Retinotomy and silicone oil for detachments complicated by anterior inferior proliferative vitreoretinopathy.
OBJECTIVE
To describe a subset of patients with recurrent retinal detachments caused by anterior intraretinal and subretinal proliferative vitreoretinopathy (PVR), which required greater than 180 degrees retinotomy and silicone oil tamponade.


METHODS
Interventional case series. Forty-one patients underwent >180 degrees retinotomy, anterior retinectomy, removal of subretinal membranes, laser to the retinotomy edge and silicone oil tamponade. Risk factors for detachment, prior surgical history and PVR location were examined. Main outcomes included change in visual acuity, recurrent detachment and postoperative complications.


RESULTS
Cataract extraction (49%), high myopia (29%) and lattice degeneration (27%) were preoperative risk factors. The average number of prior procedures for retinal attachment was 2.3 (SD 0.9). The majority of detachments were inferior and related to anterior intraretinal and subretinal PVR. Twenty-four patients (59%) saw 20/200 or better. Eleven patients (27%) had poor vision (<20/400) at the end of follow-up. Thirty-seven retinas (90%) remained attached. Increased rates of postoperative corneal decompensation (p<0.0001) and silicone oil in the anterior chamber (p<0.0001) were statistically significant markers of poor visual outcome.


CONCLUSIONS
Patients with complex PVR requiring a large retinotomy often had similar presurgical conditions. A large inferior retinotomy effectively addressed proliferations where they most frequently occur, and silicone oil was beneficial.
Tsui
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Jules Stein Eye Institute, University of California, Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA. itsui@jsei.ucla.edu
Schubert
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D055502:Secondary Prevention; D012827:Silicone Oils / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000009:adverse effects; D018630:Vitreoretinopathy, Proliferative / Q000150:complications* / Q000628:therapy; D055815:Young Adult
D012827:Silicone Oils