Abstract
Purpose: :
To improve vitreoretinal service by introducing strategies to counteract potentially upcoming complications as retinal redetachments after silicone oil removal.
Methods: :
Based on the pathbreaking work of Herbert and Williamson1 we started to follow up retinal detachments settled with a silicone oil fill retrospectively (n = 119, silicone oil removal in 2008/2009).The indications for surgical intervention in our group included a rhegmatogenous retinal detachment (RRD) in 68% and a proliferative diabetic vitreoretinopathy (PDVR) in 32%.
Results: :
Besides criteria already published (preoperative visual acuity, axial lengths, activity of proliferative vitreoretinopathy (PVR), previous unsuccessful retinal detachment surgeries, lasercoagulation before silicone oil removal) 2-4 contributing to the outcome of surgery, we detected the poor quality of pre-, intra- and postoperative documentation to be a major hurdle for the decision, timing and selection of procedures to remove the silicone oil (n = 99, 83%). Several infrequently recorded (1,7% - 95 %) criteria had a significant impact onto the timing of silicone oil removal and the decision to add laser and/or membrane peeling before or during silicon oil removal: the history of retinal detachment, the duration and control of diabetes mellitus, the thickness of the detached retina and the intraoperative quality of laser response a well as the involvement of the macula documented with drawings, fundus photography or OCT. Furthermore, there is a better surgical outcome if primary and secondary service are in the hands of the same surgeon.
Conclusions: :
Retinal redetachments after silicone oil removal are not fateful. In particular, improved documentation assists to set up a better primary retinal detachment service and more properly performed silicone oil removal interventions: this is of medicoethical interest in the first place and also economically important since a silicone oil removal procedure vs. a revision surgery come along with substantially different efforts (time, equipment ) and costs for the health care provider.References 1. Herbert and Williamson. Eye 21: 925-929 (2007). 2. Jonas JB et al. Br. J. Ophthalmol 85: 1203 - 7 (2001). 3. Lam RF et al. Am J Ophthalmol. 145: 527 - 533 (2008). 4. Pavlovic S et al. Opthalmologe 92: 672 -6 (1995)
Keywords: vitreoretinal surgery • retinal detachment • vitreous substitutes