Impact of Vitreal Tamponade on Functional Outcomes in Vitrectomy with ILM Peeling in Primary Macula-Involving Retinal Detachment: A Retrospective Analysis

Abstract

Background To compare visual outcomes of vitrectomy with internal limiting membrane (ILM) peeling and failed SF 6 gas tamponade requiring silicone oil (SO) in a second procedure with primary SO tamponade in fovea-involving retinal detachment (FiRD). Methods Retrospective analysis of 82 eyes with retinal detachment and mild, but without advanced proliferative retinopathy (PVR ≥C2) requiring vitrectomy for FiRD. Group 1 comprised 23 eyes that underwent SF 6 tamponade resulting in re-detachment requiring revision surgery with secondary SO tamponade. Based on the intraoperative findings, group 2 patients had primarily received SO as vitreal tamponade (n=59). Patients receiving a scleral buckle surgery or with advanced PVR as well as patients with underlying vascular diseases and uveitis were excluded. Results Preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 13.5 ± 19.1 in group 1 and 14.0 ± 18.3 in group 2 ( p =0.44). Twelve months after first surgery for FiRD, visual acuity was 49.8 ± 19.8 in group 1 and 51.7 ± 18.7 letters in group 2 ( p= 0.63). Re-detachment after SO removal requiring revision surgery developed in 17.4 (n=4) and 15.3% (n=9) cases. Conclusion Our findings suggest that if retinal traction is completely relieved at the end of surgery, vitrectomy with ILM peeling and SF 6 may, if successful, improve the functional outcomes in instances with visual potential, ie, a foveal detachment of short duration despite the presence of a mild to moderate PVR, but with the inherent increased risk of re-detachment requiring further intervention and the use of a SO tamponade. Hence, secondary SO installation during re-vitrectomy after failed primary reattachment surgery results in similar functional outcomes as primary oil filling.

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy

“…Used as internal tamponade, gas injection was proved to have a better visual outcome. Deiss et al reported better functional outcomes with gas tamponade compared to silicon oil [ 13 ]. Most patients in this study had cataracts, which were due to diabetes and increased age.…”

Correlation of macular optical coherence tomography pattern and visual recovery after vitrectomy with silicone oil for retinal detachment

“…SO offers superior structural reinforcement to preserve retinal attachment owing to its elevated viscosity. Nevertheless, the utilization of this substance has been linked to many side effects, such as cataract development [11] , elevation of intraocular pressure (IOP) [12] , emulsification of oil leading to secondary glaucoma [13] , migration of oil underneath the retina [14] and the development of band keratopathy [15] . Regarding, OCT findings at 3 months after surgery the current study revealed that, OCT findings after 3months from SO injection in group I (RRD) there was 12 patients with normal OCT findings and 6 patients with macular scar, 6 patients with macular degeneration and 6 patients with CME, ERM, and NSD.…”