Timing of retinal redetachment after removal of intraocular silicone oil tamponade

doi:10.1016/S0002-9394(99)00201-9

American Journal of Ophthalmology

Volume 128, Issue 5, November 1999, Pages 628-631

https://doi.org/10.1016/S0002-9394(99)00201-9 Get rights and content

Abstract

PURPOSE:

To evaluate the interval between removal of intraocular silicone oil tamponade and retinal redetachment after pars plana vitrectomy, and to investigate factors influencing the length of the interval.

PATIENTS AND METHODS:

The retrospective study included 42 eyes of 42 consecutive patients who experienced a retinal redetachment after silicone oil had been removed 8.0 ± 6.2 months after an initial pars plana vitrectomy including intraocular silicone oil (5,000 centistokes) tamponade. Pars plana vitrectomy had been performed for proliferative vitreoretinopathy caused by complicated rhegmatogenous retinal detachment.

RESULTS:

The retina redetached 2 days to 5.5 months after silicone oil removal (mean ± SD, 1.3 ± 1.4 months; median, 18 days). Thirteen (30%) of all 42 redetachments occurred in the first 9 days, 21 (50%) of all 42 retinal redetachments occurred in the first 18 days, and 32 (75%) of all 42 retinal redetachments occurred in the first 50 days. The interval between silicone oil removal and retinal redetachment was statistically (by analysis of variance) independent of the method of silicone removal (transpupillary drainage vs via pars plana sclerotomies), refractive error of the eye (P = .62), time between initial pars plana vitrectomy and silicone oil removal (P = .99), visual acuity before silicone oil removal (P = .26), type of anesthesia (P = .69), gender (P = .80), and age (P = .48) of the patients.

CONCLUSION:

The risk of retinal redetachment decreases steeply with increasing time after silicone oil removal. Three to 5 months after oil removal, retinal redetachment becomes unlikely. The time of retinal redetachment is statistically independent of the method of silicone oil removal, refractive error, time between the preceding pars plana vitrectomy and silicone oil removal, visual acuity before silicone oil removal, type of anesthesia, and gender and age of the patents. These data may be important for scheduling reexaminations and for counseling patients in their planned activities after removal of intraocular silicone oil tamponade.

Section snippets

Patients and methods

This retrospective study included 42 eyes of 42 consecutive patients in whom the retina detached after intraocular silicone oil tamponade had been removed. Silicone oil had been instilled during a preceding pars plana vitrectomy. For all patients, the only reason for pars plana vitrectomy with intraocular silicone oil tamponade had been complex retinal detachment with development of proliferative vitreoretinopathy. Patient age ranged between 6 and 86 years (mean ± SD, 49.8 ± 20.6 years; median,

Results

A retinal redetachment was detected 2 days to 5.5 months (mean ± SD, 1.3 ± 1.4 months; median, 18 days) after removal of silicone oil. The relationship between the cumulative frequency of retinal redetachment and the length of the interval between silicone oil removal and retinal redetachment was nonlinear, with a steep rise in the first month and a flattening of the curve as time passed after silicone oil removal (Figure 1). Thirteen (30%) of all 42 redetachments occurred in the first 9 days,

Discussion

The improvement of vitreoretinal microsurgical techniques during the past two decades has markedly increased the rate of successful treatment of proliferative vitreoretinopathy.1, 2, 3, 4, 5, 6, 8, 9, 10, 11, 12 The techniques most commonly employed include pars plana vitrectomy with or without scleral buckling, membrane peeling, relaxing retinotomies, endolaser coagulation, and temporary endotamponade using intraocular gas or silicone oil. If a retinal break is present at the time of surgery,

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La prolifération vitréo-rétinienne (PVR), à l’origine de membranes fibrocellulaires contractiles s’opposant à la réapplication de la rétine, reste une des complications les plus graves du décollement de rétine (DR) rhegmatogène, avec une fréquence de survenue de 5 à 11 % et une des causes les plus fréquentes d’échec de la chirurgie (50–75 %). Sa gravité est liée à la complexité de la chirurgie à mettre en œuvre pour traiter les patients, et au pronostic anatomique et fonctionnel réservé. Le traitement curatif d’une PVR inclue la réalisation d’une vitrectomie, parfois associée à une phaco-exérèse ou une indentation, un pelage systématique des membranes épirétiniennes, parfois une rétinectomie, et systématiquement une rétinopexie par photocoagulation endolaser. Le tamponnement interne privilégié est actuellement l’huile de silicone. Les huiles de silicone de différentes densités font actuellement l’objet d’études comparatives.
Proliferative vitreoretinopathy (PVR), which causes contractile fibrocellular membranes that may prevent retinal reattachment, remains one of the most severe complications of rhegmatogenous retinal detachment (RD), with an incidence of 5–11%, and one of the most frequent causes of surgical failure (50–75%). Its severity is due to the complexity of the surgery required to treat patients, and to its uncertain anatomic and functional prognosis. Curative treatment of PVR includes vitrectomy, sometimes associated with phacoemulsification or scleral buckling; systematic peeling of epiretinal membranes, occasionally retinectomy; and systematic retinopexy by endolaser photocoagulation. The current preferred internal tamponade is silicone oil. Silicone oils of various densities are undergoing comparative studies.
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^☆: This study was supported by Deutsche Forschungsgemeinschaft, Bonn, Germany (SFB 539).

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Original ArticlesTiming of retinal redetachment after removal of intraocular silicone oil tamponade☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Proliferative vitreoretinopathy (PVR)a personal approach of its pathogenesis and treatment: Proctor Lecture

Invest Ophthalmol Vis Sci

The use of liquid silicone in retinal detachment surgery

Arch Ophthalmol

Original Articles
Timing of retinal redetachment after removal of intraocular silicone oil tamponade☆