International Ophthalmology

, Volume 18, Issue 4, pp 237–241 | Cite as

Fluid air exchange in vitreo retinal surgery

  • Jean -Paul Berrod
  • Pascal Rozot
  • Antoine Raspiller
  • Didier Thiery
Regular Papers


This study evaluates the efficiency of fluid-air exchange on the reattachment of the retina and clarifies the possibility that a posterior retinotomy is a cause for intra- and postoperative complications. A consecutive series of 211 eyes with retinal detachments due to P.V.R. (47%), diabetic traction, perforating trauma, macular hole or giant tears is presented. All eyes underwent pars plana vitrectomy, fluid-air exchange, internal drainage of subretinal fluid, laser endophotocoagulation and scleral buckling of the tears; 56% of the eyes were phakic and 55% underwent a posterior retinotomy, 54% underwent tamponade with C3F8 and 46% with silicone oil. Intraoperatively the retina was completely flattened in 91% cases. The causes of incomplete reattachment were residual membranes (6.6%), poor visualization (1.4%) and suprachoroidal hemorrhage (1%). These complications were isolated as being the cause of the bad final results (p < 0.001). Postoperatively, the retina remained attached in 66% of cases after the first procedure and with further surgery in 81% (mean follow up 16 months). Best corrected visual acuity was improved in 73% of eyes, unchanged in 17%, and worse in 10%. Complications were retraction of the retinotomy site in 3 cases and peripheral choroidal hemorrhage in 4 cases. We concluded that fluid air exchange with internal subretinal fluid drainage was an efficient and safe technique even if a posterior retinotomy was necessary.

Key words

fluid air exchange retinal detachment vitrectomy central retinotomy 


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  1. 1.
    Charles S, McCarthy C, Eichenbaum D. Mechanical syringe drive for vitreous surgery. Am J Ophthalmol 1975; 79: 879.Google Scholar
  2. 2.
    Hueneke RL, Aaberg TM. Instrumentation for continuous fluid-air exchange during vitreous surgery. Am J Ophthalmol 1983; 96: 547–548.Google Scholar
  3. 3.
    Freeman HM, Tolentino F. In: Atlas of vitreoretinal surgery. Georg Thieme Verlag, Stuttgart, New York, pp 79–81, 1990.Google Scholar
  4. 4.
    Mathis A. Le ‘Fluid-air exchange’. J Fr Ophtalmol 1992; 15: 367–371.Google Scholar
  5. 5.
    McCuen BW, Bessler M, Hickingbotham D, Isbey E. Automated fluid-gas exchange. Am J Ophthalmol 1983; 95: 717.Google Scholar
  6. 6.
    McDonald HR, Lewis H, Aaberg TM, Abrams GW. Complications of endodrainage retinotomies created during vitreous surgery for complicated retinal detachment. Ophthalmology 1989; 96: 358–363.Google Scholar
  7. 7.
    The Retina Society Terminology Committee. The classification of retinal detachment with proliferative vitreoretinopathy. Ophthalmology 1983; 90: 121–125.Google Scholar
  8. 8.
    Heimann K, Wiedemann P. Cologne classification of proliferative vitreoretinopathy. In: Heimann K, Wiedmann P (eds) Proliferative vitreoretinopathy. Kaden Verlag, Heidelberg, pp 148–149, 1989Google Scholar
  9. 9.
    Zivojnovic R, Vijfvinkel GJ. A modified flute needle. Am J Ophthalmol 1983; 96: 548–549.Google Scholar
  10. 10.
    Doft BH. Intentional retinotomy for internal drainage of subretinal fluid. Arch Ophthalmol 1986; 104: 807–808.Google Scholar
  11. 11.
    Charles S, Wang C. A motorized gas injector for vitreous surgery. Arch Ophthalmol 1981; 99: 1398.Google Scholar
  12. 12.
    Campochiaro PA, Kaden JH, Vidaurri-Leal J, Glaser BM. Cryotherapy enhances intravitreal dispersion of viable retinal pigment epithelial cells. Arch Ophthalmol 1985; 103: 434–436.Google Scholar
  13. 13.
    Flynn HW, Blumenkranz MS, Parel JM, Lee WG. Cannulated subretinal fluid aspirator for vitreoretinal microsurgery. Am J Ophthalmol 1987; 103: 106–108.Google Scholar
  14. 14.
    Chang S. Low viscosity liquid fluorochemicals in vitreous surgery. Am J Ophthalmol 1987; 103: 38–43.Google Scholar
  15. 15.
    Chang S, Lincoff H, Zimmermann NJ, Fuchs W. Giant retinal tears. Surgical technics and results using perfluorocarbon liquids. Arch Ophthalmol 1989; 107: 761–766.Google Scholar
  16. 16.
    Flynn HW, Verne AZ. Letter to the editor. Retina 1989; 9: 336–337.Google Scholar
  17. 17.
    Lakhanpal V, Schockets S, Elman MJ, Dogra MR. Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy. Ophthalmology 1990; 97: 1114–1119.Google Scholar
  18. 18.
    Piper JG, Han DP, Abrams GW, Mieler WF. Perioperative choroidal hemorrhage at pars plana vitrectomy. A case-control study. Ophthalmology 1993; 100: 699–704.Google Scholar
  19. 19.
    Larrison WI, Frederick AR, Peterson TJ, Topping TM. Posterior retinal folds following vitreoretinal surgery. Arch Ophthalmol 1993; 111: 621–625.Google Scholar
  20. 20.
    Blinder RJ, Peyman GA, Paris CL, Dailey JP, Alturki W et al. Vitreon, a new perfluorocarbon. Br J Ophthalmol 1991; 75: 240–244.Google Scholar
  21. 21.
    Landers MB. Sodium hyaluronate (Healon) as an aid to internal fluid-gas exchange. Am J Ophthalmol 1982; 94: 557–558.Google Scholar
  22. 22.
    Lewis H, Aaberg Th, Abrams GW, Han D, Kreiger A. Management of the lens capsule during pars plana vitrectomy. Am J Ophthalmol 1987; 103: 109–110.Google Scholar
  23. 23.
    Eckardt C. Pupillary stretching during vitrectomy. A new procedure in vitreous surgery. Retina 1985; 5: 235–236.Google Scholar
  24. 24.
    Gaudric A. Transpupillary continuous suture for intraoperative mydriasis. Am J Ophthalmol 1993; 115: 670–671.Google Scholar
  25. 25.
    Gartry DS, Chignell AH, Francks WA, Wong D. Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy. Br J Ophthalmol 1993; 77: 199–203.Google Scholar
  26. 26.
    Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhegmatogenous retinal detachment. Greafe's Arch Clin Exp Ophthalmol 1993; 231: 344–346.Google Scholar
  27. 27.
    Lopez R, Chang S. Long-term results of vitrectomy and perfluorocarbon gas for the treatment of severe proliferative vitreoretinopathy. Am J Ophthalmol 1992; 113: 424–428.Google Scholar
  28. 28.
    Chang S, Sparrow JR, Iwamoto PT, Gershbein A, Ross R, Ortiz R. Experimental studies of tolerance to intravitreal perfluoron-octane liquid. Retina 1991; 11: 367–374.Google Scholar
  29. 29.
    Eckardt C, Nicolai U, Winter M, Knop E. Exprimental intraocular tolerance to liquid perfluorooctane and perfluoropolyether. Retina 1991; 11: 375–384.Google Scholar
  30. 30.
    Berglin L, Ren J, Algvere PV. Retinal detachment and degeneration in response to subretinal perfluorodecalin in rabbit eyes. Greafe's Arch Exp Ophthalmol 1993; 231: 233–237.Google Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • Jean -Paul Berrod
    • 1
  • Pascal Rozot
    • 1
  • Antoine Raspiller
    • 1
  • Didier Thiery
    • 1
  1. 1.Service d'Ophtalmologie C.H.U. de NancyNancy CédexFrance

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