To compare the occurrence and characteristics of retinal displacement following direct perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange versus indirect PFCL for air and air for SO exchange methods during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD).
Methods
A comparative case series study was conducted on 58 eyes with recent RRD, undergoing standard three-port PPV with SO tamponade. Fluid exchange was performed using either direct or indirect methods. Postoperatively, a comprehensive ophthalmic examination and fundus autofluorescence (FAF) imaging were conducted at one month. The presence, amount, and direction of retinal displacement were assessed based on FAF imaging and compared between the direct and indirect fluid exchange groups.
Results
FAF imaging at one month revealed retinal displacement in 41.4% of eyes in the direct group and 62.1% in the indirect group, with no statistical difference between them (P = 0.537). However, the mean displacement was significantly higher in the indirect group (282.61 ± 110.83 µm) compared to the direct group (220.33 ± 39.67 µm, P = 0.04). The direction of displacement (downward or upward) did not differ significantly between the groups (P = 0.093).
Conclusions
While the occurrence and location of postoperative retinal displacement did not significantly differ between direct and indirect fluid exchange methods during PPV for RRD, eyes treated with the direct method exhibited lower mean displacement compared to the indirect method. These findings suggest potential benefits of the direct exchange approach in minimizing retinal displacement following surgery.
McLaughlinMDHwangJC. Trends in vitreoretinal procedures for medicare beneficiaries, 2000 to 2014. Ophthalmology2017; 124: 667–673. doi:https://doi.org/10.1016/j.ophtha.2017.01.001.
WongDWilliamsRLGermanMJ. Exchange of perfluorodecalin for gas or oil: a model for avoiding slippage. Graefe’s Arch Clin Exp Ophthalmol1998; 236: 234. doi:https://doi.org/10.1007/s004170050070.
4.
WongD. Slippage of the retina: what causes it and how can it be prevented? In: Vitreo-Retinal surgery. Berlin, Heidelberg: Springer, 2007, pp. 41–51. doi:https://doi.org/10.1007/978-3-540-33670-9_4.
5.
MarafonSBJuncalVRMuniRH. Perfluorocarbon liquid assisted drainage and tamponade associated retinal displacement: a unifying theory on the etiology of retinal folds, slippage and retinal displacement. Am J Ophthalmol Case Reports2022; 25: 101337. doi:https://doi.org/10.1016/j.ajoc.2022.101337.
6.
ShiragamiCFukudaKYamajiH, et al.A method to decrease the frequency of unintentional slippage after vitrectomy for rhegmatogenous retinal detachment. Retina2015; 35: 758–763. doi:https://doi.org/10.1097/IAE.0000000000000383.
7.
PandyaVBHoIHunyorAP. Does unintentional macular translocation after retinal detachment repair influence visual outcome?Clin Experiment Ophthalmol2012; 40: 88–92. doi:https://doi.org/10.1111/j.1442-9071.2011.02666.x.
8.
BhambraNFrancisconiCLMMarafonSB, et al.A novel method of quantifying retinal displacement using ultra-widefield Fundus autofluorescence imaging. Am J Ophthalmol2022; 244: 1–10. doi:https://doi.org/10.1016/j.ajo.2022.07.012.
9.
HunterAChinETelanderDG. Macular edema in the era of spectral-domain optical coherence tomography. Clin Ophthalmol2013; 7: 2085. doi:https://doi.org/10.2147/OPTH.S49552.
MasonRHMinakerSAMarafonSB, et al.Retinal displacement following rhegmatogenous retinal detachment: a systematic review and meta-analysis. Surv Ophthalmol2022; 67: 950–964. doi:https://doi.org/10.1016/j.survophthal.2022.01.002.
13.
MuniRHBansalALeeWW,et al.Minimal gas vitrectomy with scleral buckle to minimize retinal displacement in rhegmatogenous retinal detachment with inferior breaks. Retin Cases Brief Rep2023; 17: 247–250. doi:https://doi.org/10.1097/ICB.0000000000001174.
14.
ShaheenARIyerPGFlynnHW,et al.Retinal displacement following repair of rhegmatogenous retinal detachment. Oman J Ophthalmol2023; 16: 205–210. doi:https://doi.org/10.4103/ojo.ojo_187_22.
15.
FarahvashAMarafonSBJuncalVR, et al.Impact of tamponade agent on retinal displacement following pars plana vitrectomy for rhegmatogenous retinal detachment repair: a computer simulation model. Acta Ophthalmol2022; 100: e1470–e1478. doi:https://doi.org/10.1111/aos.15118.
16.
CodenottiMFogliatoGIulianoL, et al.Influence of intraocular tamponade on unintentional retinal displacement after vitrectomy for rhegmatogenous retinal detachment. Retina2013; 33: 349–355. doi:https://doi.org/10.1097/IAE.0b013e318263d180.
dell’OmoRScupolaAViggianoD, et al.Incidence and factors influencing retinal displacement in eyes treated for rhegmatogenous retinal detachment with vitrectomy and gas or silicone oil. Investig Opthalmology Vis Sci2017; 58: BIO191. doi:https://doi.org/10.1167/iovs.17-21466.
19.
PetersenJ. The physical and surgical aspects of silicone oil in the vitreous cavity. Graefe’s Arch Clin Exp Ophthalmol1987; 225: 452–456. doi:https://doi.org/10.1007/BF02334175.
20.
FawcettIMWilliamsRLWongD. Contact angles of substances used for internal tamponade in retinal detachment surgery. Graefe’s Arch Clin Exp Ophthalmol1994; 232: 438–444. doi:https://doi.org/10.1007/BF00186587.
21.
BazvandFAzarkishARiazi-EsfahaniH, et al.Retinal displacement following pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment. Int Ophthalmol2021; 41: 3007–3011. doi:https://doi.org/10.1007/s10792-021-01861-7.
22.
BroshKFrancisconiCLMQianJ, et al.Retinal displacement following pneumatic retinopexy vs pars Plana vitrectomy for rhegmatogenous retinal detachment. JAMA Ophthalmol2020; 138: 652. doi:https://doi.org/10.1001/jamaophthalmol.2020.1046.
23.
Dell’omoRMuraMLesnik ObersteinSY, et al.Early simultaneous fundus autofluorescence and optical coherence tomography features after pars plana vitrectomy for primary rhegmatogenous retinal detachment. Retina2012; 32: 719–728. doi:https://doi.org/10.1097/IAE.0b013e31822c293e.
24.
ShiragamiCShiragaFYamajiH, et al.Unintentional displacement of the retina after standard vitrectomy for rhegmatogenous retinal detachment. Ophthalmology2010; 117: 86–92.e1. doi:https://doi.org/10.1016/j.ophtha.2009.06.025.
25.
GuberJSchawkatMLangC, et al.How to prevent retinal shift after rhegmatogenous retinal detachment repair. Ophthalmol Retin2019; 3: 417–421. doi:https://doi.org/10.1016/j.oret.2019.01.010.
26.
SchawkatMValmaggiaCLangC, et al.Influence of postoperative posture on macular slippage after Macula-off retinal detachment: a randomized controlled trial. Ophthalmol Ther2019; 8: 519–525. doi:https://doi.org/10.1007/s40123-019-0204-8.
27.
GuberJSchawkatMSchollHPN, et al.Long-term outcome of macular shift after retinal detachment repair. Graefe’s Arch Clin Exp Ophthalmol2021; 259: 1487–1491. doi:https://doi.org/10.1007/s00417-020-05019-6.
28.
MachemerRAabergTMFreemanHM, et al.An updated classification of retinal detachment with proliferative vitreoretinopathy. Retina1992; 12: 73. doi:https://doi.org/10.1097/00006982-199212010-00025.
