Incidence of retinal redetachment after silicone oil removal in cases of severe eye injuries operated during the 25th of January Egyptian Revolution

Abstract

Purpose This study aimed to evaluate the frequency of retinal redetachment after silicone oil removal (SOR) in cases of severe eye injuries operated during the 25th of January Egyptian Revolution; we also attempted to evaluate the causes behind the redetachment. Patients and methods This retrospective, noncomparative, interventional case series included patients who had undergone both vitrectomy and SOR. The cause for the primary intervention was penetrating posterior segment trauma with and without intraocular foreign body (IOFB). Indications for performing SOR were classified as increased intraocular pressure, decreasing best-corrected visual acuity because of incorrectable refractive error, and oil emulsification changes with a preceding adequate duration of silicone oil tamponade (at least 4 months) in the absence of any complication. After SOR, patients were followed up for a minimum duration of 3 months. Retinal redetachment was managed with a repeat vitrectomy and silicone oil infusion. Preoperative and intraoperative factors that might be related to the recurrent detachment were identified. We attempted to relate these factors to the redetachment. Results The age of the patients ranged from 15 to 46 years, with a mean age of 31.07 ΁ 8.3 years. The sample studied included 21 (70%) males. Preoperative retinal detachment (RD) was recorded before the first intervention in 17 (56.7%) eyes. IOFBs were found in 13 (43.3%) eyes. In nine (30%) cases, intraoperative retinotomy or retinectomy was performed to successfully flatten the retina. In the eyes with preoperative RD (17 eyes, 56.7%), an encircling band was fixed. The cause of SOR was found to be increased intraocular pressure in six (20%) eyes, decreasing best-corrected visual acuity because of incorrectable refractive error in 16 (53.3%) eyes, and oil emulsification changes in eight (26.7%) eyes. Before SOR all eyes showed an attached stable retina for a least 4 months. After 3 months of follow-up, seven (23.3%) eyes were found to have a recurrent RD. The cause for this recurrence was surmised to be because of proliferative vitreoretinopathy in two (6.7%) cases, reopening of an old break in another two (6.7%) eyes, and new breaks created because of aggressive proliferative vitreoretinopathy in three (10%) eyes. The recurrence of RD was not affected by the duration of silicone oil tamponade, preoperative RD, intraoperative retinotomy, an IOFB, the presence of vitreous remnants, and C3F8 fill with endolaser barrage at the conclusion of surgery (P = 0.76, 0.07, 0.64, 0.66, 0.54, 0.113, respectively). The only statistically significant correlation that we found was between the fixing of a tamponade and the rate of recurrence (P = 0.01). Conclusion The routine use of silicone tamponade in complicated cases such as those with penetrating trauma, even if RD was not identified beforehand and the usage of an encircling bands in difficult cases with RD, may increase the success rate after SOR.

Keywords

• Endotamponade
• retinal redetachment
• silicone oil
• vitrectomy