NW2011 Pneumatic retinopexy

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Pneumatic Pneumatic Retinopexy Retinopexy for Dummies for Dummies By By N.W N.W

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Transcript of NW2011 Pneumatic retinopexy

Page 1: NW2011 Pneumatic retinopexy

Pneumatic Pneumatic RetinopexyRetinopexy

for Dummiesfor Dummies

By N.WBy N.W

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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

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1.1. Vitreous syneresisVitreous syneresis

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2. Posterior vitreous 2. Posterior vitreous detachment (PVD)detachment (PVD)

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PVD: C/S vitreo-retinal PVD: C/S vitreo-retinal adhesionadhesion

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3. Retinal Break3. Retinal Break

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4. Retinal detachment4. Retinal detachment

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5. Vitreous hemorrhage5. Vitreous hemorrhage

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Treatment : RBTreatment : RB

RB RB laser/ cryo laser/ cryo

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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

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Retinal reattachment 1 : Retinal reattachment 1 : scleral bucklingscleral buckling

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Retinal reattachment 2 : Retinal reattachment 2 : vitrectomy with gas/oilvitrectomy with gas/oil

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Retinal reattachment 3 : Retinal reattachment 3 : pneumatic retinopexypneumatic retinopexy

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Create adhesion force to Create adhesion force to prevent redetachment 1 : prevent redetachment 1 :

cryocryo

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Create adhesion force to Create adhesion force to prevent redetachment 2 : prevent redetachment 2 :

laserlaser

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PNEUMATIC PNEUMATIC RETINOPEXYRETINOPEXY

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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

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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.

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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

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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

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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

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Retina – Gas interfaceRetina – Gas interface

The relationship betweenThe relationship between

bubble volume & area of bubble volume & area of tamponadetamponade

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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

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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.

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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

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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

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What about RD with What about RD with Inferior break(s)?Inferior break(s)?

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Inverted PR Inverted PR

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““ 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 ”

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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