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The authors report a study aimed to establish the use of air as a tamponade agent for primary rhegmatogenous retinal detachment (RRD) treatment, regardless of the position or the number of retinal breaks. Two hundred and thirty-six eyes of 230 patients (157 males, 66.8%) aged 60.4 ±10.9 years were analysed in this cases series. Preoperatively 57.1% of the patients presented with superior breaks only. 19.5% presented with inferior breaks only and 23.8% had simultaneously superior and inferior breaks. Three patients presented with giant tears defined as ≥3 clock hour extension and 6% had a subtotal or a complete RRD. The macula was detached preoperatively in 81 eyes (37.2%). Most of the patients received an air tamponade (165/236 eyes), while only 1/3 (71/236 eyes) had SF6 gas tamponade. A minimum extent of 50% of eye filling was observed for about three days on average with air tamponade according to patient evaluation and up to seven days with SF6 20%. Minimum follow-up time was three months. Success rate in treating RRD with pars plana vitrectomy (PPV) in cases involving superior, inferior, and multiple breaks was 88.5% (146/165 eyes) with air tamponade and 80.3% (57/71 eyes) with SF6 20% tamponade. Postoperative proliferative vitreoretinopathy (PVR) rate (defined as recurrent retinal detachment due to tractional membranes) occurred in 10 eyes in the air tamponade group and five eyes in the SF6 group and these did not appear to have any correlation with the number nor the location of the retinal breaks. The remaining cases of failure (nine patients for the air tamponade and nine patients for the SF6 tamponade group) had developed new retinal tears in the postoperative follow-up. This study shows encouraging results for RRD treated with air tamponade, not only for superior breaks but also for inferior and multiple breaks. A thorough removal of vitreous traction, aspiration of subretinal fluid (SRF), and sealing of all the retinal breaks are however mandatory elements of surgery. After this is accomplished, air tamponade seems to be a safe and effective agent for primary repair of RRD. Limitation: Retrospective nature.

Routine use of air tamponade in pars plana vitrectomy for primary rhegmatogenous retinal detachment repair.
Singh A, Boustani G, Michez M, Bali E.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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