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We read with great interest the scientific report published in your
journal by Zaidi AA et al(1) regarding their experience with pneumatic
retinopexy. We express our willingness to share our experience with a
unique complication mentioned by the authors. Giant retinal tear was
observed in one patient in the study by the author, which required scleral
buckle with vitrectomy.
A 32-year-old m...
A 32-year-old male presented to our vitreoretinal service with
retinal detachment in the right eye. On examination he had bilateral high
myopia with right eye subtotal rhegmatogenous retinal detachment with
superonasal (1’o clock position) horse shoe tear (HST). His best corrected
visual acuity (BCVA) was counting fingers close to face in the affected
eye and 6/18 in left eye (OS). His refractive status OS was -13.0DS/-
2.75DC@60°. We performed superior 90° scleral buckling along with 360°
band. Injection of 0.4cc of SF6 gas (sulfur hexafluoride gas) was done for
fish mouthing of tear. Residual subretinal (SRF) fluid was present on
first postoperative day. The very next day (2nd postoperative day), a
superotemporal giant retinal tear (GRT) was noticed extending from the
site of primary HST. Patient underwent pars plana vitrectomy (PPV) with
endolaser photocoagulation and silicone oil injection. The retina was
found to be attached in the subsequent follow ups. Silicone oil was
removed (SOR) 3 months later and the patient maintained BCVA of 6/18 OD
till date (6 months post-SOR).
Pneumatic retinopexy (PR) is a promising alternative technique to
scleral buckling for selected cases of retinal detachment.(2,3) Pneumatic
retinopexy may also be effectively used in treating GRT with mobile
flap.(4,5) Exceptional case reports are also available in which multiple
breaks up to five clock hours apart have been successfully treated with
PR(6) . But vitreous condensation and traction with new retinal tears and
detachments in operated cases of pneumatic retinopexy is also well
documented in literature.(7) Collaborative Pneumatic Retinopexy Study
showed new/missed retinal breaks in 7% which occurred within the first
three postoperative months.(8) But we could not find a similar reference
or case report in literature in which a GRT was documented as a
complication, till the article by Zaidi AA et al(1) which prompted us to
share our experience.
Our case was slightly different from the patient in this report since
we performed scleral buckling along with gas injection as a primary
procedure. But still it was not sufficient to prevent the extension of the
tear. SF6 will expand 2.5 times its volume in 48 hours and this may make
the early postoperative period highly vulnerable for such
complications.(9) Gas injection in eyes with extensive lattice
degeneration, stiff fixed folds or a history of a giant retinal tear in
the fellow eye is generally not recommended as this procedure increases
the risk of further separation of already compromised vitreous base in
such patients. Though it is widely accepted that retina with significant
traction is not a good case for PR, our case and the author’s article
reiterate once again the significance of careful patient selection before
retinal tamponade with intravitreal gas.
1. Zaidi et al. Pneumatic retinopexy: success rate and complications.
Br J Ophthalmol.2006; 90: 427-428.
2. Tornambe PE et al. Pneumatic retinopexy. Surv Ophthalmol. 1988 Jan
-Feb; 32 (4):270-81. Review.
3. Eter N, Boker T, Spitznas M. Long-term results of pneumatic
retinopexy. Graefes Arch Clin Exp Ophthalmol. 2000 Aug; 238(8):677-81.
4. Irvine AR, Lahey JM. Pneumatic retinopexy for giant retinal tears.
Ophthalmology. 1994 Mar; 101(3):524-8.
5. Ando F, Hirose H, Nagasaka T. Treatment of retinal detachment with
giant tear by pneumatic retinopexy. Eur J Ophthalmol. 1993 Oct-Dec;
6. Tornambe PE. Bilateral retinal detachment repaired with bilateral
pneumatic retinopexy. Case report. Arch Ophthalmol. 1987 Nov;
7. Dreyer RF. Sequential retinal tears attributed to intraocular gas.
Am J Ophthalmol. 1986 Aug 15; 102(2):276-8.
8. Hilton GF, Kelly NE, Salzano TC, et al. Pneumatic retinopexy: a
collaborative report of the first 100 cases. Ophthalmology 1987; 94:307-
9. Abrams GW, Swanson DE, Sabates WI, GoldmanAI. The results of
sulfur hexafluoride gas in vitreous surgery. Am J Ophthalmol. 1982 Aug; 94