Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): A novel surgical technique for closing retinal breaks

Abstract

Purpose: This study describes a novel surgical technique of fibrin glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD) without oil or gas tamponade after pars plana vitrectomy (PPV).

Methods: This pilot clinical trial included five eyes of five patients with rhegmatogenous retinal detachments (RD). A complete PPV was done in all cases followed by fluid-air exchange, laser photocoagulation around the break/s, and application of 0.1-0.2 mL of fibrin glue. No air, long-acting gas or silicone oil was used subsequently. No specific postoperative positioning was prescribed. The primary outcome measure was efficacy of the procedure defined as successful anatomical retinal reattachment. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) and complications.

Results: The median age of patients was 55 (range: 36-61 years) years and median duration of symptoms was 15 (range: 7-60) days. All eyes were pseudophakic, four eyes had inferior and one eye had total RD. Successful retinal reattachment was achieved in all (100%) cases and was maintained at the end of 3-8 months of follow-up. The median BCVA improved from 20/100 preoperatively to 20/80 at 1-week and 20/50 at 1-month postoperatively. None of the eyes had any postoperative complications such as elevated intraocular pressures or unexpected inflammation.

Conclusion: The findings of this study suggest that GuARD is a promising technique for treatment of rhegmatogenous RD that may allow early visual recovery while avoiding the problems of gas or oil tamponade and obviating the need of postoperative positioning.

Keywords: Fibrin glue; retinal detachment surgery; rhegmatogenous retinal detachment.

Figure 1

Schematic representation of the surgical technique of glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD). (a) Representative depiction of inferior retinal detachment with inferior break. (b) After pars-plana vitrectomy and fluid–air exchange the subretinal fluid is drained internally using a flute needle; the retina is settled, and the break is subsequently lasered. (c) In an air-filled eye, 0.1–0.2 mL of fibrin glue is injected and applied over the break. (d) Subsequently at the end of the surgery, air is replaced by balanced salt solution and the retina is left attached with a clot of fibrin covering the break

Figure 2

Early clinical course of glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD). (a) Fundus photograph of the left eye of a 36-year-old male patient with inferior retinal detachment. (b) Same eye on first postoperative day with attached retina and fibrin clot covering the inferior retinal breaks (white bold arrow); (c) At 1-week, the inferior fibrin clot over the breaks is still visible but has decreased in size; (d) At 2-weeks the fibrin clot has completely disappeared and the lasered inferior breaks are now visible (white asterisks). The visual acuity improved from 20/100, preoperatively to 20/80 at 6 months

Figure 3

Long-term clinical course of glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD). (a) Fundus photograph of the right eye of a 61-year-old male patient with total retinal detachment with inferior horse-shoe tear (bold white arrow) and two additional retinal breaks temporally. Fibrin glue was used for tamponading all the breaks (b) Same eye at 1-month postoperative visit with attached retina and lasered inferior (white bold arrow) and temporal retinal breaks (white asterisk); (c) At 3-months and 6-months (d) postoperatively, the retina remained attached and the visual acuity improved from 20/100 to 20/30 at 6-months