Name

Intérêt de l’air comme tamponnement dans les décollements de rétine supérieurs rhegmatogènes

The aim of this study was to compare surgical outcomes and postoperative characteristics, between eyes that underwent pars plana vitrectomy (PPV) for RRD, with air or different gas agents as tamponade.

The records of 262 patients that underwent PPV for RRD with air or different gas tamponades and a follow-up of at least 6 months were examined. Only cases with superior retinal breaks were included. Demographic, pre-, intra- and postoperative characteristics including rate of recurrence and complications were analysed

Fourty eight patients were treated with air and 214 were treated with gas. No differences were found in success rate between air and gas group at both 3 and 6 months (respectively, 93.8% vs 93.6% and 100% vs 100%, all P values > 0.05). Postoperative best corrected visual acuity (BCVA) was significantly higher in the air group compared with the gas group 7 days and 1 month postoperatively (respectively, 0.2±0.4 vs 2.6±0.5, P<0.001 and 0.1±0.4 vs 0.4±0.9, P=0.04). The occurrence ocular hypertension at 1 month postoperatively was significantly higher in the gas group compared with the air group (15.4 % vs 0%, P < 0.001). At 6 months, the prevalence of epiretinal membrane (ERM) was significantly higher in the gas group compared with air group (4.2% vs 16.8%, P = 0.02).

We observed the same efficacy of air and gas tamponade in terms of surgical success at both 3 and 6 months. We found no difference in the time to recurrence evaluated at 6 months.The good efficacy of air probably lies in the fact that the adhesion between the retina and the retinal pigment epithelium occurs within 24 hours in the absence of subretinal fluid, thus the persistence time of air in the vitreous cavity is enough to ensure the reattachment of the retina.In the present study, air showed better outcomes compared with gas tamponades in terms of early visual recovery. In fact, patients in air group presented a significantly better BCVA at both 7 days and 1 month after surgical procedure. This is related to the fact that it has a persistence time of 7 days, which is shorter compared with those of long-acting gas tamponades agents, in particular 1-2 weeks for SF6, 4-5 weeks for C2F6 and 6-8 weeks for C3F8 2. In this way, air allows a faster functional recovery of the patient resulting in reduced socio-economic burden. Despite the treatment with hypotonizing eye drops, a high rate of patients in the long-acting gas group presented ocular hypertension during the first month after the surgical procedure. No patient in the air group showed this complication. Although, the present study has several strengths, such as the well-matched baseline characteristics between the two groups and the evaluation of different postoperative complications, it suffers from some limitations that need to be acknowledged. In particular, its retrospective nature may have resulted in selection or indication bias, limiting the conclusions we can draw from our results. In addition, although a 6-month follow-up is considerable, studies with a longer follow-up are desirable to asses more accurately both postoperative complications and final BCVA.

Air was comparable to gas tamponades in terms of surgical outcome and BCVA at 6 months. In addition, air allowed an earlier visual recovery and resulted in a lower rate of postoperative ocular hypertension and ERM.