Purchase this article with an account.
Dirk Sandner, Egbert Matthe, Lutz E. Pillunat; Outcomes Of Vitrectomy With Large Relaxing Retinotomy In Patients With Retinal Detachment Complicated By Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6147.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report the functional and anatomical outcomes and incidence of postoperative complications of patients treated with vitrectomy and large relaxing retinotomy in repair of complex retinal detachment (RD) attributable to severe posterior and anterior proliferative vitreoretinopathy (PVR).
Retrospective, consecutive, noncomparative, interventional case series.The records of twenty-four patients (mean age: 63.3 years; 27 to 85 years) who underwent peripheral relaxing retinotomy (mean size: 180 degrees) during RD repair were reviewed. All eyes received silicone oil (Oxane 5700) as long-acting postoperative tamponade (mean duration of endotamponade: 6.2 ± 3.4 months). A minimum follow up of 12 months after silicone oil removal was required. The primary end point was reattached retina without endotamponade. Secondary outcomes included change in visual acuity, the mean number of re-surgeries required for anatomic success and the number of postoperative adverse effects.
Final anatomic success with complete retinal reattachment without endotamponade was achieved in 22 of 24 patients (91.7%), with a mean follow up of 27.4 months (range: 13-36 months). Two eyes (8.3%) developed retinal re-detachment after silicone removal. After the initial retinotomy in 9 of the 24 eyes (37.5%) additional surgery (mean: 0.58±0.77; excluded silicone oil removal) was required, due to recurrent circumscribed re-detachment with silicone oil in situ. The visual acuity increased from mean logMAR 1.75 ± 1.15 to 0.81 ± 0.34 (p< 0.0001; 95% confidence interval, 0.469 to 1.410), representing a gain of 3.96-lines. Twenty eyes (83.3%) achieved a final visual acuity of 20/200 or better, eleven eyes (46.0%) had visual acuity of 20/100 or better and tree eyes (12.6%) achieved visual acuity of 20/40 or better. Most frequent side effect was temporary IOP-elevation with silicone oil in situ in 17 of 24 (70.8%) eyes. Four eyes (16.7%) required permanent topical antiglaucoma therapy (mean number of medication 1.5). One eye (4.2%) underwent Ahmed valve implantation due to refractory glaucoma. No eye developed hypotony after silicone removal.
Large relaxing retinotomy with silicone oil endotamponade in selected cases of vitreoretinal surgery for severe PVR retinal detachment seems to be an effective procedure. Despite the need of re-surgery in one-third of eyes due to recurrent circumscribed retinal re-detachment the visual outcomes and the final anatomic success are encouraging. Postoperative chronic hypotony was not seen in this case series.
This PDF is available to Subscribers Only