Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery

Int J Ophthalmol, Vol. 11, No. 1, Jan.18, 2018 www.ijo.cn Tel:8629-82245172 8629-82210956 Email: ·Clinical Research· Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery Maedbh Rhatigan, Elizabeth McElnea, Patrick Murtagh, Kirk Stephenson, Elaine Harris, Paul Connell, David Keegan Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 KH4C, Ireland Correspondence to: Maedbh Rhatigan. Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 KH4C, Ireland. Received: 2017-04-18 Accepted: 2017-09-04 Abstract ● AIM: To report anatomic and visual outcomes following silicone oil removal in a cohort of patients with complex retinal detachment, to determine association between duration of tamponade and outcomes and to compare patients with oil removed and those with oil in situ in terms of demographic, surgical and visual factors. ● METHODS: We reported a four years retrospective case series of 143 patients with complex retinal detachments who underwent intraocular silicone oil tamponade. Analysis between anatomic and visual outcomes, baseline demographics, duration of tamponade and number of surgical procedures were carried out using Fisher’s exact test and unpaired two-tailed t-test. ● RESULTS: One hundred and six patients (76.2%) had undergone silicone oil removal at the time of review with 96 patients (90.6%) showing retinal reattachment following oil removal. Duration of tamponade was not associated with final reattachment rate or with a deterioration in best corrected visual acuity (BCVA). Patients with oil removed had a significantly better baseline and final BCVA compared to those under oil tamponade (P=0.0001, <0.0001 respectively). ● CONCLUSION: Anatomic and visual outcomes in this cohort are in keeping with those reported in the literature. Favorable outcomes were seen with oil removal but duration of oil tamponade does not affect final attachment rate with modern surgical techniques and should be managed on a case by case basis. ● KEYWORDS: silicone oil tamponade; proliferative vitreoretinopathy; retinal detachment DOI:10.18240/ijo.2018.01.15 Citation: Rhatigan M, McElnea E, Murtagh P, Stephenson K, Harris E, Connell P, Keegan D. Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery. Int J Ophthalmol 2018;11(1):83-88 INTRODUCTION ilicone oil was first used as an intraocular tamponade in humans by Cibis et al[1] in 1962 in retinal detachments with proliferative vitreoretinopathy (PVR). Silicone oils are hydrophobic compounds constituted of silicone and oxygen bonds. Silicone oils are chemically inert which is advantageous for intraocular use as they can remain in situ for an extended period of time. Silicone oil tamponade is intended to be temporary as prolonged intraocular duration may lead to ocular complications, such as oil emulsification, band keratopathy, elevated intraocular pressure and cataract formation[2]. They are also potentially retinotoxic with reported cases of permanent central vision loss following removal of silicone oil (ROSO)[3]. In certain patients ROSO may not be appropriate due to patient preference, fitness for surgery or eyes with a high risk of redetachment or no visual potential. The main indications for silicone oil tamponade are retinal detachment (RD) complicated by PVR, giant retinal tears (GRT), traumatic RD and certain cases of proliferative diabetic retinopathy (PDR) with combined tractional rhegmatogenous retinal detachment (TRRD). PVR, the most common indication for oil tamponade, is a disease that complicates rhegmatogenous retinal detachment (RRD). The critical factor in developing PVR is the presence of a full thickness retinal break. PVR involves the migration of retinal pigment epithelial (RPE) and glial cells through a retinal break and proliferation on the retinal surface. They form a contractile fibrocellular membrane on the surface of the retina and beneath it leading to fibrosis, traction and subsequent RD[4]. PVR can occur in longstanding primary RD (primary PVR) but the majority of cases occur with redetachment after initial RD repair. Risk factors for PVR include uveitis, vitreous haemorrhage, giant or multiple retinal tears, aphakia, pre- S 83 Silicone oil in retinal detachment surgery or post-operative choroidal detachments, large detachment involving greater than two retinal quadrants [4-5] . PVR complicates 5%-10% of RD surgery and is the most common cause of surgical failure in RRD[4]. Classification of PVR is currently based on the updated Retina Society Guidelines 1991[6]. The primary objective of this study was to report anatomic and visual outcome following silicone oil removal at varying duration of tamponade in a cohort of patients with complex RD requiring silicone oil. Secondary objectives were to compare patients with oil removed and those with oil in situ in terms of associated factors. SUBJECTS AND METHODS All procedures performed in this study were in accordance with the guidelines set out by the Irish Council for Bioethics on audit studies section 2.2 and with the principles outlined in the 2008 Declaration of Helsinki. All retinal detachments that underwent silicone oil tamponade over a four years period were retrospectively examined. This case series included 143 eyes of 143 patients who underwent pars plana vitrectomy (PPV) with intraocular silicone oil injection from January 2012 to December 2015 at a Tertiary Ophthalmology Referral Centre. All surgeries were carried out by two vitreoretinal surgeons. Data was gathered on patient demographics, baseline vision, indications for and duration of oil tamponade, number of surgeries required, final anatomic and functional status. Best corrected visual acuity (BCVA) was measured by Snellen visual acuity at each clinic visit. Inclusion criteria were patients who underwent silicone oil tamponade for each of the following clinical scenarios: 1) retinal detachment with PVR; 2) GRT associated RD; 3) traumatic retinal detachment; 4) other, as specified. Exclusion criteria were patients with tractional retinal detachment (TRD) as a consequence of PDR. The primary outcome measures were anatomic success and visual outcome following silicone oil removal. Anatomic success was defined as complete retinal attachment following oil removal at 6mo or at patients most recent follow up visit. Significant improvement or deterioration in BCVA was based on ≥0.3 logMAR unit change in BCVA[7]. Ambulatory visual acuity (VA) was defined as 1.7 logMAR unit or better[8]. Secondary outcome measures were retinal status in patients with oil in situ. Statistical Analysis Data was collected using Microsoft® Excel for Mac Version 15.22 and statistical analysis was carried using Prism 7© for Mac. Snellen acuity was (...truncated)