Fluid-gas exchange and photocoagulation after vitrectomy. Indications, technique, and results

We describe the indications, complications, and results of postvitrectomy fluid-gas exchange and laser photocoagulation for management of complicated vitreoretinal disease. Indications include proliferative vitreoretinopathy, vitreous opacities associated with proliferative diabetic retinopathy, giant retinal tear, recurrent rhegmatogenous retinal detachment, and trauma. Eyes treated with 50% sulfur hexafluoride gas rather than sterile air demonstrated a higher intraocular pressure on the first postexchange day, which was not a significant source of disease. There was no statistically significant difference in retinal reattachment between eyes treated with gas and those treated with air. Fluid-gas exchange in eyes with partial or total retinal detachment resulted in total or partial retinal reattachment, with the macula attached in 82% of cases within the first 48 hours following exchange. Final reattachment rate, with a mean follow-up of 8.9 months (range, six to 36 months), was 55%. In eyes with proliferative vitreoretinopathy, the combination of postoperative argon or krypton laser photocoagulation with fluid-gas exchange was associated with a final reattachment rate of 75%. Postoperative fluid-gas exchange and photocoagulation appear to be safe and effective advances in the treatment of complicated vitreoretinal diseases requiring vitrectomy.