Management of macula-on giant retinal tear detachments- outcome of pars-plana-vitrectomy with silicone oil versus gas tamponade.
Endotamponade
Gas tamponade
Giant retinal tear
Pars-plana-vitrectomy
Rhegmatogenous retinal detachment
Silicone oil
Journal
BMC ophthalmology
ISSN: 1471-2415
Titre abrégé: BMC Ophthalmol
Pays: England
ID NLM: 100967802
Informations de publication
Date de publication:
22 Apr 2024
22 Apr 2024
Historique:
received:
06
08
2023
accepted:
08
04
2024
medline:
23
4
2024
pubmed:
23
4
2024
entrez:
22
4
2024
Statut:
epublish
Résumé
To compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade. All consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded. Overall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008). Surgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade. The trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).
Sections du résumé
BACKGROUND
BACKGROUND
To compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade.
METHODS
METHODS
All consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded.
RESULTS
RESULTS
Overall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).
CONCLUSIONS
CONCLUSIONS
Surgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.
TRIAL REGISTRATION
BACKGROUND
The trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).
Identifiants
pubmed: 38649837
doi: 10.1186/s12886-024-03437-2
pii: 10.1186/s12886-024-03437-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
184Informations de copyright
© 2024. The Author(s).
Références
Ang GS, Townend J, Lois N. Epidemiology of giant retinal tears in the United Kingdom: the British Giant Retinal tear Epidemiology Eye Study (BGEES). Invest Ophthalmol Vis Sci. 2010;51(9):4781–7.
doi: 10.1167/iovs.09-5036
pubmed: 20393105
Schepens CL, Hartnett ME, Hirose T. Schepens’ retinal detachment and allied diseases. 2nd ed. Boston: Butterworth-Heinemann; 2000.
Lucke K, Laqua H. Silicone oil in the treatment of complicated Retinal detachments. Techniques, results, and complications. Berlin: Springer-; 1990.
doi: 10.1007/978-3-642-84266-5
Lee SY, Ong SG, Wong DW, Ang CL. Giant retinal tear management: an Asian experience. Eye (Lond). 2009;23(3):601–5.
doi: 10.1038/eye.2008.48
pubmed: 18309333
Banerjee PJ, Chandra A, Petrou P, Charteris DG. Silicone oil versus gas tamponade for giant retinal tear-associated fovea-sparing retinal detachment: a comparison of outcome. Eye (Lond). 2017;31(9):1302–7.
doi: 10.1038/eye.2017.167
pubmed: 28799555
Ferrara M, Coco G, Sorrentino T, Jasani KM, Moussa G, et al. Retinal and Corneal Changes Associated with intraocular silicone oil tamponade. J Clin Med. 2022;11(17):5234.
doi: 10.3390/jcm11175234
pubmed: 36079165
pmcid: 9457190
Moharram HM, Abdelhalim AS, Hamid MA, Abdelkader MF. Comparison between silicone oil and gas in Tamponading Giant Retinal Breaks. Clin Ophthalmol. 2020;14:127–32.
doi: 10.2147/OPTH.S237783
pubmed: 32021077
pmcid: 6970250
Machemer R, Allen AW. Retinal tears 180 degrees and greater. Management with vitrectomy and intravitreal gas. Arch Ophthalmol. 1976;94(8):1340–6.
doi: 10.1001/archopht.1976.03910040212014
pubmed: 949277
Rodriguez M, Lin J, Townsend JH, et al. Giant retinal tears: clinical features and outcomes of vitreoretinal surgery at a university teaching hospital (2011–2017). Clin Ophthalmol. 2018;12:2053–8.
doi: 10.2147/OPTH.S180353
pubmed: 30349189
pmcid: 6190638
Ghasemi Falavarjani K, Alemzadeh SA, Modarres M, et al. Outcome of surgery in patients with giant retinal tear: 10 years experience. Eye (Lond). 2017;31(9):1284–9.
doi: 10.1038/eye.2017.145
pubmed: 28776588
Taleb EA, Nagpal MP, Mehrotra NS, Bhatt K, Goswami S, Noman A. Giant retinal tear retinal detachment etiologies, surgical outcome, and incidence of recurrent retinal detachment after silicone oil removal. Oman J Ophthalmol. 2020;13(3):117–22.
doi: 10.4103/ojo.OJO_206_2017
pubmed: 33542598
pmcid: 7852423
Gutierrez M, Rodriguez JL, Zamora-de La Cruz D, et al. Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear. Cochrane Database Syst Rev. 2019;12(12):CD012646.
pubmed: 31840810
Goezinne F, LA Heij EC, Berendschot TT, et al. Low redetachment rate due to encircling scleral buckle in giant retinal tears treated with vitrectomy and silicone oil. Retina. 2008;28(3):485–92.
doi: 10.1097/IAE.0b013e318150d879
pubmed: 18327143
Pitcher JD, Khan MA, Storey PP, et al. Contemporary Management of Rhegmatogenous Retinal Detachment due to giant retinal tears: a consecutive Case Series. Ophthalmic Surg Lasers Imaging Retina. 2015;46(5):566–70.
doi: 10.3928/23258160-20150521-08
pubmed: 26057760
Ramamurthy S, Raval V, Ali H, et al. GIANT RETINAL TEAR DETACHMENT: clinical presentation and treatment outcomes in 396 patients. Retina. 2023;43(5):784–92.
doi: 10.1097/IAE.0000000000003720
pubmed: 36728871
Barth T, Helbig H, Maerker D, Gamulescu MA, Radeck V. Unexplained visual loss after primary pars-plana-vitrectomy with silicone oil tamponade in fovea-sparing retinal detachment. BMC Ophthalmol. 2023;23(1):75.
doi: 10.1186/s12886-023-02823-6
pubmed: 36829157
pmcid: 9951486
Batman C, Cekiç O. Vitrectomy with silicone oil or long-acting gas in eyes with giant retinal tears: long-term follow-up of a randomized clinical trial. Retina. 1999;19(3):188–92.
pubmed: 10380022
Scheerlinck LM, Schellekens PA, Liem AT, Steijns D, Leeuwen Rv INCIDENCE, RISK FACTORS, AND CLINICAL CHARACTERISTICS OF UNEXPLAINED VISUAL LOSS AFTER INTRAOCULAR SILICONE OIL FOR MACULA-ON RETINAL DETACHMENT. Retina. 2016;36(2):342–50.
doi: 10.1097/IAE.0000000000000711
pubmed: 26308530
Roca JA, Wu L, Berrocal M, Rodriguez F, Alezzandrini A, Alvira G, et al. Un-explained visual loss following silicone oil removal: results of the Pan American collaborative retina study (PACORES) Group. Int J Retina Vitreous. 2017;3:26.
doi: 10.1186/s40942-017-0079-6
pubmed: 28748109
pmcid: 5523152
Al-Khairi AM, Al-Kahtani E, Kangave D, Abu El-Asrar AM. Prognostic factors associated with outcomes after giant retinal tear management using perfluorocarbon liquids. Eur J Ophthalmol. 2008;18(2):270–7.
doi: 10.1177/112067210801800216
pubmed: 18320521
Li KX, Carducci N, Moinuddin O, et al. Contemporary Management of Complex and Non-complex Rhegmatogenous Retinal Detachment due to giant retinal tears. Clin Ophthalmol. 2021;15:1013–22.
doi: 10.2147/OPTH.S299762
pubmed: 33727784
pmcid: 7953883