| Purpose: To report the surgical outcomes of primary rhegmatogenous retinal detachment(RRD)repaired by 27-gauge pars plana vitrectomy(PPV)combined with Healaflow patch and air tamponade.Based on the principle of scleral buckling and the concept of minimally invasive,Healaflow,a new type of internal padding material,was injected into suprachoroidal space by the special microcatheter system.The objective of this research was to observe the safety,effectiveness and repeatability of suprachoroidal internal buckling and to provide the basis for clinical application.Based on Healaflow characteristics,it can be applied to other ophthalmological diseases to develop new and more clinical viscous materials,especially for vitreous cavity filling,which provide theoretical basis and accumulate experience and expand the applications for other ophthalmic diseases.Methods:(1)The vitro experiment: In the air condition,0.05 ml of Healaflow and sodium hyaluronate(Alcon,USA),a common viscoelastic agent,were injected into the upper wall,side wall and lower wall of the culture-flask respectively,and then the culture-flask was filled with balanced salt solution(BSS)and placed in a incubator with 37 degrees Celsius.Regular observation and comparison of dissolution and translocation of two different types of viscoelastic agents.(2)The first prospective clinical trail: The patients with primary rhegmatogenous retinal detachment(proliferative vitreous retinopathy(PVR)A&B)were enrolled in the group.All patients were treated with 27-gauge(27G)vitrectomy combined with Healaflow patch and sterile air tamponade.There was no postoperative position limitation.The primary and final anatomic attachment rate,the best corrected visual acuity(BCVA)after operation,the intraoperative and postoperative complications,the recurrence of retinal detachment and so on were recorded.(3)The second prospective clinical trail: The patients with primary rhegmatogenous retinal detachment(below PVR C1)were enrolled.All patients underwent routine slit lamp examination,indirect ophthalmoscope fundus examination and B-ultrasound examination before operation.Intraocular illumination was carried out by 27 G transconjunctival sclerostomy,the location of retinal holes was localized under the pan retinoscopy,scleral freezing of the hole and degenerative area,and retinal drainage when necessary.Using a 15-degree scalpel to cut the whole sclera at 3.0–4 mm posterior to the limbus,the incision length was about 2mm and parallel to the limbus,to expose pars plana.A special blunt needle(Olive Tip SC Cannula)was inserted into the suprachoroidal space through the scleral incision,and 0.1-0.4 ml Healaflow was injected into the target position under pan retinoscopy.The catheter was pulled out and the scleral and conjunctival incisions were sutured.The intraoperative primary outcome measures were operation time and complications.Broad-spectrum antibiotic eye drop was routinely given.One week,one month,three months and six months after operation,the retinal detachment reattachment,BCVA,intraocular pressure(IOP),the postoperative complications and the progress of the disease were recorded in detail.(4)Healaflow for other ocular diseases: 1)Healaflow was used to treat refractory macular hole(MH).After vitrectomy,air-liquid exchange,Healaflow patching the MH after complete removal of subretinal fluid,sterile air tamponade at the end of operation,with no postoperative position limitation;2)Healaflow was used to treat severe proliferative diabetic retinopathy(PDR),after gas-liquid exchange,Healaflow was covered on retinal hole,sterile air tamponade and free postoperative position.3)Healaflow application in the treatment of patients with hypotony.Healaflow was injected into anterior chamber to maintain IOP.Results:(1)The vitro experiment: At different time points(including 1 day,3 days,1 week and 2 weeks),Healaflow group remained undissolved,the diameter and size did not change.However,the common viscoelastic agent group,sodium hyaluronate,dissolved into BSS after 3 days.(2)The first prospective clinical trail: 38 eyes of 37 patients were enrolled,including 16 women(43.2%)and 21 men(56.8%)(mean age,59.5±9.5 years;mean follow-up period,8.9±3.8 months).A single break was present in 21(55.3%)and 2 to 5 breaks in 17 cases(44.8%).The macula was involved in 25(65.8%)and attached in 13 cases(34.2%)intraoperatively.Initial reattachment was achieved in 37(97.4%)and final reattachment in 38 cases(100%).In one case(2.6%),the macula redetached because of failure of the chorioretinal scar to develop around the treated break.Mean preoperative and postoperative BCVAs were 1.02±0.82 and 0.23 ± 0.17 logarithm of the minimum angle of resolution(Log MAR),respectively.IOP was elevated transiently in 28 eyes(73.7%).There were no other intraoperative complications or postoperative scleral incision leakage.(3)The second prospective clinical trail: 7 eyes of 7patients were enrolled,including 4 women(57.1%)and 3 men(42.9%)(mean age,33.7±10.0 years;mean follow-up period,7.6 ± 3.4 months).A single break was present in 4(57.1%)and 2-3 breaks in 3 cases(42.9%).The macula was involved in 5(71.4%)and attached in 2 cases(28.6%)intraoperatively.Initial reattachment was achieved in 7 eyes(100%).The BCVA of reoperation and 3 months after operation were 0.4±0.5 and 0.1±0.1 Log MAR(P=0.093),respectively.IOP was elevated transiently in one eye(14.3%).There were no retinal redetachment or other postoperative complications during follow-up.(4)Healaflow for other ocular diseases: Healaflow was successfully used to treat one refractory macular hole and one severe PDR.Air tamponade and no postoperative postural limitations.Good closure of retinal hole,rapid recovery of visual function after operation,and reduction of postoperative complications.Healaflow has been used in 3 hypotony cases with good results.The IOPs were maintained between 6 and 11 mm Hg for more than 6 months,which decrease the repeated injection times.Conclusion:(1)In vitro experiments confirmed that Healaflow lasted for at least two weeks after it adhered to the different locations of culture bottle.(2)The treatment of primary RRD with 27 G PPV combined with Healaflow patch and sterile air tamponade is a safe,effective and convenient method with high success rate,rapid recovery of visual function and no postoperative postural limitation.(3)Healaflow has a long half-life,high viscosity and cohesion,and good biocompatibility.It is an ideal filling material for suprachoroidal space at present.The operation time is greatly shortened on the premise of ensuring high success rate and minimally invasive surgery.The special suprachoroidal catheter system provides an approach and feasibility for minimally invasive surgery for other retinal and choroidal diseases,and also provides a theoretical basis and accumulates experience for the development of a new treatment approach of suprachoroidal cavity.(4)Based on the characteristics of Healaflow,it could be applied to other ophthalmic diseases,such as high myopia macular hole,diabetic retinopathy and high myopia damages. |
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