Scleral Buckling With Intravitreal Air Injection

ObjectiveAnalyse the clinical data of middle-aged and old patients who were diagnose with rhegmatogenous retinal detachment(RRD),with the superior horse-shoe hole and with proliferative vitreoretinopathy(PVR) less than C₃ before surgery to investigate the early effect of scleral buckling with intravitreal air injection after the surgery.Methods1.General information:We selected sixty-three RRD cases treated with scleral buckling in Qilu hospital of Shandong university from Jan 2007 to Dec 2008.All patients was elder then forty,with the superior horse-shoe holes and with PVR less than C₃ before the surgery.Twenty-nine patients were treated with scleral buckling combining with intravitreal air injection.Thirty-four patients were treated with simple scleral buckling.2.Surgical techniques:The patients were divided into two groups——air injection group and no-air injection group.The patients of air injection group were treated with scleral buckling combining with intravitreal air injection which meant scleral buckling+subretinal fluid drainage+cryocoagulation+intravitreal air injection. The patients of no-air injection group were treated with simple scleral buckling which meant scleral buckling+subretinal fluid drainage+cryocoagulation.3.Treatment and observation after surgery:The patients of air injection group had to maintain semi-supine three days after surgery to make sure the hole at the highest point,while there was no special request to no-air injection group.Visual acuity and intraocular pressure and anterior and posterior segment were checked every day after surgery. 4.Follow-up:Followed up all patients one month after surgery,focusing on whether the retina was anatomic reattachment and whether there were complications.5.Statistical treatment:SAS statistical softwareResults1.The anatomic reattachment of retina:The differences between retinal reattachment of air injection group and that of no-air injection group were not statistically significant(P＞0.05) at first day and seventh day and one month.2.IOP:At the first day after surgery,IOP was in the range of 8.1～23.7mmHg and the average of IOP was 15.37±4.22mmHg with 11 cases were hypotonic.At the third day after surgery,IOP was in the range of 7.9～21.2mmHg and the average of IOP was 15.10±2.83mmHg with 5 cases were hypotonic.The differences between IOP of air injection group and that of no-air injection group were statistically significant(P＜0.05).At the fifth day after surgery,IOP was in the range of 7.8～18.9mmHg and the average of IOP was 14.58±2.00mmHg with 1 case was hypotonic.The differences between lOP of air injection group and that of no-air injection group were not statistically significant(P＞0.05).3.The best-corrected visual acuity:At the third day after surgery,the best-corrected visual acuity of 13 patients was less than 3.5,16 patients in range of 3.6～4.0 and 34 patients more than 4.0.The best-corrected visual acuity was increased significantly in 28 patients,increased in 28 patients and invariable in 7 patients.The differences between best-corrected visual acuity of air group and that of no-air group were not statistically significant(P＞0.05) and the differences between rate of increase of best-corrected visual acuity of air group and that of no-air group were statistically significant(P＜0.05).At the seventh day after surgery, the best-corrected visual acuity of 10 patients was less than 3.5,10 patients in range of 3.6～4.0 and 43 patients more than 4.0.The best-corrected visual acuity was increased significantly in 42 patients,increased in 19 patients and invariable in 2 patients.The differences between best-corrected visual acuity of air group and that of no-air group were not statistically significant(P＞0.05) and the differences between rate of increase of best-corrected visual acuity of air group and that of no-air group were not statistically significant(P＞0.05).At one month after surgery, the best-corrected visual acuity of 9 patients was less than 3.5,6 patients in range of 3.6～4.0 and 48 patients more than 4.0.The best-corrected visual acuity was increased significantly in 46 patients,increased in 15 patients and invariable in 2 patients.The differences between best-corrected visual acuity of air group and that of no-air group were not statistically significant(P＞0.05) and the differences between rate of increase of best-corrected visual acuity of air group and that of no-air group were not statistically significant(P＞0.05).4.Complication:When draining subretinal fluid,one patient bled in air injection group.Then after pressure bleeding was stopped.After surgery,new retinal hole was found in one case and proliferative vitreoretinopathy happened in one case in air injection group.In no-air injection group,corneal epithelial defect was found in one case during surgery,restored two days after surgery.After surgery,new retinal hole was found in two cases and PVR happened in three cases in no-air injection group.The differences between the incidence of PVR and new retinal hole in air group and that in no-air group were not statistically significant(P＞0.05).ConclusionsFor the middle-aged and old RRD patients with the superior horse-shoe hole and without PVR pre-operation,scleral buckling with intravitreal air injection is helpful to restore IOP and visual acuity earlily,and do not increase the incidence of complications.