June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Important issues to reduce the retinal redetachment rate after vitrectomy with temporary silicone oil tamponade
Author Affiliations & Notes
  • Svenja Deuchler
    Vitreo Retinal Unit, Univ Eye Clinic Frankfurt/M - Germany, Frankfurt/main, HE, Germany
  • Pankaj Singh
    Vitreo Retinal Unit, Univ Eye Clinic Frankfurt/M - Germany, Frankfurt/main, HE, Germany
  • Michael Mueller
    Vitreo Retinal Unit, Univ Eye Clinic Frankfurt/M - Germany, Frankfurt/main, HE, Germany
  • Thomas Kohnen
    Ophthalmology, Goethe University Frankfurt, Frankfurt, HE, Germany
  • Clemens Wagner
    VG magic Gmbh, Mannheim, BW, Germany
  • Markus Schill
    VG magic Gmbh, Mannheim, BW, Germany
  • hanns Ackermann
    Institute of Biostatistics and Mathematical Modelling, University Hospital, Frankfurt, HE, Germany
  • Joerg Iwanczuk
    Oculus Optikgeräte GmbH, Wetzlar, HE, Germany
  • Frank H J Koch
    Vitreo Retinal Unit, Univ Eye Clinic Frankfurt/M - Germany, Frankfurt/main, HE, Germany
  • Footnotes
    Commercial Relationships   Svenja Deuchler, None; Pankaj Singh, None; Michael Mueller, None; Thomas Kohnen, None; Clemens Wagner, VRmagic (E); Markus Schill, VRmagic (E); hanns Ackermann, None; Joerg Iwanczuk, Oculus Optikgeraete GmbH (E); Frank Koch, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2813. doi:
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    • Get Citation

      Svenja Deuchler, Pankaj Singh, Michael Mueller, Thomas Kohnen, Clemens Wagner, Markus Schill, hanns Ackermann, Joerg Iwanczuk, Frank H J Koch; Important issues to reduce the retinal redetachment rate after vitrectomy with temporary silicone oil tamponade. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2813.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To optimize management of retinal detachments with silicone oil (SO) focussing on factors as the type of oil, number of entry sites, timing of lens surgery, documentation details and the value of virtual reality training.

Methods : Utilizing a retrospective analysis (n=101) we found a 35.6% redetachment rate. Consequently, we designed a prospective study. After receiving IRB approval, 113 patients were included and followed up for at least 12 months. We created a standard operation procedure (SOP), an extensive evaluation protocol (EVALP) and several modules for the virtual reality training (VRT) device Eyesi® to measure the training and warming up effect of the simulator. Scheimflug photography measurements were taken to find out the effect of the pars plana vitrectomy with temporary SO tamponade onto the lens as well as a lab analysis to detect type and degree of SO emulsification.

Results : The retinal redetachment rate dropped from 35.6% down to 6.8 % (p=0.0022). Significant aspects for achieving this reduced redetachment rate are the extensiveness of removed vitreous, criteria for membrane peeling, timing of laser coagulation, size of retinectomies, use of heavy liquids, frequency of f/u after SO removal, consistency of surgeon/eye etc.. We found the simulator performance to be linked (p=0.0003) to the performance in the operating room. A surgical warm up with Eyesi® was prooven to be of help (p=0.0302) for the performance in the patient's eye. Scheimflug photography showed a transparency loss of the lens segments all over (p<0.05). Lens opacifications predominantly affected the anterior lens segment and the nucleus especially in middle aged patients‘ eyes. We found the need to perform repeated fluid-air-exchanges in order to guarrantee sufficient oil removal. No significant relation was found between emulsification and type of SO chosen (p=0.677). However, we found the quality of former surgery in the anterior and/or posterior eye segment as well as the vitreous medium in which laser was applied to be meaningful for the development of oil emulsification.

Conclusions : SOPs and EVALPs as well as VRT significantly helped to approach the goal of achieving maximal stability of a formerly detached retina with optimized visual acuity levels as well as quality of vision and significant increase of the final succes rate in retinal reattachment surgery.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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