Adequate silicone oil tamponade technique for recurrent retinal detachment:An effectiveness and safety study
Objective To assess the surgical outcomes of phaco-vitrectomy following posterior capsulotomy,infe-rior peripheral iridotomy,and adequate silicone oil tamponade in a series of patients with recurrent retinal detachment,in-cluding the anatomical surgery successful rate,visual function,and surgical complications.Methods In this prospective case series study,25 eyes of 25 patients diagnosed with recurrent retinal detachment between June 2018 and June 2022 in Joint Shantou International Eye Center were included.All patients had a history of one or more rhegmatogenous retinal de-tachment surgeries.Fourteen patients were male and 11 patients were female.The mean age was(52.92±13.94)years old with an average of 1.44±0.71 times of retinal detachment surgery.The proliferative vitreoretinopathy(PVR)grade at first presentation was C1(n=3),C2(n=9),C3(n=11),and D1(n=2).Five eyes showed superior retinal breaks,18 eyes showed inferior breaks,and 2 eyes presented with both.Two patients presented with combined choroidal detachment.Adequate silicone oil tamponade followed by posterior capsulotomy and inferior peripheral iridotomy was performed.Preoperative and follow-up data including best corrected visual acuity,intraocular pressure,the retina and silicone oil status,and surgical complications and management,were collected and analyzed.Results On the day of discharge,all eyes demonstrated an attached retina and complete migration of the anterior chamber silicone oil into the vitreous cavity.At the 3-month follow-up,all retinas were attached with a mean intraocular pressure of(14.24±6.28)mmHg.The mean follow-up time was(20.64±12.20)months,and all the eyes presented relatively adequate silicone oil tamponade with no signs of oil-fluid in-terface in the vitreous cavity.Seventeen eyes had the silicone oil removal at(7.26±2.02)months after the primary proce-dures.18.57%of corneal endothelial loss was found at the time of silicone oil removal in these patients.Eight eyes,with a follow-up period of(24.38±12.07)months,did not perform the silicone oil removal procedure due to myopic macular atrophy-associated poor vision(n=3),diffused chorioretinal scarring with intraocular pressure less than 8 mmHg(n=3),and treatment refusals by the patients(n=2).No sign of silicone oil emulsion was found.At the final visit,all 25 eyes dem-onstrated a completely attached retina,including 17 eyes with silicone oil removal and 8 eyes with silicone oil not removed.The overall logMAR best corrected visual acuity significantly improved from(1.62±0.66)before operation to(1.21±0.60)in the final follow-up(P<0.05).The main complications included acute intraocular pressure elevation(n=15,60%)in the early period of post-operation,among which 10 eyes had medical treatments,and 5 eyes received an extraction of a small amount of aqueous humor(n=2)or silicone oil(n=3)through anterior chamber paracentesis.All eyes had well-controlled intraocular pressure(<21 mmHg)at discharge.Conclusions Adequate silicone oil tamponade followed by posterior cap-sulotomy and inferior peripheral iridotomy is effective and safe for the treatment of recurrent retinal detachment.This surgi-cal technique is responsible for a more complete tamponade of silicone oil in the vitreous cavity,especially in the eyes pre-senting with inferior retinal breaks.Although intraocular pressure often increases in the early stage of post-operation,it can be well controlled without the need for anti-glaucoma surgery.This technique can be considered as a modified and supple-mentary procedure for the treatment of recurrent retinal detachment.
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