Improved Retinal Re-attachment Rate In Complicated Retinal Detachments: What Parameters Have To Be Recalled Before Removing Silicone Oil From The Vitreous Cavity?

Abstract

Purpose: : To introduce clinical pathways to reduce the retinal re-detachment rate after performing pars plana vitrectomy with silicone oil (SO) installation.

Methods: : According to data in literature1-4 and our own retrospectively evaluated data, we designed an electronic evaluation list which incorporates pre-, intra- and postoperative criteria being essential for the management of complicated retinal detachments. Prospectively we currently follow up 69 patients with the aim to lower the re-detachment rate from 34 % (retrospectively) to less than 17%. We examine with an electronic visual acuity test, a contrast viewing and an autofluorescence test as well as with spectral domain optical coherence tomography. SO removal with or without revision is performed 4 months after primary service. Since retrospective data showed us 71% of retinal re-detachments developing early (in the first month) after SO removal, we set up our first follow-up 1 month post SO removal. A final examination is performed 4 months after SO removal.

Results: : By means of the evaluation list we decide whether the SO can be safely removed without further intervention or after revising surgical steps: If retinal thickness did not allow to sufficiently laser the retina, revision surgery focuses on adding more laser; if membrane peeling couldn’t be completed or regrowth of membranes happened postoperatively, revision surgery allows us to re-peel. This peeling particularly in the macula improves visual acuity and quality of vision. If lens transparency loss is clinically significant, we combine the vitrectomy procedure with cataract surgery. Fluid air exchange during revision surgery assists cleaning up the eye from residual oil bubbles. Currently we observe a need for revision surgery in about 85% and a final rate of SO being removed in over 94% as well as a reduction of early retinal re-detachments after SO removal.

Conclusions: : Based on the concept of our evaluation list, pathways are developed which enable to safely decide about SO removal with or without revision surgery ending up with a lower complication rate. We have to be aware that this might come along with increased efforts and costs in the first place. However - in the long run - a reduction of the re-operation rate will compensate for that.References 1. Lucke KH et al. Am J Ophthalmol.104: 624-33 (1987) 2. Hoerauf H et al. Ophthalmol. 92: 657-662 (1995) 3. Lam RF et al. Am J Ophthalmol. 145: 527-533 (2008). 4. Heimann H and Bopp S Ophthalmol. 226 Suppl: 18-26 (2011)

Keywords: vitreoretinal surgery • retinal detachment • proliferative vitreoretinopathy