Double Retinal Tamponade for Retinal Detachment With PVR and Inferior Breaks.
Condition: Retinal Detachment
MeSH terms: Retinal Detachment; Dissociative Disorders
Study type: Interventional

Summary: 
      Purpose To evaluate the efficacy of perfluorocarbone liquids (PFCLs) for tamponading lower
      retinal breaks to achieve retinal reattachment in eyes of retinal detachment with
      proliferative vitreoretinopathy (PVR) and inferior breaks.

      Patients and methods The study was prospective non comparative interventional study. It
      included thirty eyes of 30 patients suffering from retinal detachment with proliferative
      vitreoretinopathy and inferior breaks attending the ophthalmology department at Minia
      University Hospital. The mean age was 50.2± 10.63 years, 18 females and 12 males. Double
      retinal tamponade procedure were done and the patients were followed for one year. The
      primary outcome was to achieve successful retinal reattachment and the secondary outcome is
      to achieve improvement in the postoperative visual acuity.
    

Detailed description: 
      Patients and methods The study includes thirty eyes of 30 patients with dense cataract,
      retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and inferior breaks (18
      females and 12 males) in the period from October, 2017 to August, 2019 at ophthalmology
      department, Minia University Hospital. Approval of the study was provided by Faculty of
      Medicine, Research Ethics Committee and it was in agreement with the tents of Declaration of
      Helsinki and all patients were singed a consent explaining the risk and benefits of their
      operation. All of the patients was followed for 12 months.

      Preoperative examinations History taking included age, sex, laterality and systemic diseases
      and medications. Ophthalmological examinations including visual acuity assessment, IOP
      measurement, anterior segment slit lamp examinations, Dilated fundus examinations using
      indirect ophthalmoscope as well as with the auxiliary lenses and slit lamp aid, retinal chart
      drawing, biometry and ultrasonography if needed.

      Surgical technique All of cases were done under peribulbar anesthesia. First,
      phacoemulsification was performed through clear corneal temporal incision with implantation
      of hydrophobic acrylic IOL in the capsular bag and closure of wound by a 10/0 nylon suture.
      This was followed by 23-G pars plana vitrectomy. Core vitrectomy was done and triamcinolone
      acetonide was injected to ensure complete posterior vitreous detachment. All epiretinal
      membranes were removed helped by the use of membrane blue (trypan blue 0.15%, DORC
      International). Then, perfluorocarbone liquid (PFCL) was injected to flatten the posterior
      retina and base vitrectomy was performed helped by scleral depression. More PFCL was injected
      to drain subretinal fluid through the original retinal breaks. All retinal breaks were
      surrounded by 3-4 rows of diode endolaser photocoagulation. Then, fluid air exchange was
      performed to aspirate PFCL leaving a part of it enough to tamponade the lower retinal breaks
      and 12% C3F8 (perfluoropropane) was injected into the eye. After 2 weeks, the remaining PFCL
      was aspirated and replaced with 12% C3F8.

      Post-operative management All patients were given topical prednisolone 1% (Optipred, Jamjoom
      pharma Co.) eye drops (QID) and tapered through 4-6 weeks, cyclopentolate 0.5 % eye drops
      (TID), moxifloxacin 0.3 mg (Vigamox, Alcon Co.) eye drops QID for 1 week and Maxitrol
      ointment (Neomycin sulphate 3.5 mg, Polymyxin B sulphate 10000 IU and dexamethasone 0.1%,
      Alcon Co) at night for 4 weeks. Follow up visits were advised next postoperative day, one
      week, , one month, and then each three months for 1 year.

      All patients underwent full ophthalmologic examination including BCDVA, IOP, anterior segment
      slit lamp examination, and dilated fundus examination. Baseline results and that of 1, 3 6, 9
      months, and 1year were included in the statistical analysis. This study primary outcome is to
      achieve successful retinal reattachment and the secondary outcome is to achieve improvement
      in the visual acuity (BCDVA, log MAR). Successful surgery was considered when retinal
      reattachment was achieved, improvement in the visual acuity without serious complications
      such as suprachoroidal hemorrhage, retinal detachment or endophthalmitis.
    

Intervention name(s): Double tamponade
Intervention type(s): Procedure
Intervention description(s): Double tamponade procedure in retinal detachment with PVR and inferior breaks
Intervention model: Single Group Assignment
Intervention model description: Retinal detachment with proliferative vitreoretinopathy and inferior breaks
Masking: None (Open Label)
Primary purpose: Treatment