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AA Castellarin, R Grigorian, N Bhagat, L Del Priore, C Seery, M Zarbin; Vitrectomy and Silicone Oil Infusion in Severe Diabetic Retinopathy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3514.
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Purpose: To determine the results of pars plana vitrectomy (PPV) and silicone oil infusion (SOI) in severe proliferative diabetic retinopathy (PDR). Methods: The records of 22 eyes (18 patients) with PDR who had undergone PPV and SOI were reviewed retrospectively. Average follow-up was 5.2 mos. In 10 eyes (46%), SOI was part of the initial operation; in 12 eyes (54%), SOI was performed after previous failed PPV. A complexity score (range: 1 - 7) was defined to grade the complexity of membrane dissection. Results: Demographics were: 10 males (56%) and 8 females (44%); 7 Hispanics (39%); 11 (61%) African Americans. Surgical indications were: tractional retinal detachment (TRD) (6 eyes, 27%), tractional-rhegmatogenous retinal detachment (2 eyes, 9%), TRD with vitreous hemorrhage (VH) (9 eyes, 41%), TRD with VH and neovascular glaucoma (NVG) (1 eye, 4.5%), TRD with NVG (1 eye, 4.5%), and TRD with fibrinoid syndrome (3 eyes, 14%). Eight of 14 phakic eyes underwent lensectomy (5 were left aphakic). Postoperative visual acuity (VA) improved in 9 eyes (41%), was unchanged in 3 (14%), and decreased in 10 eyes (45%). At last follow-up, the retina was flat in 15 eyes (68%). Of these, 7 eyes (47%) underwent only one operation, 6 eyes (40%) had 2, and 2 (13%) had a total of 3 operations. In the 10 eyes that were operated for the first time with primary SOI, the retina was attached in 7 (70%). In the 12 eyes that underwent SOI after previously failed PPV, the retina was attached in 8 (67%). Average complexity score of the two groups was 4.5. Case complexity did not correlate with anatomic success but was significantly greater than cases in which silicone oil was not deemed necessary (complexity 3.5, p<0.0058). Posterior segment fibrovascular proliferation was the most important cause of anatomic failure. Rubeosis iridis (RI) was present preoperatively in 4 eyes, 2 of which had NVG. Postoperatively, 3 of 4 eyes had regressed RI. No eye had postoperative NVG. One eye developed RI postoperatively. Postoperative complications included keratopathy (2 eyes), SO in the anterior chamber (1 eye), cataract (1 eye), and fibrinoid reaction with pupillary membrane formation (2 eyes). SO was removed in 2 eyes (9%), at 5 months and 8 months respectively, without complication. Conclusion: SO tamponade is a useful option in severely diseased eyes with PDR, even in the presence of RI and NVG or the fibrinoid syndrome. Retinal attachment was achieved in 70% of cases. The majority of patients had stable or improved VA. The use of SO in severely diseased eyes with PDR may be of benefit, especially in the presence of RI.
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