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C. A. Amstutz, E. P. Messmer; Silicone Oil Tamponade for the Prevention of Posterior Arcuate Retinal Folds Following Pars Plana Vitrectomy for Superior Bullous Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5236.
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With respect to postoperative visual acuity, the occurrence of posterior, so-called ‘arcuate’ retinal folds following retinal detachment surgery represents a potentially devastating complication. In almost all reported patients with arcuate folds, the retinal detachment was acute, superior and bullous, and gas injection was performed at the end of either a scleral buckling procedure or a primary pars plana vitrectomy. It has been proposed that the mechanism leading to arcuate folds is similar to the slippage phenomenon observed in the treatment of giant retinal tears and macula translocation surgery. It is hypothesized that, similar to slippage in giant retinal tear surgery, postoperative arcuate folds can be avoided by the use of silicone oil instead of intraocular gases.
Retrospective analysis of 48 consecutive patients with superior bullous retinal detachment, treated with standard two or three port vitrectomy. For the intraocular tamponade, silicone oil was applied in 21 patients, and gas was applied in 27 patients. Patients receiving intraocular gas postoperatively were positioned in a manner to minimize posterior dislocation of residual subretinal fluid. All patients had a follow-up of at least six months, and were evaluated for redetachment of the retina, the presence of retinal folds, best-corrected visual acuity, and metamorphopsias.
In only one patient of the gas group a retinal redetachment occurred (primary reattachment rate 96%). A macula-on retinal detachment was present in 11 patients (48%) of the silicone oil group and in 12 patients (44%) of the gas group. Posterior arcuate retinal folds were not observed in any patient (0%) of the silicone oil group, but did occur in three patients (12.5%) of the gas group. For the patients with macula-on retinal detachment, the mean best-corrected visual acuity was 0.8 before and 0.9 after the surgical intervention for both groups. For the patients with macula-off retinal detachment, the mean best-corrected visual acuity was 0.1 before and 0.5 after surgery for the silicone oil group, and 0.2 before and 0.6 after surgery for the gas group. All three patients in which arcuate folds occurred suffered a decrease in best-corrected visual acuity and had marked metamorphopsias.
The risk of posterior arcuate retinal folds following pars plana vitrectomy for superior bullous retinal detachment, especially those bisecting the macula can likely be reduced using silicone oil instead of gas for intraocular tamponade.
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