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. 2017:2017:2323897.
doi: 10.1155/2017/2323897. Epub 2017 Jul 9.

Key Factors to Improve the Outcome of Retinal Reattachment Surgery in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy

Svenja Deuchler  1 , Hanns Ackermann  2 , Pankaj Singh  1 , Thomas Kohnen  3 , Clemens Wagner  4 , Frank Koch  1
Affiliations

Key Factors to Improve the Outcome of Retinal Reattachment Surgery in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy

Svenja Deuchler et al. J Ophthalmol. 2017.

Abstract

Introduction: For management of complicated retinal detachments, a pars plana vitrectomy with temporary silicone oil (SO) fill is the method of choice. According to literature, the retinal redetachment rate varies between <10% and >70% with around 36% in our own group (retrospective data analysis, n = 119 eyes).

Methods: The main goal was to reduce the retinal redetachment rate. Standard operating procedures (SOPs) and evaluation protocols (EVALPs) were developed to prospectively analyse risk factors. Lab analysis of SO was performed, and the role of surgical experience was evaluated and investigated with Eyesi®.

Results: We achieved a significant reduction of the retinal redetachment rate (to 6.80%, n = 101, p = 0.002). After surgery with SO injection, neither further membrane peeling (in 16.5%) nor retinal laser coagulation (in 100%) during revision surgery had a significant effect on the reattachment rate (p = 0.167, p = 0.23), while extensive additional laser coagulation reduced visual acuity (p = 0.01). A 3-port approach had to be set up to complete SO removal. A difference in success rate depending on surgical experience was confirmed, and the performance in Eyesi correlated with that in the patients' eye.

Conclusions: A SOP- and EVALP-based management and new strategies to secure the surgical performance seem to be essential for successful surgery.

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Figures

Figure 1
Figure 1
Scenes to document essential surgical steps: (a) filling of perfluorocarbon liquids (PFCL); (b) trimming necrotic retina tissue edges; (c) peeling of the inner limiting membrane after staining with indocyanine green; (d) laser coagulation of the retina edges after exchange of the PFCL against air before instillation of silicone oil.
Figure 2
Figure 2
Standard operation procedure for the surgery of complex retinal detachments with preliminary silicone oil tamponade (initial version). EDTRS = international standard to present visual acuity (v.a.) values; biomicroscopy = examination of the anterior segment of the eye, for example, the lens; i.o. pressure = measurement of the pressure in the eye; funduscopy = examination of the retina; OCT: optical coherence tomography = noninvasive “cutting through” the retina using light wavelengths; autofluorescence; special photography of the retina RPE complex; Scheimpflug photography; special measurement of lens changes, related, for example, to aging, diabetes mellitus, inflammation, and trauma.
Figure 3
Figure 3
Distribution of silicone oil droplets after diameter size, in % with standard deviation.
See this image and copyright information in PMC

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