Comparison of Two Techniques for the Decrease of Perfluoropropane Gas Volume in the Management of Retinal Detachment in Thammasat Hospital

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kittichai akrapipatkul

Abstract

ABSTRACT


Purpose: To compare the residual gas (perfluoropropane, C3F8) volume between fixed-concentration and fixed-volume method of air-gas exchange procedure used in rhegmatogenous retinal detachment surgery in Thammasat hospital.


Methods: We did a prospective, randomized clinical trial in the 56 patients whose eyes were diagnosed as rhegmatogenous retinal detachment and underwent pars plana vitrectomy combined with laser  endophotocoagulation and air-perfluoropropane gas exchange. In the 28 patients whose eyes were in fixed-concentration group, air-perfluoropropane gas exchange was done by using 20% C3F8 50 cc replacing air within eye globe and the 28 eyes in fixed-volume group, 0.8 cc of 100% C3F8 was injected into the eye. We followed up 1 day, 1 week, and 1 month postoperatively to measure outcomes including post-operative intraocular gas volume (in percent), anatomical retinal reattachment rate and post-operative complications such as ocular hypertension and endophthalmitis.


Results: A total of 56 eyes (56 patients) with pars plana vitrectomy combined with laser  endophotocoagulation and air-perfluoropropane gas exchange were performed in this study. The patients consisted of 34 men (60.7%) and 22 women (39.3%). Their ages were between 33-84 years old with a mean of 59.84 ± 10.4 years old. The mean post-operative residual intraocular gas volume for the fixed-volume method after 1 day, 1 week, and 1 month were 81.25 ± 8.57%, 62.14 ± 12.87%, and 31.25 ± 11.52% respectively. And the mean post-operative residual intraocular gas volume for the fixed-concentration method after 1 day, 1 week, and 1 month were also 85.36 ± 10.71%, 70.36 ± 17.74% and 38.93 ± 16.18% respectively. There were no significant difference in residual intraocular gas volume  between the two groups in 1 day and 1 week postoperatively. After 1 month, there were difference of mean post-operative residual intraocular gas volume between 2 groups; 31.25 ± 11.52% for the fixed-volume method and 38.93 ± 16.18% for the fixed-concentration method (p>0.05).  The anatomical retinal reattachment rates were 85.7% and 89.3% for the fixed-volume method and fixed concentration method, respectively. There was no difference in the rates of ocular hypertension between two groups, and none of the patient developed post-operative endophthalmitis.


Conclusions: Both techniques of air-perfluoropropane gas exchange in pars plana vitrectomy combined with laser endophotocoagulation was comparable when considering on the anatomical retinal reattachment rate, though there was smaller intraocular gas volume in fixed-volume technique when compared to fixed-concentration technique.


Keywords: Perfluoropropane Gas, C3F8, Residual gas volume, Air-gas exchange procedure, Rhegmatogenous retinal detachment surgery


Ethics: This study was approved for ethical research in human with the human research ethics committee of Thammasat university, Thailand (Research ID: MTU-EC-OP-0-244/61).

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