Key Factors to Improve the Outcome of Retinal Reattachment Surgery in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy

Abstract

Introduction. For management of complicated retinal detachments, a pars plana vitrectomy with temporary silicone oil (SO) fill is the method of choice. According to literature, the retinal redetachment rate varies between 70% with around 36% in our own group (retrospective data analysis, n=119 eyes). Methods. The main goal was to reduce the retinal redetachment rate. Standard operating procedures (SOPs) and evaluation protocols (EVALPs) were developed to prospectively analyse risk factors. Lab analysis of SO was performed, and the role of surgical experience was evaluated and investigated with Eyesi®. Results. We achieved a significant reduction of the retinal redetachment rate (to 6.80%, n=101, p=0.002). After surgery with SO injection, neither further membrane peeling (in 16.5%) nor retinal laser coagulation (in 100%) during revision surgery had a significant effect on the reattachment rate (p=0.167, p=0.23), while extensive additional laser coagulation reduced visual acuity (p=0.01). A 3-port approach had to be set up to complete SO removal. A difference in success rate depending on surgical experience was confirmed, and the performance in Eyesi correlated with that in the patients’ eye. Conclusions. A SOP- and EVALP-based management and new strategies to secure the surgical performance seem to be essential for successful surgery.