Abstract
Purpose: :
The purpose of this study was to determine if combined 5–fluorouracil (5–FU) and low–molecular–weight heparin (LMWH) could improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment (CRD) with proliferative vitreoretinopathy (PVR) grade C.
Methods: :
Interventional prospective controlled non–randomized study. Sixty–four patients (eyes) participated. We consecutively assigned 33 patients (eyes) with CRD and PVR to vitrectomy with silicone oil, and peroperative infusion of 5–FU and LMWH (study group). We included a historical matched control group of 31 patients (eyes) who underwent vitrectomy with silicone oil without adjunctive medication (control group). Main outcome measures were anatomic success 6 months after the primary operation. Secondary outcome measures were number of vitreoretinal reoperations, and change in best–corrected visual acuity (BCVA).
Results: :
Of the 64 patients (eyes) with complicated retinal detachment and PVR, all eyes had a reattached retina after vitrectomy with silicone oil with and without peroperative infusion of 5–FU and LMWH. In the study group, 24 eyes (72.7%) had the retina attached, and 9 had a retinal redetachment (27.3%) at 6–moths. In the control group, 25 eyes (80.6%) had the retina attached, and 6 (19.4%) had a retinal redetachmnet (x2: 0.53, P > 0.05). One–year postoperative data was available for 17 eyes in the study group, and for 19 eyes in the control group; four patients in each group (23.5% and 21%) developed retinal redetachment respectively (x2: 0.03, P > 0.05). After additional procedures, 3 eyes remained with retinal detachment in the study group, and 5 eyes in the control group (x2: 1, P > 0.05). The difference in BCVA between both groups was not statistical significant.
Conclusions: :
Although our study failed to reach statistical significance, there was a trend in final retinal reattachment rate in favor of the study group after a second vitreoretinal procedure when there was a failed primary surgery during follow–up. This observation supports the concept that combined adjunctive treatment with 5–FU and LMWH may be effective in reducing new proliferation, and enhances the possibility to reattach the retina if a second procedure is necessary after a primarily failed vitreoretinal surgery for CRD with PVR grade C.
Keywords: retinal detachment • proliferative vitreoretinopathy • differentiation