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Natalia Vila, Radwan Ajlan, Ali Dirani, Emmanouil Rampakakis, Flavio Rezende; Advantages of endoscopy-assisted vitrectomy for silicone oil removal in complex retinal detachments. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4247.
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To identify intraoperative treatable findings associated with risk of re-detachment during endoscopy-assisted pars plana vitrectomy (E-PPV) for silicone oil removal, and compare postoperative stability.
Single-centre retrospective study (Hôpital Maisonneuve-Rosemont, Université de Montréal, Canada). Medical records and surgical OR reports of 55 consecutive eyes were reviewed. Patients who underwent vitrectomy for silicone oil removal after rhegmatogenous retinal detachment between July 2009 and January 2017 were included. Patients with diabetic tractional detachment, history of trauma or uveitis were excluded. After 2013, endoscopic visualization system (E2 MicroProbe ™; EndoOptiks, Little Silver,USA) was used in a non-randomized fashion. Data collection included reattachment rate at final follow up, intraoperative endoscopic findings and phthisis rate. E-PPV group and PPV only group were compared using Chi-square or Fisher’s exact test.
Fifty-five eyes of 55 patients were included. The median participant age was 58.4 SD12.8 year old (range 23 – 78) and 65.5% (n=36) were males. The median follow up post oil removal was 24.3SD20.1 months. E-PPV was performed in 47.3% (n=26) of the patients and in 92.3% (n=24) of the cases it was combined with wide-angle visualization system. The intraoperative surgical management was modified after endoscopy examination in 57.7% (n=15) of the cases. Additional benefits during E-PPV were the following: extension of retinectomy (n=7), anterior hyaloid / vitreous base peeling (n=2), anterior PVR peeling (n=3), dissection ciliary body traction and capsular fibrosis connections (n=1), perisilicone oil proliferation removal (n=1), and overcoming media opacity (n=2). Reattachment at final follow up in E-PPV was 96.2% and 76.0% in PPV only group (p=0.04). No phthisis was observed in the E-PPV group while 10.3% (n =3) occurred in the non-endoscopy group(p = 0.2).
Endoscopy-assisted vitrectomy seems to be advantageous to prevent recurrence achieving better reattachment rates after oil removal. A thorough examination is facilitated by endoscopic visualization and contributory factors for anterior PVR can be identified and treated. Evolution to phthisis is absent when endoscopy is used.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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