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. 2009 Oct 7:(4):CD006126.
doi: 10.1002/14651858.CD006126.pub2.

Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy

Stephen G Schwartz  1 , Harry W Flynn Jr, Wen-Hsiang Lee, Elizabeth Ssemanda, Ann-Margret Ervin
Affiliations

Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy

Stephen G Schwartz et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery. During surgery, a tamponade agent is needed to reduce the rate of recurrent retinal detachment.

Objectives: The objective of this review was to evaluate the benefits and adverse outcomes of surgery with various tamponade agents.

Search strategy: We searched the Cochrane Controlled Register (CENTRAL), MEDLINE, EMBASE, Latin America and Carribbean Health Sciences (LILACS) and the UK Clinical Trials Gateway (UKCTG). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 9 July 2009.

Selection criteria: We included randomized clinical trials comparing patients treated with various tamponade agents.

Data collection and analysis: Two individuals screened the search results independently. One study with two trials was eligible for inclusion in the review.

Main results: One study with two trials was included in the review. The first trial randomized 151 eyes to receive either silicone oil or sulfur hexafluoride (SF(6)) gas tamponades; the second trial randomized 271 eyes to receive either silicone oil or perfluropropane (C(3)F(8)) gas tamponades. In patients with RD associated with PVR, pars plana vitrectomy and infusion of either silicone oil or perfluropropane gas appear comparable for a broad variety of cases. Sulfur hexafluoride gas was associated with worse anatomic and visual outcomes than either silicone oil or perfluropropane gas.

Authors' conclusions: The use of either C(3)F(8) or silicone oil appears reasonable for most patients with RD associated with PVR. Because there do not appear to be any major differences in outcomes between the two agents, the choice of a tamponade agent should be individualized for each patient.

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Conflict of interest statement

Declarations of interest

Harry W. Flynn, Jr., MD is a co-author on several of the studies that were eligible for inclusion in this review.

Figures

Figure 1
Figure 1
Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.
Figure 2
Figure 2
(Analysis 1.1). Forest plot of comparison: 1 Silicone oil versus SF6, outcome: 1.1 Visual acuity ≥ 5/200 at 24 months.
Figure 3
Figure 3
(Analysis 1.2). Forest plot of comparison: 1 Silicone oil versus SF6, outcome: 1.2 Macular attachment at 24 months.
Figure 4
Figure 4
(Analysis 2.1). Forest plot of comparison: 2 Silicone oil versus perfluropropane (C3F8), outcome: 2.1 Visual acuity ≥ 5/200 at last follow-up examination.
Figure 5
Figure 5
(Analysis 2.2). Forest plot of comparison: 2 Silicone oil versus perfluropropane (C3F8), outcome: 2.2 Macular attachment at last follow-up examination.
See this image and copyright information in PMC

References

References to studies

Included studies
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    4. Azen SP, Boone DC, Barlow W, McCuen BW, Walonker AF, Anderson MM, et al. Methods, statistical features, and baseline results of a standardized, multicentered ophthalmologic surgical trial: the Silicone Study. Controlled Clinical Trials. 1991;12(3):438–55. - PubMed
    5. Barr CC, Lai MY, Lean JS, Linton KL, Trese M, Abrams G, et al. Postoperative intraocular pressure abnormalities in the Silicone Study. Silicone Study Report 4. Ophthalmology. 1993;100(11):1629–35. - PubMed
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Excluded studies
    1. Avci R. Cataract surgery and transpupillary silicone oil removal through a single scleral tunnel incision under topical anesthesia; sutureless surgery. International Ophthalmology. 2001;24(6):337–41. - PubMed
    1. Brazitikos PD, Androudi S, Christen WG, Stangos NT. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial. Retina. 2005;25(8):957–64. - PubMed
    1. Gao R, Lu L, Zhang S, Tang S, Liu Q, Hu Z. Study on application of the silicone oil in the reattachment of complicated retinal detachment. Yan Ke Xue Bao [Eye Science] 1993;9(3):146–8. - PubMed
    1. Hammer M, Margo CE, Grizzard WS. Complex retinal detachment treated with silicone oil or sulfur hexafluoride gas: a randomized clinical trial. Ophthalmic Surgery & Lasers. 1997;28(11):926–31. - PubMed
    1. Hutchins RK, Kaufman AH, Augsburger JJ. Perfluoro-octane internal tamponade when using a temporary keratoprosthesis during retinal detachment repair. Retina. 2003;23(1):106–10. - PubMed
Studies awaiting classification
    1. Oncel M, Acikalin B. Heavy silicone oil vs. standard silicone oil for the management of complicated retinal detachment: A prospective randomized study. American Academy of Ophthalmology. 2006:301.
Ongoing studies
    1. Joussen AM, Kirchhof B, Schrage N, Ocklenburg C, Hilgers RD. Heavy silicone oil versus standard silicone oil as vitreous tamponade in inferior PVR (HSO Study): design issues and implications. Acta Ophthalmologica Scandinavica. 2007;85(6):623–30. [ISRCTN Register: ISRCTN47399029 ; Study Name: The Heavy Silicone Oil versus Standard Silicone Oil Study] - PubMed

Other references

Additional references
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