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Krishnapriya kalyam, Parisa Emani, Dipal Shah, Kavya Gorukanti, Marco A. Zarbin, Neelakshi Bhagat; Use of Silicone Oil for Complex Retinal Detachment in Pediatric Population. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5813.
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To assess characteristics, complications, anatomical and functional outcomes of pediatric eyes with silicone oil (SO) tamponade for complex retinal detachment repair (RDR).
Retrospective chart review of all pediatric patients who underwent pars plana vitrectomy (PPV) and SO tamponade for RDR by two surgeons between 2000 and 2010. Variables assessed were: age, gender, macular involvement, anatomic status, adverse effects of intraocular SO, recurrent RD, and type of SO used.
66 pediatric eyes were identified with at least 6 months follow-up. Mean follow-up was 46 months. There were 52 males, 14 females. Average age was 8.74 years SD=5.35. Median age was 9 years (range: 0-18 years). Etiology of RD included trauma (22 eyes), retinopathy of prematurity (11 eyes), proliferative vitreous retinopathy (11 eyes), giant retinal tear (6 eyes), rhegamatogenous RD (6 eyes), vitreous hemmorhage (4 eyes), tractional retinal detachment (3 eyes), and macular hole (3 eyes). 4 eyes had 1000-cs SO placed in their eyes and 62 eyes had 5000-cs density oil. SO was removed only in 21 of 66 eyes (32%) at a mean duration of 9.8 months SD=9.04. Mean follow-up duration of 45 eyes with no oil removal was 54 months. Mean follow-up duration of 21 eyes with SO removal was 42 months. Complications noted for the duration of follow up with SO in the eyes included emulsification (8 eyes, 12%), corneal opacification (5 eyes, 8%) epiretinal membrane (ERM) (14 eyes, 21%), band keratopathy (6 eyes, 11%), retinal folds (4 eyes), oil migration (4 eyes), corneal stromal haze (2 eyes) and bullous keratopathy (1 eye). 1 out of 4 eyes (25%) of patients with 1000-cs SO placed developed emulsification, in contrast to 7 out of 55 eyes (13%) of patients with 5000-cs SO (chi2:p=0.4). The patients were categorized into two groups by age (0-9 years: group A, 10-18 years: group B). The two groups did not differ with respect to preoperative visual acuity(Va), post-operative Va at 1 and 6 months. Retinal attachment was noted in 40 eyes after one surgery with oil tamponade. Recurrent RD was seen in 26 of 66 (40%) eyes overall. 9 out of 21 eyes (46%) that had SO removed had recurrent RD while 14 out of 44 eyes (23%) with no SO removal had recurrent RD (p=0.051, OR= 2.86). Retina was attached subsequently in all these eyes with further surgery.
Retinal reattachment was achieved in the majority (98.5%) of pediatric eyes with PPV and SO tamponade after multiple surgeries. ERM and emulsification of oil were the most common complications from SO use in this population. These complications were greater with use of 1000-cs SO compared to 5000-cs SO. Eyes that had SO removed had higher rates of recurrent RD than those that did not undergo oil removal.
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