NW2011 Pneumatic retinopexy
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Transcript of NW2011 Pneumatic retinopexy
Pneumatic Pneumatic RetinopexyRetinopexy
for Dummiesfor Dummies
By N.WBy N.W
Retinal DetachmentRetinal Detachment
What happensWhat happens Vitreous degenerationVitreous degeneration
Vitreous syneresisVitreous syneresis Posterior vitreous detachment (PVD)Posterior vitreous detachment (PVD)
Retinal breakRetinal break Retinal detachmentRetinal detachment
1.1. Vitreous syneresisVitreous syneresis
2. Posterior vitreous 2. Posterior vitreous detachment (PVD)detachment (PVD)
PVD: C/S vitreo-retinal PVD: C/S vitreo-retinal adhesionadhesion
3. Retinal Break3. Retinal Break
4. Retinal detachment4. Retinal detachment
5. Vitreous hemorrhage5. Vitreous hemorrhage
Treatment : RBTreatment : RB
RB RB laser/ cryo laser/ cryo
Treatment : RDTreatment : RD
RulesRules 1. retinal reattachment1. retinal reattachment
Scleral bucklingScleral buckling Vitrectomy with gas/ oilVitrectomy with gas/ oil Pneumatic retinopexyPneumatic retinopexy
2. Create adhesion force to prevent 2. Create adhesion force to prevent redetachmentredetachment LaserLaser CryoCryo
Retinal reattachment 1 : Retinal reattachment 1 : scleral bucklingscleral buckling
Retinal reattachment 2 : Retinal reattachment 2 : vitrectomy with gas/oilvitrectomy with gas/oil
Retinal reattachment 3 : Retinal reattachment 3 : pneumatic retinopexypneumatic retinopexy
Create adhesion force to Create adhesion force to prevent redetachment 1 : prevent redetachment 1 :
cryocryo
Create adhesion force to Create adhesion force to prevent redetachment 2 : prevent redetachment 2 :
laserlaser
PNEUMATIC PNEUMATIC RETINOPEXYRETINOPEXY
Pneumatic retinopexyPneumatic retinopexy
A procedure for A procedure for retinal retinal reattachmentreattachment
Intravitreal gas injectionIntravitreal gas injection Transconjunctival cryopexy /Transconjunctival cryopexy /
Laser photocoagulationLaser photocoagulation Appropriate head positioningAppropriate head positioning
HistoryHistory 1911 : Ohm, 11911 : Ohm, 1STST intravitreal air injectionintravitreal air injection for RD. for RD. 1938 : Rosengren, using 1938 : Rosengren, using intravitreal air withintravitreal air with SRF drainage.SRF drainage. 1973 : Norton, using 1973 : Norton, using intravitreal SF6 with SB orintravitreal SF6 with SB or vitrectomy.vitrectomy. 1985 : Blodi, using intravitreal gas for MH with1985 : Blodi, using intravitreal gas for MH with detachment.detachment. Hilton & Grizzard, using the term Hilton & Grizzard, using the term ““PRPR”.”. 1989 : Tornambe & Hilton, comparing PR with SB.1989 : Tornambe & Hilton, comparing PR with SB.
Gas InjectionGas Injection Buoyant ForceBuoyant Force Tamponade EffectTamponade Effect
Gas occluding retinal break Gas occluding retinal break Preventing fluid influx through the Preventing fluid influx through the
hole hole
Inferior SRF displacementInferior SRF displacement
Re-absorption of SRF Re-absorption of SRF
Retina ReattachmentRetina Reattachment
What to injectWhat to inject
Small amount of gas bubbleSmall amount of gas bubble High percentageHigh percentage
Expand to required volumeExpand to required volume N2, O2, CO2N2, O2, CO2
Non toxicNon toxic
types of gas in usetypes of gas in use
LESS solubilityLESS solubility MORE MORE expansionexpansion
Solubility : Solubility : C3F8C3F8 < < SF6SF6 < < AIRAIR Average expansion : Average expansion : 4x4x : : 2x2x : : xx
Retina – Gas interfaceRetina – Gas interface
The relationship betweenThe relationship between
bubble volume & area of bubble volume & area of tamponadetamponade
In normal outflow channels, In normal outflow channels, 20 – 25 20 – 25 %% of of vitreous volumevitreous volume may be may be replaced by gas without an abnormal replaced by gas without an abnormal rising in IOP.rising in IOP.
AIR : AIR : ~ 1.2 ml used~ 1.2 ml used
SF6 : SF6 : ~ 0.6 ml used~ 0.6 ml used
C3F8 : C3F8 : ~ 0.3 ml used~ 0.3 ml used
The The most rapid rate of volume most rapid rate of volume expansionexpansion occurs within the occurs within the first first 6- 8 hrs6- 8 hrs, so IOP should be , so IOP should be monitored during this period.monitored during this period.
Initial criterias for PRInitial criterias for PR
Size of break : Size of break : No greater than 1 No greater than 1 clock hourclock hour
Site of breaks : Site of breaks : Superior 2/3 of the Superior 2/3 of the fundusfundus
PVR : PVR : GR. A or BGR. A or B Ability to Ability to maintain positionmaintain position No Hx of No Hx of Severe GlaucomaSevere Glaucoma No Cloudy mediaNo Cloudy media
Expanded criteriasExpanded criterias
Breaks extensionBreaks extension : Single or multiple : Single or multiple tearstears
which spanning up to 3 clock hourswhich spanning up to 3 clock hours
What about RD with What about RD with Inferior break(s)?Inferior break(s)?
Inverted PR Inverted PR
““ Inverted PR can successfully re Inverted PR can successfully re paired RRD with the inferior retin paired RRD with the inferior retin
al breaks under appropriate condi al breaks under appropriate condi tion ” tion ”
ComplicationsComplications
Corneal edemaCorneal edema Posterior corneal membrane formationPosterior corneal membrane formation Cataract formationCataract formation
Resulting fromResulting from deprivation of deprivation of nutrient effectnutrient effect than from a toxic effectthan from a toxic effect
- GlaucomaGlaucoma- EndophthalmisisEndophthalmisis- Subretinal gas/ fish eggsSubretinal gas/ fish eggs