Title : Air versus Fluorinated Gas Tamponades in Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: Systematic Review and Meta-analysis
To compare air versus gas tamponades in pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).
Rhegmatogenous retinal detachment (RRD) is the most common type of retinal detachment involving full-thickness retinal breaks in the neurosensory retina due to vitreous traction. This requires urgent surgical interventions. Pars plana vitrectomy is the most commonly adopted surgical technique that involves the removal of the vitreous and vitreoretinal traction, sealing the retinal breaks and the introduction of a tamponading agent. Several studies in the literature compared the use of air against gas as a potential tamponading agent for patients with RRD undergoing PPV. This is the first systematic review and meta-analysis that aims to amalgamate all comparative studies of air versus gas tamponades for primary RRD and evaluate their surgical outcomes following PPV.
A systematic review and meta-analysis were performed as per the PRISMA Guidelines and a search of electronic information was conducted to identify all comparative studies of air versus gas tamponades in PPV for primary RRD. Surgical success and re-detachment rate were primary outcome measures. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), complications and predictive factors of surgical success. Fixed effects model was used for the analysis.
Seven studies enrolling a total sample size of 1954 eyes from 1942 patients were identified. No statistically significant difference was noted between air and gas tamponade in primary surgical success (OR = 1.26, P = 0.53) and retinal re-detachment (OR = 1.42, P = 0.25). However, the final surgical success rate was significantly higher in the gas tamponade group (OR = 0.47, P ≤ 0.00001). For secondary outcomes, the air group had similar results compared with the gas group in the changes of BCVA and IOP and overall complications, including cataract, ERM, proliferative vitreoretinopathy, macular hole and pucker formation. Potential predictive factors of surgical success included the choice of tamponade and location of RRD.
Air is equivalent to fluorinated gas tamponade for patients with primary RRD undergoing PPV as both are not statistically different in terms of primary surgical success and re-detachment rates. However, as expected, gas tamponade is significantly superior to air in the final surgical re-attachment.