How to Avoid Giant Retinal Tear Slippage: New Surgical Approach

M. Zidi
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Abstract

Introduction: The retinal detachment (RD) by giant tear is a rare but serious clinical form. Apart from its therapeutic difficulty, during the fluid-air exchange, it poses a problem of retinal slippage which may be responsible for therapeutic failure or at best for retinal folds with serious anatomical and functional consequences. The purpose of this study is to shed light on the keys to the success of this technique. Material and methods: Retrospective study over 5 years from January 2014-December 2019 concerning 56 cases of retinal detachment by giant tear. All the patients were operated on by vitrectomy and laser endophotocoagulation of the tear edge and on 360°. The technique involved a first transient exchange of PFCL-air followed by a second exchange of silicone-air or gas-air depending on the case. Results: Intraoperatively, no cases of slipping, even in the cases of gas tamponade, have been observed. A primary retinal re-application of the RD was noticed in 87.5% of cases. The rate of retinal detachment recurrence was 12.5% (all had an advanced vitreoretinal proliferation). After recurrence surgery, the final reapplication rate was 100%. Conclusion: Mastering the PFCL-Air exchange during vitrectomy retinal detachments by giant tearing according to the technique described helps to prevent the slippage of the retina. The gas tamponade can be an alternative to silicone tamponade in some cases of giant tears selected with lower horns above the 4 – 8 meridians.
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如何避免巨大的视网膜撕裂滑移:新的手术途径
摘要视网膜脱离(RD)是一种罕见但严重的临床形式。除了治疗困难外,在液气交换过程中,它还会造成视网膜滑脱的问题,这可能导致治疗失败,或者充其量造成视网膜褶皱,造成严重的解剖和功能后果。这项研究的目的是阐明这种技术成功的关键。材料与方法:回顾性研究2014年1月至2019年12月5年间56例巨大撕裂性视网膜脱离病例。所有患者均行玻璃体切除和激光撕边内凝术,并360°切除。该技术包括第一次pfcl -空气的短暂交换,然后根据情况进行第二次硅空气或气体-空气交换。结果:术中无滑倒病例,即使在气体填塞的情况下,也未观察到。在87.5%的病例中发现了RD的原发性视网膜再应用。视网膜脱离复发率为12.5%(均为晚期玻璃体视网膜增生)。复发手术后,最终复涂率为100%。结论:掌握大撕裂法玻璃体切除视网膜脱离术中PFCL-Air交换有助于防止视网膜滑脱。气体填塞可以替代硅胶填塞,在某些情况下,巨大的撕裂选择较低的角以上的4 - 8个经络。
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