Prevention and control of proliferative vitreoretinopathy: primary retinal detachment surgery using silicone oil as a planned two-stage procedure in high-risk cases

Abstract

Aims For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure. Methods We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date. Results Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR. Discussion A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.

Heavy tamponade 1: a review of indications, use, and complications

“…PVR remains the major complication associated with RRD surgery and the main reason for unsatisfactory anatomical and functional outcomes. Despite some progress seems to have been achieved regarding PVR rates over the past decades, 36 there are also reports demonstrating no major differences in its incidence in a tertiary centre between 1988 and 2003. 37 Medical adjunctive therapy so far has not found widespread acceptance, although two studies have shown beneficial effects of intravitreal application of daunorubicin 38 or a combination of 5-fluorouracil and low molecular weight heparin.…”

“…Very good results have also recently been published with conventional silicone oil as a primary tamponade as well as a different method that uses only an air tamponade or avoids internal tamponades completely. 36,62 Currently, a multi-centre randomised trial is on its way comparing heavy silicone oil with conventional silicone oil in complicated RRD surgery. 54 It is to be hoped that the results of this trial will enable us to better define the current role of the next generation of heavy tamponades.…”

Scleral buckling—a brief historical overview and current indications

“…Scleral buckling can also play an important adjunctive role to PPV in the management of more complex RRD associated with multiple or large retinal breaks, proliferative vitreoretinopathy (PVR), schisis and patients in whom postoperative posturing with PPV alone may be problematic [84].…”

Retinal pigment epithelium transplantation: concepts, challenges, and future prospects

“…82 Although some authors report the use of pharmacological agents to prevent PVR development, none of these is used in routine clinical practice. The use of silicone oil as an intraocular tamponade has been well described in the prevention and control of PVR, 83 although a recent Cochrane review could find no major difference between silicone oil and C 3 F 8 gas tamponade. 84 …”