Patching retinal breaks with Healaflow in 27G vitrectomy in the treatment of rhegmatogenous retinal detachment_Chinese Journal of Ocular Fundus Diseases

Authors：

Ren Xinjun , Zheng Chuanzhen , Wen Dejia , Ke Yifeng ,  Li Xiaorong

Tianjin Medical University Eye Hospital, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China;

Corresponding author：

Li Xiaorong, Email: xiaorli@163.com

Keywords：

Retinal detachment/surgery; Retinal perforations/surgery; Vitrectomy

DOI：

10.3760/cma.j.cn511434-20190729-00239

Video：

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Objective To observe the safety and effectiveness of patching retinal breaks with Healaflow in 27G vitrectomy combined with air tamponade in the treatment of rhegmatogenous retinal detachment (RRD).Methods Clinical-based prospective continuous study. From March 2017 to May 2018, 51 eyes of 50 RRD patients diagnosed in Tianjin Medical University Eye Hospital were included in the study. All eyes were treated with 27G vitrectomy, and laser photocoagulation was performed around retinal hiatus and denaturation zone after complete retinal reattachment. A blunt 27G needle was used to completely cover the surface of the retinal tear with the Healaflow. The injection amount was determined according to the size of the retinal tear, and the standard was that the tear was completely contained. There was no postoperative position limitation. The average follow-up was 15.8±6.3 months. The primary and final anatomic attachment rate, BCVA after operation, the intraoperative and postoperative complications, the recurrence of retinal detachment and so on were recorded.Results 51 eyes of 50 patients were enrolled, including 29 males (58.0%) and 21 females (42.0%). The average age was 58.5±1 years. A single break was present in 28 eyes (54.9%) and 2 to 5 breaks in 23 eyes (45.1%). The macula was involved in 32 eyes (62.7%) and attached in 19 eyes (37.3%) intraoperatively. Initial reattachment was achieved in 50 eyes (98.0%) and final reattachment in 51 eyes (100.0%). The logMAR BCVA before and 3 months after operation were 0.95±0.80 and 0.22±0.17, respectively. The difference of logMAR BCVA between before and after operation was significant (t=7.336, P＜0.001). The intraocular pressure was elevated transiently in 31 eyes (60.8%). No other complications occurred during follow-up.Conclusion The treatment of primary RRD with 27G vitrectomy combined with Healaflow patch and air tamponade is a safe, effective and convenient method with high success rate and rapid recovery of visual function.

Citation： Ren Xinjun, Zheng Chuanzhen, Wen Dejia, Ke Yifeng, Li Xiaorong. Patching retinal breaks with Healaflow in 27G vitrectomy in the treatment of rhegmatogenous retinal detachment. Chinese Journal of Ocular Fundus Diseases, 2020, 36(3): 200-204. doi: 10.3760/cma.j.cn511434-20190729-00239 Copy

1.	Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study[J]. Ophthalmology, 2007, 114(12): 2142-2154. DOI: 10.1016/j.ophtha.2007.09.013.
2.	Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments[J]. Ophthalmology, 1999, 106(9): 1811-1816. DOI: 10.1016/S0161-6420(99)90353-6.
3.	Soni C, Hainsworth DP, Almony A. Surgical management of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled trials[J]. Ophthalmology, 2013, 120(7): 1440-1447. DOI: 10.1016/j.ophtha.2012.12.033.
4.	Zhou C, Qiu Q, Zheng Z. Air versus gas tamponade in rhegmatogenous retinal detachment with inferior breaks after 23-gauge pars plana vitrectomy: a prospective, randomized comparative interventional study[J]. Retina, 2015, 35(5): 886-891. DOI: 10.1097/IAE.0000000000000416.
5.	Tanner V, Minihan M, Williamson TH. Management of inferior retinal breaks during pars plana vitrectomy for retinal detachment[J]. Br J Ophthalmol, 2001, 85(4): 480-482. DOI: 10.1136/bjo.85.4.480.
6.	Colyer MH, Barazi MK, von Fricken MA. Retrospective comparison of 25-gauge transconjunctival sutureless vitrectomy to 20-gauge vitrectomy for the repair of pseudophakic primary inferior rhegmatogenous retinal detachment[J]. Retina, 2010, 30(10): 1678-1684. DOI: 10.1097/IAE.0b013e3181dd6da1.
7.	Stappler T, Heimann H, Wong D, et al. Heavy tamponade 2 Densiron 68 in routine clinical practice: anatomical and functional outcomes of a consecutive case series[J]. Eye (Lond), 2008, 22(10): 1360-1365. DOI: 10.1038/eye.2008.62.
8.	Sharma A, Grigoropoulos V, Williamson TH. Management of primary rhegmatogenous retinal detachment with inferior breaks[J]. Br J Ophthalmol, 2004, 88(11): 1372-1375. DOI: 10.1136/bjo.2003.041350.
9.	Wickham L, Connor M, Aylward GW. Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle?[J]. Br J Ophthalmol, 2004, 88(11): 1376-1379. DOI: 10.1136/bjo.2004.043687.
10.	Wang F, Garza LA, Kang S, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin[J]. Arch Dermatol, 2007, 143(2): 155-163. DOI: 10.1001/archderm.143.2.155.
11.	Turlier V, Delalleau A, Casas C, et al. Association between collagen production and mechanical stretching in dermal extracellular matrix: in vivo effect of cross-linked hyaluronic acid filler: a randomised, placebo-controlled study[J]. J Dermatol Sci, 2013, 69(3): 187-194. DOI: 10.1016/j.jdermsci.2012.12.006.
12.	Stead RE, Juma Z, Turner S, et al. A novel use of reticulated hyaluronic acid (Healaflow) for hypotony eyes in patients with uveitis[J]. Br J Ophthalmol, 2016, 100(6): 727-730. DOI: 10.1136/bjophthalmol-2015-307799.
13.	Martinez-Castillo V, Verdugo A, Boixadera A, et al. Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air[J]. Arch Ophthalmol, 2005, 123(8): 1078-1081. DOI: 10.1001/archopht.123.8.1078.
14.	Tan HS, Oberstein SY, Mura M, et al. Air versus gas tamponade in retinal detachment surgery[J]. Br J Ophthalmol, 2013, 97(1): 80-82. DOI: 10.1136/bjophthalmol-2012-302140.
15.	Martinez-Castillo V, Boixadera A, Verdugo A, et al. Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position[J]. Ophthalmology, 2005, 112(7): 1222-1226. DOI: 10.1016/j.ophtha.2004.12.046.
16.	Martínez-Castillo VJ, Garcia-Arumi J, Boixadera A. Pars plana vitrectomy alone for the management of pseudophakic rhegmatogenous retinal detachment with only inferior breaks[J]. Ophthalmology, 2016, 123(7): 1563-1569. DOI: 10.1016/j.ophtha.2016.03.032.
17.	Zhang Z, Peng M, Wei Y, et al. Pars plana vitrectomy with partial tamponade of filtered air in rhegmatogenous retinal detachment caused by superior retinal breaks[J]. BMC Ophthalmol, 2017, 17(1): 64. DOI: 10.1186/s12886-017-0459-6.
18.	Hotta K, Sugitani A, Uchino Y. Pars plana vitrectomy without long-acting gas tamponade for primary rhegmatogenous retinal detachment[J]. Ophthalmologica, 2004, 218(4): 270-273. DOI: 10.1159/000078619.
19.	Ruamviboonsuk P, Limwattanayingyong J, Tadarati M. Sutureless 25-gauge vitrectomy for rhegmatogenous retinal detachment caused by superior breaks using air tamponade[J]. Asia Pac J Ophthalmol (Phila), 2015, 4(2): 92-96. DOI: 10.1097/APO.0000000000000047.
20.	马恩普, 赵小钊, 董良, 等. Healaflow在青光眼小梁切除术中的应用[J]. 眼科新进展, 2012, 32(6): 570-572. DOI: 10.13389/j/chki.rao.2012.06.020.Ma EP, Zhao XZ, Dong L, et al. Application of crosslinked sodium hyaluronate (Healaflow) in trabeculectomy[J]. Rec Adv Ophthalmol, 2012, 32(6): 570-572. DOI: 10.13389/j/chki.rao.2012.06.020.
21.	Bettin P, Di Matteo F, Rabiolo A, et al. Deep sclerectomy with mitomycin C and injectable cross-linked hyaluronic acid implant: long-term results[J]. J Glaucoma, 2016, 25(6): 625-629. DOI: 10.1097/IJG.0000000000000309.
22.	Barth H, Crafoord S, O'Shea TM, et al. A new model for in vitro testing of vitreous substitute candidates[J]. Graefe’s Arch Clin Exp Ophthalmol, 2014, 252(10): 1581-1592. DOI: 10.1007/s00417-014-2714-3.
23.	Gupta D. Rethinking surface tension and buoyancy[J]. Arch Ophthalmol, 2011, 129(8): 1109-1110. DOI: 10.1001/archophthalmol.2011.176.
24.	Sebag J, Tang M. Pneumatic retinopexy using only air[J]. Retina, 1993, 13(1): 8-12. DOI: 10.1097/00006982-199313010-00003.
25.	Foster WJ, Chou T. Physical mechanisms of gas and perfluoron retinopexy and sub-retinal fluid displacement[J]. Phys Med Biol, 2004, 49(13): 2989-2997. DOI: 10.1088/0031-9155/49/13/015.
26.	Chang S. Intraocular gases[M]//Ryan SJ, Hinton DR, Schachat AP. Retina. 4th ed. Philadelphia: Mosby, 2006: 2165-2178.

1. Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study[J]. Ophthalmology, 2007, 114(12): 2142-2154. DOI: 10.1016/j.ophtha.2007.09.013.
2. Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments[J]. Ophthalmology, 1999, 106(9): 1811-1816. DOI: 10.1016/S0161-6420(99)90353-6.
3. Soni C, Hainsworth DP, Almony A. Surgical management of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled trials[J]. Ophthalmology, 2013, 120(7): 1440-1447. DOI: 10.1016/j.ophtha.2012.12.033.
4. Zhou C, Qiu Q, Zheng Z. Air versus gas tamponade in rhegmatogenous retinal detachment with inferior breaks after 23-gauge pars plana vitrectomy: a prospective, randomized comparative interventional study[J]. Retina, 2015, 35(5): 886-891. DOI: 10.1097/IAE.0000000000000416.
5. Tanner V, Minihan M, Williamson TH. Management of inferior retinal breaks during pars plana vitrectomy for retinal detachment[J]. Br J Ophthalmol, 2001, 85(4): 480-482. DOI: 10.1136/bjo.85.4.480.
6. Colyer MH, Barazi MK, von Fricken MA. Retrospective comparison of 25-gauge transconjunctival sutureless vitrectomy to 20-gauge vitrectomy for the repair of pseudophakic primary inferior rhegmatogenous retinal detachment[J]. Retina, 2010, 30(10): 1678-1684. DOI: 10.1097/IAE.0b013e3181dd6da1.
7. Stappler T, Heimann H, Wong D, et al. Heavy tamponade 2 Densiron 68 in routine clinical practice: anatomical and functional outcomes of a consecutive case series[J]. Eye (Lond), 2008, 22(10): 1360-1365. DOI: 10.1038/eye.2008.62.
8. Sharma A, Grigoropoulos V, Williamson TH. Management of primary rhegmatogenous retinal detachment with inferior breaks[J]. Br J Ophthalmol, 2004, 88(11): 1372-1375. DOI: 10.1136/bjo.2003.041350.
9. Wickham L, Connor M, Aylward GW. Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle?[J]. Br J Ophthalmol, 2004, 88(11): 1376-1379. DOI: 10.1136/bjo.2004.043687.
10. Wang F, Garza LA, Kang S, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin[J]. Arch Dermatol, 2007, 143(2): 155-163. DOI: 10.1001/archderm.143.2.155.
11. Turlier V, Delalleau A, Casas C, et al. Association between collagen production and mechanical stretching in dermal extracellular matrix: in vivo effect of cross-linked hyaluronic acid filler: a randomised, placebo-controlled study[J]. J Dermatol Sci, 2013, 69(3): 187-194. DOI: 10.1016/j.jdermsci.2012.12.006.
12. Stead RE, Juma Z, Turner S, et al. A novel use of reticulated hyaluronic acid (Healaflow) for hypotony eyes in patients with uveitis[J]. Br J Ophthalmol, 2016, 100(6): 727-730. DOI: 10.1136/bjophthalmol-2015-307799.
13. Martinez-Castillo V, Verdugo A, Boixadera A, et al. Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air[J]. Arch Ophthalmol, 2005, 123(8): 1078-1081. DOI: 10.1001/archopht.123.8.1078.
14. Tan HS, Oberstein SY, Mura M, et al. Air versus gas tamponade in retinal detachment surgery[J]. Br J Ophthalmol, 2013, 97(1): 80-82. DOI: 10.1136/bjophthalmol-2012-302140.
15. Martinez-Castillo V, Boixadera A, Verdugo A, et al. Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position[J]. Ophthalmology, 2005, 112(7): 1222-1226. DOI: 10.1016/j.ophtha.2004.12.046.
16. Martínez-Castillo VJ, Garcia-Arumi J, Boixadera A. Pars plana vitrectomy alone for the management of pseudophakic rhegmatogenous retinal detachment with only inferior breaks[J]. Ophthalmology, 2016, 123(7): 1563-1569. DOI: 10.1016/j.ophtha.2016.03.032.
17. Zhang Z, Peng M, Wei Y, et al. Pars plana vitrectomy with partial tamponade of filtered air in rhegmatogenous retinal detachment caused by superior retinal breaks[J]. BMC Ophthalmol, 2017, 17(1): 64. DOI: 10.1186/s12886-017-0459-6.
18. Hotta K, Sugitani A, Uchino Y. Pars plana vitrectomy without long-acting gas tamponade for primary rhegmatogenous retinal detachment[J]. Ophthalmologica, 2004, 218(4): 270-273. DOI: 10.1159/000078619.
19. Ruamviboonsuk P, Limwattanayingyong J, Tadarati M. Sutureless 25-gauge vitrectomy for rhegmatogenous retinal detachment caused by superior breaks using air tamponade[J]. Asia Pac J Ophthalmol (Phila), 2015, 4(2): 92-96. DOI: 10.1097/APO.0000000000000047.
20. 马恩普, 赵小钊, 董良, 等. Healaflow在青光眼小梁切除术中的应用[J]. 眼科新进展, 2012, 32(6): 570-572. DOI: 10.13389/j/chki.rao.2012.06.020.Ma EP, Zhao XZ, Dong L, et al. Application of crosslinked sodium hyaluronate (Healaflow) in trabeculectomy[J]. Rec Adv Ophthalmol, 2012, 32(6): 570-572. DOI: 10.13389/j/chki.rao.2012.06.020.
21. Bettin P, Di Matteo F, Rabiolo A, et al. Deep sclerectomy with mitomycin C and injectable cross-linked hyaluronic acid implant: long-term results[J]. J Glaucoma, 2016, 25(6): 625-629. DOI: 10.1097/IJG.0000000000000309.
22. Barth H, Crafoord S, O'Shea TM, et al. A new model for in vitro testing of vitreous substitute candidates[J]. Graefe’s Arch Clin Exp Ophthalmol, 2014, 252(10): 1581-1592. DOI: 10.1007/s00417-014-2714-3.
23. Gupta D. Rethinking surface tension and buoyancy[J]. Arch Ophthalmol, 2011, 129(8): 1109-1110. DOI: 10.1001/archophthalmol.2011.176.
24. Sebag J, Tang M. Pneumatic retinopexy using only air[J]. Retina, 1993, 13(1): 8-12. DOI: 10.1097/00006982-199313010-00003.
25. Foster WJ, Chou T. Physical mechanisms of gas and perfluoron retinopexy and sub-retinal fluid displacement[J]. Phys Med Biol, 2004, 49(13): 2989-2997. DOI: 10.1088/0031-9155/49/13/015.
26. Chang S. Intraocular gases[M]//Ryan SJ, Hinton DR, Schachat AP. Retina. 4th ed. Philadelphia: Mosby, 2006: 2165-2178.

Chinese Journal of Ocular Fundus Diseases

Patching retinal breaks with Healaflow in 27G vitrectomy in the treatment of rhegmatogenous retinal detachment

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