Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy

The Wisconsin silicone oil study (report #1): anatomical and functional outcomes of repair of retinal detachment with proliferative vitreoretinopathy

BACKGROUND

Silicone oil (SO) is a long-term tamponade for repair of complex retinal pathology but has limitations including late redetachment. This study describes our experience with SO tamponade for repair of retinal detachment with proliferative vitreoretinopathy (PVR), with attention to anatomic and functional outcomes.

METHODS

Retrospective consecutive case series of eyes with retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) receiving SO tamponade at the University of Wisconsin between 2013 and 2019. Group 1 defined as primary SO placement; Group 2 had SO placed after failing prior retinal detachment repair.

RESULTS

Inclusion criteria of SO placement for repair of RD with PVR was met for 117 eyes. The final reattachment rate was 84% for all eyes, with no difference between Groups 1 and 2. Vision improvement was 2.1 lines for Group 1 (p = 0.06 from baseline) and 4.6 lines for Group 2 (p < 0.0001). The mean number of silicone oil placements was 1.4. Less improvement in vision was noted with repeat SO placement, though overall functional vision of 5/200 or better was achieved in 63.2% of patients.

CONCLUSIONS

SO tamponade allows long-term anatomical stabilisation and substantial vision recovery in eyes with retinal detachment complicated by PVR. Rates of anatomic and functional success have improved significantly when compared to prior studies using oil tamponade for repair of PVR.

Development of cystoid macular edema after uneventful cataract surgery in eyes with a history of vitrectomy using silicone oil versus gas tamponade

BACKGROUND/OBJECTIVES

The purpose of this study is to investigate whether history of silicone oil tamponade may predispose to the development of cystoid macular edema (CMO) following uneventful post-vitrectomy cataract surgery.

SUBJECTS/METHODS

This is a retrospective study that was conducted at a single academic institution. Records of patients who underwent pars plana vitrectomy (PPV) with or without silicone oil tamponade and subsequent cataract surgery between 2017-2020 were reviewed. Macular optical coherence tomography (OCT) findings up to 4 years after surgery were assessed.

RESULTS

A total of 95 eyes were included. Forty-one eyes underwent cataract surgery and had a history of PPV with silicone oil tamponade (Group 1). Fifty-four eyes underwent cataract surgery by phacoemulsification and had a history of PPV with gas tamponade (Group 2). Average follow up time after cataract surgery was 41.1 months. In Group 1, the incidence of OCT-detected CMO was 39.0%, compared to 27.8% in Group 2 (p = 0.247). The incidence of clinically significant CMO in Group 1 was 22.0%, compared to 18.5% in Group 2 (p = 0.679). The duration of CMO was significantly longer in Group 1 (p = 0.041) and cases were less likely to resolve by the last follow up visit (p = 0.040).

CONCLUSIONS

The incidence of OCT-detected or clinically significant pseudophakic CMO is not significantly different between eyes with prior PPV with gas tamponade versus silicone oil tamponade. However, CMO after uneventful cataract surgery may have a prolonged course if there is history of silicone oil tamponade, requiring longer treatment.

Outcomes of short- versus long-acting gas tamponades in vitrectomy for rhegmatogenous retinal detachment

BACKGROUND

In vitrectomy for rhegmatogenous retinal detachment, long-acting gas tamponades (LGT) such as C3F8 or C2F6 may improve surgical success rate due to their prolonged effect compared to a short-acting gas tamponade (SGT) with SF6. On the other hand, SGT allow a significantly faster visual rehabilitation after surgery and may reduce the risk of gas-related complications. As comparative data in retinal detachment surgery is limited, we assessed the outcomes of vitrectomies using either LGT or SGT.

METHODS

We retrospectively analyzed 533 eyes of 524 consecutive patients diagnosed with primary rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy (PVR) and treated by vitrectomy at two clinical sites. Depending on the site the patients presented at, they received either preferentially LGT (study site 1) or SGT (study site 2). Retinal re-detachment rates during a period of 6 months following surgery were analyzed.

RESULTS

At study site 1, 254 of 278 eyes (91.4%) were treated by LGT (C3F8 72.3%; C2F6 19.1%), whereas at study site 2, 246 of 255 eyes (96.5%) received SGT (SF6). Rates of retinal re-detachment in the LGT- and SGT-treated groups were similar with 23 of 254 eyes (9.1%) and 24 of 246 eyes (9.8%), respectively (p = 0.9). Median time to re-detachment was 5.7 weeks in the LGT-treated group and 4.4 weeks in the SGT-treated group (p = 0.4).

CONCLUSION

In rhegmatogenous retinal detachment repair by vitrectomy, the use of SGT results in comparable rates of successful retinal re-attachment as LGT. Given the faster visual rehabilitation with SGT, these results suggest SGT as a sensible alternative to LGT in surgery of retinal detachment without PVR.

Rhegmatogenous Retinal Detachment in Syphilitic Uveitis: A Case Series and Comprehensive Review of the Literature

PURPOSE

Uveitis is the most common ocular manifestation of syphilis. However, an association between syphilitic uveitis and rhegmatogenous retinal detachment (RRD) is not widely recognized. We report a consecutive series of six new cases of syphilitic uveitis complicated by RRD and describe the typical characteristics, clinical course, and surgical management of such cases.

METHODS

Consecutive case series and comprehensive review of the literature.

RESULTS

We identified a total of 19 cases (23 eyes) with syphilitic uveitis subsequently complicated by RRD, including six new cases (seven eyes) reported here and 13 cases (16 eyes) previously reported in the literature. Fifteen patients (79%) were positive for human immunodeficiency virus (HIV) and not on combination antiretroviral therapy. Most retinal detachments developed within two months of uveitis presentation; retinal breaks were often found in areas of previous retinitis. Sixteen eyes (70%) were complicated by early proliferative vitreoretinopathy. Twenty-one eyes underwent surgical repair, of which six (26%) suffered re-detachment. Surgical management commonly involved pars-plana vitrectomy and silicone oil tamponade, with or without scleral buckling. Visual outcomes were generally poor: only six eyes (26%) attained visual acuity of 20/40 or better and 11 eyes (48%) remained 20/200 or worse.

CONCLUSIONS

Patients with syphilitic uveitis, as with viral retinitis, should be monitored closely for the development of retinal tears and RRD. A combination of pars plana vitrectomy with silicone oil tamponade and/or scleral buckle placement is a prudent surgical approach to most cases of syphilitic RRD, although visual prognosis remains guarded.

Early vascular changes after silicone oil removal using optical coherence tomography angiography

BACKGROUND

This study evaluated the vascular changes in the macular and peripapillary regions before and after silicone oil (SO) removal in patients with rhegmatogenous retinal detachment.

METHODS

This single-center case series assessed patients who underwent SO removal at one hospital. Patients who underwent pars plana vitrectomy and perfluoropropane gas tamponade (PPV + C₃F₈) were selected as controls. Superficial vessel density (SVD) and superficial perfusion density (SPD) in the macular and peripapillary regions were assessed by optical coherence tomography angiography (OCTA). Best-corrected visual acuity (BCVA) was assessed using LogMAR.

RESULTS

Fifty eyes were administered SO tamponade, 54 SO tamponade(SOT) contralateral eyes, 29 PPV + C₃F₈ eyes, and 27 PPV + C₃F₈ contralateral eyes were selected. SVD and SPD in the macular region were lower in eyes administered SO tamponade compared with SOT contralateral eyes (P < 0.01). Except for the central area, SVD and SPD in the other areas of the peripapillary region were reduced after SO tamponade without SO removal (P < 0.01). No significant differences were found in SVD and SPD between PPV + C₃F₈ contralateral and PPV + C₃F₈ eyes. After SO removal, macular SVD and SPD showed significant improvements compared with preoperative values, but no improvements in SVD and SPD were observed in the peripapillary region. BCVA (LogMAR) decreased post-operation and was negatively correlated with macular SVD and SPD.

CONCLUSIONS

SVD and SPD are decreased during SO tamponade and increased in the macular region of eyes that underwent SO removal, suggesting a possible mechanism for reduced visual acuity during or after SO tamponade.

TRIAL REGISTRATION

Registration date: 22/05/2019; Registration number, ChiCTR1900023322; Registration site, Chinese Clinical Trial Registry (ChiCTR).

Air versus Perfluoropropane Gas in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment: A 3-Year Retrospective Study

INTRODUCTION

This study aimed to compare anatomical outcomes of air and perfluoropropane gas (C3F8) tamponade in pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD).

METHODS

In this retrospective study, data were gathered from 578 patients (578 eyes) with RRD. The follow-up records of all 578 patients that underwent primary vitrectomy for RRD with air or C3F8 were examined and analyzed. Surgical outcomes of the two groups were compared.

RESULTS

A total of 342 eyes were treated with air and 236 with C3F8. The mean follow-up period was 37.65 ± 2.33 months. Baseline and preoperative clinical characteristics were similar between groups, but the period to intraocular bubble disappearance (p < 0.0001), intraocular pressure on the first postoperative day (p < 0.0001), number of cases with intraocular pressure >21 mm Hg within 3 days post-surgery (p < 0.0001), and the number with intraocular pressure >21 mm Hg during follow-up (p = 0.0002) differed significantly between groups. Primary reattachment rates for air and C3F8 groups were 95.03% and 95.34%, respectively. Clinical characteristics were similar in those with and without successful reattachment, and the frequency of new or unclosed breaks was similar between the two groups. There was no significant difference in two groups according to the presence or absence of inferior retinal breaks and inferior detached quadrants. Univariate and multivariate logistic regression identified no risk factor for surgical failure.

CONCLUSIONS

Air showed equivalent effects to C3F8, with a shorter period to intraocular bubble disappearance, less risk of postoperative intraocular hypertension, and less expense.

Comparison of Intraocular Tamponade in Patients with Peripheral Tear-Induced Retinal Detachment and Coexisting Macular Hole without High Myopia

INTRODUCTION

To introduce the surgical results and examine the effect of intraocular tamponades on surgical outcomes in patients with coexisting macular hole (MH) and rhegmatogenous retinal detachment (RRD) without high myopia.

METHODS

This retrospective, cross-sectional, two-center study was carried out with 29 eyes of 29 patients. The patients were divided into two groups according to the intraocular tamponade used in surgery: silicone oil (Group 1) and C₃F₈ gas (Group 2). In all patients, the internal limiting membrane was peeled during surgery. Exclusion criteria were determined as RRD with MH due to high myopia (≥ 6 D) without peripheral retinal tears and traumatic MH.

RESULTS

In Group 1, the median preoperative best-corrected visual acuity (BCVA) was 3.0 (M ± SD: 2.85 ± 0.27) logMAR, while the median postoperative BCVA was 1.0 (M ± SD: 1.39 ± 0.83) logMAR (p < 0.001). In Group 2, the median preoperative BCVA was 3.0 (M ± SD: 2.37 ± 0.93) logMAR, while the median postoperative BCVA was 0.76 (M ± SD: 1.06 ± 0.86) logMAR (p = 0.008). The retinal attachment success rate was 15/17 (89.3%) in Group 1, and 11/12 (91.7%) in Group 2 (p = 0.64). The MH closure rate was 12/17 (71.6%) in Group 1, and 10/12 (78.1%) in Group 2 (p = 0.52). No difference was determined between the groups in terms of preoperative and postoperative BCVA, preoperative and postoperative intraocular pressure, and BCVA improvement.

CONCLUSIONS

The study results showed no significant difference between using silicone oil or C₃F₈ gas as an intraocular tamponade after internal limiting membrane peeling in patients with RRD due to peripheral tear with coexisting MH.