Rhegmatogenous Retinal Detachment Clinical Trial
Official title:
Corneal Endothelial Cell Loss After Pneumatic Retinopexy for the Repair of Primary Rhegmatogenous Retinal Detachment
There are multiple ways to treat retinal detachment, the aim of this study is to compare the amount of corneal endothelial cell loss after pneumatic retinopexy in comparison to vitrectomy.
Retinal detachment is a separation of the neurosensory retina from the retinal pigment
epithelium. The most common form is rhegmatogenous retinal detachment, which occurs as the
result of a full-thickness retinal break. There are three major techniques available to
repair the detachment: scleral buckling, primary vitrectomy, and pneumatic retinopexy. At
our institution, pneumatic retinopexy is the technique most commonly employed for primary
repair. Pneumatic retinopexy is a minimally invasive surgery that involves injection of an
intravitreal gas bubble to tamponade the causative retinal tear(s) and cryotherapy or laser
photocoagulation to create a permanent chorioretinal adhesion.
Endothelial cells pumping function is essential to keep the cornea in a relatively
dehydrated state that allows optical clarity. Corneal endothelial damage has been associated
with almost all types of intraocular surgery. Cell loss due to vitrectomy in phakic eyes
varies between 0.4 and 2.8%. , , , , During pars plana vitrectomy, all manipulation take
place in the vitreous cavity; a certain distance from the corneal endothelium. Cataract
extraction by phacoemulsification results in greater endothelial cell loss (4-18%), because
of the greater proximity to the corneal endothelium during manipulation and direct damage
from the use of ultrasound. To our knowledge, corneal endothelial cell loss after pneumatic
retinopexy has never been studied. Corneal endothelium can be damaged during pneumatic
retinopexy because an anterior paracentesis is performed before the gas injection. A 5/8-in
25-gauge needle is used to withdraw 0.3 to 0.35 ml of aqueous fluid form the anterior
chamber. The procedure is invariably accompanied by a certain degree of shallowing of the
anterior chamber. We postulate that endothelial cell damage can result from the direct
contact of the needle tip with the corneal endothelium during wound creation and by
inadvertent contact during shallowing of the anterior chamber.
A standard method of endothelial cell analysis used worldwide is specular microscopy.
Specular microscopy is a non-invasive technique to access the structure and function of the
corneal endothelium by permitting visualization of the corneal endothelial mosaic. From the
areas of the cornea measured with specular microscopy, an estimate of endothelial cell
density can be made.
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Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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