Abstract
Purpose: :
To assess anatomic and functional outcomes in eyes that underwent diabetic tractional retinal detachment (TRD) repair with silicone oil tamponade (SOT).
Methods: :
Retrospective chart review of all diabetics who underwent pars plana vitrectomy (PPV) between 2000 and 2006 for TRD or combined rhegmatogenous TRD (TRRD). Only eyes with SOT were included. Variables assessed were: age, gender, diabetes type, hyperlipidemia, hypertension, pre-op visual acuity (VA), macular involvement, anatomical retinal status, vitreous hemorrhage (VH), and post-op retinal status.
Results: :
We identified 30 eyes that underwent retina surgery for TRD or TRRD with SO with at least 6 month follow-up. Mean follow-up was 14 months, ranging from 6-41 months. There were 15 males, 15 females. Average age was 50 years. Nine patients (eyes) had Type I Diabetes. Nine eyes had a TRRD. Macula-involving RD was found in 27 eyes. Fifteen eyes were also found to have VH. Pre-op VA was 20/400 or better in 10 eyes, count fingers (CF) in 9 eyes, hand motion (HM) or light perception (LP) in 11 eyes. Average pre-op VA logmar was 1.73 SD 0.68. Final VA at 4-6 months was 20/400 or better in 9 eyes, CF in 9 eyes, HM/LP in 10 eyes and NLP in 2 eyes. Average post-op VA in logmar was 1.94 SD 0.76. There was no significant change in VA compared to baseline (p > 0.05). Of all the variables assessed, only pre-op VA was a significant predictive factor for final VA of 20/400 or better (p<0.002).Anatomic success (total retinal attachment) was achieved in 28 eyes with one surgery. Two eyes required additional surgeries to attach the retina: one with recurrent TRD and another with RRD. Post-operative complications included: VH (16%), worsening cataract requiring extraction (7%), and ocular hypertension (20%). No eyes were noted to have corneal decompensation, band keratopathy, or corneal edema. No oil was noted in the anterior chamber of any eye. Seven eyes underwent cataract removal at the time of PPV; 4 were left aphakic. Average intraocular pressure (IOP) at post-operative day 1 was 24 +/- 9 mmHg; post- operative day 2 was 17 +/- 8 mm Hg. One patient had IOP of 54 post-op day 1 requiring anterior chamber paracentesis, pressuring lowering eyedrops, and diamox tabs; IOP on day 2 was 18 mmHg and was maintained within normal limits with medications. Five patients underwent surgical removal of SO within 1-6 months.
Conclusions: :
A high anatomic success rate of 94% with one surgery was noted in this series of eyes that underwent oil tamponade for diabetic TRD repair. The complication rate with silicone oil tamponade was low. Pre-operative VA was the sole significant factor in predicting final VA of 20/400 or better.
Keywords: diabetic retinopathy • retinal detachment