Anatomical outcome after pars plana vitrectomy using silicone oil versus C3F8 gas tamponade for the management of rhegmatogenous retinal detachment.

Abstract

INTRODUCTION: Rhegmatogenous retinal detachment (RD) occurs when fluid from vitreous cavity passes through a retinal break into the subretinal space. There are different types of retinal reattachment surgeries among which pars plana vitrectomy (PPV) is a preferential surgical procedure for the management of complex rhegmatogenous retinal detachments (RRD). A tamponading agent (silicone oil or C₃F₈ gas) is required to decrease the recurrence of retinal detachment.

OBJECTIVE: This study was done to compare the anatomical outcome after pars plana vitrectomy using silicone oil versus C₃F₈ tamponades for the management of rhegmatogenous RD.

STUDY DESIGN: This was a prospective, comparative, interventional (quasi-experimental) study.

PLACE AND DURATION OF STUDY: Ophthalmology department unit-3 Mayo Hospital Lahore and duration was 6 months from September 2016 to March 2017.

MATERIAL AND METHODS: Fifty eyes of fifty patients that underwent PPV with silicone oil versus gas C₃F₈ tamponades were enrolled in this study. Pars plana vitrectomy was done with 23G vitrectomy system. On the basis of the completely flat retina at least 6 to 8 weeks postoperative or oil associated complications silicone oil removal was done. Postoperatively all the patients were followed up on the next day, after 7 days and then at 1 month, 3 months and 6 months interval. According to the surgical procedure performed the patients were divided into two groups. Both groups were compared regarding the anatomical outcome. The number of patients in PPV plus Silicone oil and PPV with C₃F₈ gas group were equal 25 (50%), 25 (50%) respectively.

RESULTS: Anatomical attachment of the retina was achieved in 22/25 (88%) patients in PPV with Silicone Oil group after Removal of Silicone Oil (ROSO) and in 23/25 (92%) patients in PPV plus C₃F₈ group after the absorption of the gas and re-detachment occurred in 3 eyes (12%) in silicone oil and in 2 patients (8%)  in the gas groups. Attainment of visual acuity of 6/60 or more which was gained in 44 (88%) of patients after ROSO or absorption of C₃F₈ gas as the case may be. Anatomical outcome rates were same in both groups primarily and in final situation. Significant differences were not seen between both the groups regarding primary and final anatomical outcome. According to our results anatomically, either of the two options (PPV plus silicone oil or PPV plus C₃F₈ gas) can be used in the treatment of rhegmatogenous RD. Although more complications were noted in the silicone oil group as compared to gas.

CONCLUSION: Silicone oil or C₃F₈ gas tamponades gave same results regarding reattachment of the retina and to improve or preserve vision. No major differences were noted in the anatomical outcomes between both tamponading agents, the choice of an internal tamponading agent should be individualized for each patient.

KEYWORDS: (PPV) pars plana vitrectomy; (RRD) rhegmatogenous retinal detachment; (ROSO) removal of silicone oil, (PVR) Proliferative vitreoretinopathy,