FLUID AIR EXCHANGE IN VITREO RETINAL SURGERY

This study evaluates the efficiency of fluid-air exchange on the reatt achment of the retina and clarifies the possibility that a posterior r etinotomy is a cause for intra- and postoperative complications. A con secutive series of 211 eyes with retinal detachments due to P.V.R. (47 %), diabetic traction, perforating trauma, macular hole or giant tears is presented. All eyes underwent pars plana vitrectomy, fluid-air exc hange, internal drainage of subretinal fluid, laser endophotocoagulati on and scleral buckling of the tears; 56% of the eyes were phakic and 55% underwent a posterior retinotomy, 54% underwent tamponade with C3F 8 and 46% with silicone oil. Intraoperatively the retina was completel y flattened in 91% cases. The causes of incomplete reattachment were r esidual membranes (6.6%), poor visualization (1.4%) and suprachoroidal hemorrhage (1%). These complications were isolated as being the cause of the bad final results (p < 0.001). Postoperatively, the retina rem ained attached in 66% of cases after the first procedure and with furt her surgery in 81% (mean follow up 16 months). Best corrected visual a cuity was improved in 73% of eyes, unchanged in 17%, and worse in 10%. Complications were retraction of the retinotomy site in 3 cases and p eripheral choroidal hemorrhage in 4 cases. We concluded that fluid air exchange with internal subretinal fluid drainage was an efficient and safe technique even if a posterior retinotomy was necessary.