Clinical Ophthalmology (Dec 2020)
Impact of Vitreal Tamponade on Functional Outcomes in Vitrectomy with ILM Peeling in Primary Macula-Involving Retinal Detachment: A Retrospective Analysis
Abstract
Mario Deiss,1,* Cagdas Kaya,2,3,* Isabel B Pfister,2,3 Justus G Garweg1– 4 1University of Bern, Bern, Switzerland; 2Swiss Eye Institute, Rotkreuz, Switzerland; 3Berner Augenklinik am Lindenhofspital, Bern, Switzerland; 4Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland*These authors contributed equally to this workCorrespondence: Justus G GarwegBerner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, Bern CH – 3012, SwitzerlandEmail [email protected]: To compare visual outcomes of vitrectomy with internal limiting membrane (ILM) peeling and failed SF6 gas tamponade requiring silicone oil (SO) in a second procedure with primary SO tamponade in fovea-involving retinal detachment (FiRD).Methods: Retrospective analysis of 82 eyes with retinal detachment and mild, but without advanced proliferative retinopathy (PVR ≥C2) requiring vitrectomy for FiRD. Group 1 comprised 23 eyes that underwent SF6 tamponade resulting in re-detachment requiring revision surgery with secondary SO tamponade. Based on the intraoperative findings, group 2 patients had primarily received SO as vitreal tamponade (n=59). Patients receiving a scleral buckle surgery or with advanced PVR as well as patients with underlying vascular diseases and uveitis were excluded.Results: Preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 13.5 ± 19.1 in group 1 and 14.0 ± 18.3 in group 2 (p=0.44). Twelve months after first surgery for FiRD, visual acuity was 49.8 ± 19.8 in group 1 and 51.7 ± 18.7 letters in group 2 (p= 0.63). Re-detachment after SO removal requiring revision surgery developed in 17.4 (n=4) and 15.3% (n=9) cases.Conclusion: Our findings suggest that if retinal traction is completely relieved at the end of surgery, vitrectomy with ILM peeling and SF6 may, if successful, improve the functional outcomes in instances with visual potential, ie, a foveal detachment of short duration despite the presence of a mild to moderate PVR, but with the inherent increased risk of re-detachment requiring further intervention and the use of a SO tamponade. Hence, secondary SO installation during re-vitrectomy after failed primary reattachment surgery results in similar functional outcomes as primary oil filling.Keywords: internal limiting membrane, ILM peeling, macula-off, retinal detachment, silicone oil tamponade, vitrectomy
