Outcomes of 25-gauge pars plana vitrectomy alone with air tamponade for the management of rhegmatogenous retinal detachment with inferior breaks

(2022) 22:213 Tang et al. BMC Ophthalmology https://doi.org/10.1186/s12886-022-02445-4 Open Access RESEARCH Outcomes of 25‑gauge pars plana vitrectomy alone with air tamponade for the management of rhegmatogenous retinal detachment with inferior breaks Yongping Tang1,2, Bo Lin1,2, Jing Chen1,2, Daosen Chen3 and Ronghan Wu1,2* Abstract Background: This study was investigated the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRBs) that were repaired by 25-gauge pars plana vitrectomy (PPV) with air tamponade. Methods: This retrospective review included 81 consecutive patients who had RRD with IRBs and underwent PPV with air tamponade in our hospital from January 2017 to January 2020. The main outcomes were single surgery anatomical success (SSAS) rate, postoperative best-corrected visual acuity (BCVA), and complications. Results: The patient population consisted of 29 women and 52 men (mean age, 52.12 years); the mean follow-up interval was 8.88 months. The mean number of affected quadrants was 1.65 (range, 1–4 quadrants) and the mean number of breaks was 3.25. A single break was present in 20 cases (24.7%); two to 10 breaks were present in 61 (75.3%) cases. The SSAS rate was 91.36% (74/81) and the final anatomical success rate was 96.30% (78/81). More than half of the patients had BCVA < 0.3 logarithm of the minimum angle of resolution at the last follow-up. Axial length and patient age were candidate risk factors for redetachment (axial length, p = 0.03; age, p = 0.002). Postoperative complications included macular epiretinal membrane formation in one patient, lens opacity in three patients, and clinically significant macular edema in one patient. Conclusions: PPV with air tamponade may be effective for the treatment of primary RRD with IRBs. Extensive preoperative discussion may be necessary for young patients and patients with particularly long axial length. Keywords: Rhegmatogenous retinal detachment, Inferior retinal break, Air tamponade, Pars plana vitrectomy Background Retinal detachment is an important cause of vision loss. Because of improvements in surgical techniques, the rate of successful anatomical retinal reattachment in primary retinal detachment is high (> 80%) [1]. However, *Correspondence: 1 Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China Full list of author information is available at the end of the article the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRBs) via pars plana vitrectomy (PPV) surgery remains challenging because of insufficient intraocular tamponade (e.g., long-acting gases, silicone oil [SO], and air). Thus, other strategies have been proposed, including the combined use of scleral buckling (SB) and PPV, as well as the use of heavy silicone oil or perfluoro-n-octane as a tamponade agent [2]. Those strategies can cause substantial complications: combined SB may lead to choroidal hemorrhage, myopia, © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Tang et al. BMC Ophthalmology (2022) 22:213 diplopia or ptosis [3]. Long-acting gases can disturb the vitreous, thus increasing the risks of elevated intraocular pressure (IOP), lens opacity, proliferative vitreoretinopathy (PVR) and new or missed breaks [4]. SO, heavy SO and perfluoro-n-octane may cause high intraocular pressure (IOP), lens opacity, corneal degeneration and retinal toxicity. Furthermore, secondary surgery is needed to remove SO, heavy SO and perfluoro-n-octane; such surgery increases the financial burden carried by patients [5]. Although air tamponade is rapidly absorbed and may not provide a substantial tamponade effect, previous studies have demonstrated that this approach can be used to successfully repair RRD with superior retinal breaks [6, 7]. There remains controversy concerning the advantages of air tamponade for treatment of RRD with IRBs, compared with long-acting gases [8–11]. In China, long-acting gases are not commercially available because of legislative changes made in 2016; thus, surgeons can use either air or SO as the tamponade for RRD during PPV, considering the findings in the preoperative evaluation and clinical examination [10]. Importantly, many patients with noncomplicated RRD including IRBs have undergone PPV plus air tamponade since 2016 in China. Here, we reviewed clinical data from patients with primary RRD and causative retinal breaks located between 5- and 7-o’clock, all of whom underwent PPV with air tamponade. We evaluated the anatomical and functional outcomes of vitrectomy with air tamponade in the treatment of primary RRD with IRBs, with the expectation that an IRB was a risk factor for redetachment. Methods In this retrospective analysis, we collected clinical data from patients who had undergone 25-gauge PPV with air tamponade for primary RRD in our hospital, during the period from January 2017 to January 2020. Exclusion criteria were giant retinal tears, retinal dialysis, tractional, serous retinal detachment, posttraumatic retinal detachment, PVR of grade ≥ C2 and history of PPV. Of the 245 patients who underwent PPV with air tamponade during the inclusion period, 81 patients had retinal breaks located between 5 and 7 o’clock. Each patient received information about the procedure, then provided written informed consent to undergo surgery. This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University (2020–086-K-78). Pre-, intra- and postoperative findings were documented. Preoperative evaluations included best-corrected visual acuity (BCVA) assessment, IOP assessment, slit-lamp biomicroscopy, fundus Page 2 of 7 examination with an indirect ophthalmoscope, optical coherence tomography and ocular B-scan ultrasonography. Surgica (...truncated)