Simultaneous external subretinal fluid drainage and intravitreal gas injection

Area of Science:

• Ophthalmology
• Retinal Surgery
• Vitreoretinal Surgery

Background:

• Large or near-total internal gas tamponade is crucial for retinal reattachment in complex cases.
• Traditional methods like internal fluid-gas exchange require a posterior retinal break and prolonged facedown positioning.
• Facedown positioning can be challenging for patients, impacting compliance and recovery.

Purpose of the Study:

• To evaluate the efficacy of simultaneous external subretinal fluid drainage and intravitreal gas injection.
• To assess this technique as an alternative to internal fluid-gas exchange in patients needing large gas tamponade.
• To determine if this procedure can avoid the need for a posterior retinal break and associated facedown positioning.

Main Methods:

• A cohort of 12 patients requiring large or near-total internal gas tamponade underwent the procedure.
• The study included patients with proliferative vitreoretinopathy post-vitrectomy and those without prior vitrectomy.
• No pre-existing or intentional posterior retinal breaks were present in the study group.

Main Results:

• Retinal reattachment was achieved in 9 out of 12 patients (75%) at six months or longer postoperatively.
• One patient developed an iatrogenic retinal break without incarceration.
• The procedure successfully avoided the need for internal fluid-gas exchange through a posterior retinal break.

Conclusions:

• Simultaneous external subretinal fluid drainage and intravitreal gas injection is a viable alternative for specific retinal detachment cases.
• This technique can eliminate the need for postoperative facedown positioning, enhancing patient comfort and compliance.
• It may also serve as a preventative measure against the formation of "fish-mouthed" retinal breaks.