Figure 12.1 Gas injection is performed at the highest point of the eye with the patient lying on his or her side.

If the breaks could not be treated before gas injection because of a bullous detachment, retinopexy can be performed 1 or 2 days after the gas injection when the subretinal fluid has pumped out. The laser indirect ophthalmoscope is preferred to the 3-mirror contact for postreattachment retinopexy (Fig. 12.3). If there are concerns about the ability to visualize the breaks after reattachment, preattachment retinopexy with transscleral cryopexy can be utilized.

IN-OFFICE FLUID-GAS EXCHANGE

Postvitrectomy retinal detachment without traction or PVR or hemorrhage patients can be managed by in-office fluid-gas exchange using isoexpansive concentrations of C₃F₈ (16%) or SF₆ (25%) (Fig. 12.4). The injection needle is positioned 3 to 4 mm posterior to the limbus at the highest part of the eye as in pneumatic retinopexy. The needle is advanced only 3 mm into the eye to avoid multiple bubbles. This 32-gauge needle is connected via a short piece of tubing to a 30- to 60-mL air- or gas-filled syringe operated by the assistant. A second 25- to 30-gauge needle, depending on the viscosity of the intraocular fluid, is positioned 4 mm posterior to the limbus, at the lowest portion of the eye. This needle is connected to a tuberculin syringe, with the plunger removed, to act as a handle. The open end of this needle is positioned over a waste can to collect the fluid. The exchange is continued until gas appears in the egress needle. The egress needle is withdrawn and the intraocular pressure adjusted using the gas syringe and tactile assessment of the IOP with a sterile applicator stick.

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