Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

Abstract

AIM: To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil (SO) endotamponade for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR). METHODS: This is a retrospective, interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade. Eyes with a minimum follow-up of 6mo after SO extraction were included. Eyes were classified into three PVR subgroups according to severity and extension of proliferation. The influence of several preoperative, intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis. RESULTS: A hundred and one eyes of 101 patients that met the inclusion criteria were studied. Seventy-five of 101 eyes (74.3%) had successful retinal reattachment after one operation. Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment, recurrent membrane proliferation and keratopathy. Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values, primary vitrectomy and PVR outside of the posterior pole. CONCLUSION: Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR, an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications. Primary vitrectomy, PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.

Nomogram for predicting non-proliferative vitreoretinopathy probability after vitrectomy in eyes with rhegmatogenous retinal detachment

“…In 2005, Pastor et al [10] devised a statistical model specifically for patients with RD repair surgery to assess the probability of PVR. Although the sensitivity and specificity of this model were higher than those of previous studies [9,11] , the optimal values were still only 78.0% and 75.6%, respectively. Later, Wickham et al [12] developed a simplified formula to predict the risk for PVR in patients with primary RD after vitrectomy using preoperative clinical data.…”

“…In addition, the majority of postoperative PVR were grade B (94.0%), which was less serious and did not affect the final surgical success rate. Previous studies reported different results on whether tamponade (SO or gas) was a risk factor for PVR [11,19,[23][24] . In the present study, the type of tamponade (SO or C 3 F 8 ) was not associated with postoperative PVR.…”

“…However, the results of these studies were frequently inconsistent and contradictory. Some researchers have used these risk factors to devise formulas to predict the risk for PVR development [9][10][11][12] . Nevertheless, these formulas are complex, have low sensitivity and specificity, and external validation showed that they are not reliable for clinical application [13] .…”

Silicone oil as a corneal lubricant to reduce corneal edema and improve visualization during vitrectomy

“…I n addition to retinal-related complications [1][2][3][4][5] vitreoretinal surgery can also cause corneal complications [6] , including persistent corneal epithelial defects [7][8][9] , diabetic keratopathy [10][11][12][13] , etc., which are caused by prolonged duration of surgery and intraoperative epithelial debridement. It is well known that corneal edema often occurs during vitreoretinal surgery.…”

“…This procedure may result in postoperatively ocular discomfort, increased incidence of persistent corneal defect or haze formation, particularly in diabetic patients [11,13] . Recently, with the popular use of a noncontact wide-angle viewing system, various viscoelastic corneal lubricants or antidrying contact lenses were developed to avoid drying [4,[15][16][17][18][19][20][21][22][23] . However, they seem powerless to prevent occurrence of corneal edema.…”