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P.H. Scharper, Jr., R. Morris, E. Parma, C. Witherspoon, L. Tehranchi, G. Lewis, Z. Segal; Prophylactic Silicone Oil Placement For Retinal Detachments With Grades A And B Proliferative Vitreoretinopathy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4671.
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Proliferative vitreoretinopathy (PVR) is the most common cause of treatment failure in rhegmatogenous retinal detachments (RRDs). PVR occurs in approximately 10% of uncomplicated RD repairs, and more often in eyes with primary PVR. Typically, silicone oil (SO) or a long–acting gas is used as tamponade in RDs with advanced PVR (grades C or worse, by the updated Retina Society classification). To our knowledge, there have been no reports describing the use of SO as prophylaxis against advanced PVR in patients with RD and early primary PVR (grades A and B).
To examine the effectiveness of 1000–centistoke SO in the prevention of post–operative PVR in the repair of retinal detachments with early primary PVR.
We performed a prospective study of sixteen patients who presented with retinal detachment and grade A or B PVR. A standard vitrectomy (PPV) with laser was performed, and SO was placed. Nineteen matched controls were treated with PPV, laser, and air or gas (AG) tamponade. Encircling bands were placed at the surgeon’s discretion. No patients had cryopexy. The development of advanced post–operative PVR and re–detachment, along with the number of surgeries required to achieve reattachment were compared.
In sixteen cases where SO was placed initially, only one (6%) patient developed PVR and a re–detachment. This re–detachment occurred inferiorly, and did not involve the macula. In the AG group, eight (42%) patients developed PVR and a re–detachment. These patients required an additional 2.9 surgeries on average to achieve complete retinal re–attachment. The use of SO prophylactically significantly lowered post–operative PVR and re–detachment (P = 0.02).
Treatment of advanced PVR is difficult, costly, and minimally productive, in that the eye in most cases remains legally blind. We have shown that SO is effective prophylaxis against the progression of early PVR, likely by limiting the seeding of the retinal surface it contacts and by imprisoning actively proliferating cells. We suggest that retinal surgeons should consider using SO to prevent the formation of advanced PVR and redetachment in those RRD patients who present with early PVR. This first report of the prophylactic use of silicone oil is the beginning of an ongoing study of both silicone oil and intravitreal triamcinolone to prevent advanced PVR in high risk eyes.
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