Important issues to reduce the retinal redetachment rate after vitrectomy with temporary silicone oil tamponade

Abstract

Purpose : To optimize management of retinal detachments with silicone oil (SO) focussing on factors as the type of oil, number of entry sites, timing of lens surgery, documentation details and the value of virtual reality training.

Methods : Utilizing a retrospective analysis (n=101) we found a 35.6% redetachment rate. Consequently, we designed a prospective study. After receiving IRB approval, 113 patients were included and followed up for at least 12 months. We created a standard operation procedure (SOP), an extensive evaluation protocol (EVALP) and several modules for the virtual reality training (VRT) device Eyesi® to measure the training and warming up effect of the simulator. Scheimflug photography measurements were taken to find out the effect of the pars plana vitrectomy with temporary SO tamponade onto the lens as well as a lab analysis to detect type and degree of SO emulsification.

Results : The retinal redetachment rate dropped from 35.6% down to 6.8 % (p=0.0022). Significant aspects for achieving this reduced redetachment rate are the extensiveness of removed vitreous, criteria for membrane peeling, timing of laser coagulation, size of retinectomies, use of heavy liquids, frequency of f/u after SO removal, consistency of surgeon/eye etc.. We found the simulator performance to be linked (p=0.0003) to the performance in the operating room. A surgical warm up with Eyesi® was prooven to be of help (p=0.0302) for the performance in the patient's eye. Scheimflug photography showed a transparency loss of the lens segments all over (p<0.05). Lens opacifications predominantly affected the anterior lens segment and the nucleus especially in middle aged patients‘ eyes. We found the need to perform repeated fluid-air-exchanges in order to guarrantee sufficient oil removal. No significant relation was found between emulsification and type of SO chosen (p=0.677). However, we found the quality of former surgery in the anterior and/or posterior eye segment as well as the vitreous medium in which laser was applied to be meaningful for the development of oil emulsification.

Conclusions : SOPs and EVALPs as well as VRT significantly helped to approach the goal of achieving maximal stability of a formerly detached retina with optimized visual acuity levels as well as quality of vision and significant increase of the final succes rate in retinal reattachment surgery.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.