Gas tamponade recommended for retinal detachment involving lower quadrants

This retrospective review found that gas tamponade is superior to air tamponade in rhegmatogenous retinal detachment (RRD) cases with involvement of the lower quadrants. These results suggest that air tamponade should only be used in retinal detachments that are restricted to the superior quadrants.

The use of primary vitrectomy to repair RRD has increased significantly in the last decade. Octafluoropropace (C3F8) and sulfur hexafluoride (SF6) are the typical gases utilized in vitrectomy surgery for tamponade. Visual recovery after retinal detachment surgery is limited by the length of time that gas remains in the eye. C3F8 has a longer half-life than SF6 gas. The use of SF6 gas has increased, with the trend toward shortened duration of endotamponade as surgical techniques improve. Traditionally, air tamponade has not been utilized for retinal detachment repair given its very short half-life.

The study included 524 eyes that underwent primary vitrectomy for RRG, of which 318 were treated with vitrectomy surgery and 20% SF6 gas tamponade and 128 with vitrectomy and air tamponade. Follow-up was at least three months and a mean of approximately nine months for both treatment groups. Compared to the SF6 group, the air group included more phakic eyes, more macula-on retinal detachments, and fewer inferiorly located retinal breaks.

Single-operation retinal reattachment occurred in 81 percent of eyes with air tamponade versus 86.9 percent of eyes with SF6 tamponade (P = 0.083). Involvement of lower retinal quadrants in the retinal detachment was found to be a significant confounding factor. After correction for this confounder using a multivariate logistic regression model, air versus gas tamponade became a statistically significant determinant for success (P = 0.012).

Although inferior retinal breaks were excluded from this study, eyes with inferior retinal detachment had lower retinal reattachment rates with air (69.6 percent) than with SF6 tamponade (84.7 percent, P = 0.009).

Therefore, the authors caution against the use of air tamponade in eyes with inferior detachment or breaks. Randomized prospective trials are needed to determine if air tamponade is a safe viable option for some retinal detachment repairs.