Air Versus Gas Tamponade During Macular Hole Repair Surgery

Air tamponade is just as effective as gas tamponade when used during full-thickness (FTMH) repair surgery, according to a study presented by Shriji Patel, MD, of the Vanderbilt Eye Institute in Nashville, at the 37^th Annual ASRS Meeting.

This was a retrospective chart review which included 211 eyes and was conducted on all patients undergoing pars plana vitrectomy (PPV) for idiopathic FTMH at Vanderbilt University Medical Center from January 2010 to May 2017. Inclusion criteria included patients with small-gauge PPV (23-, 25-,27-guage as discerned at the discretion of the operating surgeon) for idiopathic full-thickness macular hole as confirmed on pre-operative optical coherence tomography (OCT). Exclusion criteria included any patients with previous incisional vitreoretinal surgery in the study eye, traumatic or pediatric macular holes, associations with detached retinas, and tractional macular membranes from secondary retinopathy.  Researchers reviewed each operative note to investigate which agent (air or gas) was used for tamponade at the conclusion of surgery. They measured pre-operative hole size using optical coherence tomography (OCT) and recorded post-operative hole closures. Gas was administered to tamponade agent in 171 of the 211 eyes; most of these eyes (144 of 171) received sulfur hexafluoride (SF6) with the remaining portion receiving perfluoro propane (C3F8).  Forty eyes underwent only a complete fluid-air exchange without any gas placement following vitrectomy.

The results suggest that there was no statistically significant difference between the two groups in terms of mean pre-operative macular hole size (P=0.43).  Nine of the 171 macular holes receiving gas tamponade failed to close (5.3%) juxtaposed to only one of the 40 macular holes receiving only air failed to close (2.5%).  The authors noted that were no significant differences in hole closure rates between the two groups.

“Anti-VEGF IVT was used earlier in patients with an ID of severe NPDR compared to PDR,” the study authors wrote in summarizing their findings. “These results along with our finding that many pts with moderate NPDR progress directly to PDR underscores the need to refer moderate and severe NPDR patients to a retina specialist.”

Shriji P. Air Versus Gas Tamponade During Macular Hole Repair Surgery. Presented at the 37^th ASRS Annual Meeting; July 26-30, 2019; Chicago, IL.

Read more (login required): https://meeting2019.asrs.org/ondemand#/ondemand/papers/air-versus-gas-tamponade-during-macular-hole-repair-surgery-535