 6 hours.
The patient achieved retinal reattachment and post-operative wide-field fundus autofluorescence imaging demonstrated a high integrity retinal attachment (HIRA) with no retinal displacement.
The traditional approach to retinal detachment repair has been to perform a procedure that maximizes single operation re-attachment rate. Solely focusing on this outcome, does not take into account functional outcomes, which are primarily based on the integrity of anatomic attachment. The MGV-SB technique has the potential to minimize retinal displacement in cases with inferior break(s) by using a small volume expansile gas tamponade and localized scleral buckle compared to standard vitrectomy or vitrectomy/scleral buckle with a full gas fill. Modifications to standard vitrectomy that minimize retinal displacement may lead to better functional outcomes for patients.
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