Management of Pseudophakic Retinal Detachments by Endovitreal Surgery with Vitreal Cavity Tamponade by Silicone Oil and Air-Gas Mixture

The aim of the investigation was to assess the efficacy of using air-gas mixture as a substitute for vitreous body in microinvasive surgical management of primary pseudophakic retinal detachment (PRD) and its recurrence after extrascleral intervention performed by 25G endovitreal surgery technique.

Materials and Methods. Two groups of patients, which underwent vitrectomy with tamponade of the vitreal cavity by silicone oil or gas, were formed: group 1 (n=24) with primary unoperated PRD and group 2 (n=10) with recurrent PDR after extrascleral surgery. Both groups were further divided into subgroups: A — patients with vitrectomy and introduction of silicone oil; B — patients with vitrectomy and air-gas mixture.

Results. A comparative analysis of PRD surgical treatment data, carried out in our investigation, showed that in case of primary PRD treatment higher anatomical and functional results were achieved, when vitrectomy was made with application of silicone oil, which performed more controlled and prolonged tamponade of the vitreal cavity than in vitrectomy with replacement of the vitreous body by air-gas mixture.

In case of PRD recurrence after extrascleral surgery greater efficacy in comparison with the application of the silicone oil was revealed in vitrectomy and air-gas tamponade of the vitreal cavity if there were no coarse retinal fibrosis and large extension of redetached retina.

Conclusion. Only differentiated approach to the choice of temporal substitute of vitreous body after vitrectomy in patients with pseudophakic retinal detachment will allow the surgeons to achieve maximally feasible anatomical and functional results.

1. Neroev V.V., Zakharova G.Yu., Razik S. Skleroplasticheskie operatsii pri otsloyke setchatki bez razryvov. V kn.: Sovremennye vozmozhnosti v diagnostike i lechenii vitreoretinal’noy patologii [Scleroplastic operations in retina detachment without tears. In: State-of-the-art resources in diagnosis and treatment of vitreoretinal pathology]. Moscow; 2004; p. 219–220.
2. Bobr T.V., Rozhko Yu.I., Sklimenok E.M. Iskhod khirurgicheskogo lecheniya otsloek setchatki na afakichnykh i artifakichnykh glazakh. V kn.: Sovremennye tekhnologii lecheniya vitreoretinal’noy patologii — 2009 [Outcome of surgical retinal detachment treatment on aphakic and pseudoaphakic eyes. In: Up-to-date technologies of treating vitreoretinal pathology — 2009]. Moscow; 2009. URL: http://www.eyepress.ru/article.aspx?6655.
3. Zakharov V.D., Khodzhaev N.S., Gorshkov I.M., Malyatsinskiy I.A. Current surgery of retinal detachment recurrence. Review. Oftal'mologiya 2012; 9(1): 10–13.
4. Riemann C.D., Miller D.M., Foster R.E., Petersen M.R. Outcomes of transconjuctival suture — less 25 gauge vitrectomy with silicone oil infusion. Retina 2007; 27(3): 296–303, http://dx.doi.org/10.1097/01.iae.0000242761.74813.20.
5. Shah C.P., Ho A.C., Regillo C.D., Fineman M.S., Vander J.F., Brown G.C. Short-term outcomes of 25-gauge vitrectomy with silicone oil for repair of complicated retinal detachment. Retina 2008; 28(5): 723–728, http://dx.doi.org/10.1097/IAE.0b013e318166976d.
6. Takhchidi Kh.P., Kazaikin V.N., Rapoport A.A. Tamponade of the vitreal cavity with silicone oil in the surgery of retinal detachment. Relapses of retinal detachment. Oftal’mologiya 2004; 2: 29–33.
7. Takhchidi Kh.P., Kazaykin V.N., Rapoport A.A. Surgical treatment of retinal detachment recurrence, originated during vitreal cavity tamponade by silicone oil. Oftal’mokhirurgiya 2005; 3: 20–24.
8. Kapran Z., Uyar O.M., Kaya V., Eltutar K. Reccurences of retinal detachement after vitreoretinal surgery, surgical approach. Eur J Ophthalmol 2001; 11(2): 166–170.
9. La Heij E.C., Kessels A.G., Hendrikse F. Results and complications of temporary silicone oil tamponade in patients with complicated retinal detachments. Retina 2001; 21(2): 107–114, http://dx.doi.org/10.1097/00006982-200104000-00002.
10. Lam R.F., Cheung B.T., Yuen C.Y., Wong D., Lam D.S., Lai W.W. Retinal redetachment after silicone oil removal in proliferative vitreoretinopathy: a prognostic factor analysis. Am J Ophthalmol 2008; 145(3): 527–533, http://dx.doi.org/10.1016/j.ajo.2007.10.015.
11. Zakharov V.D., Balinskaya N.R., Lazarenko L.F. Combined intravitral surgical interventions in retinal detachment, complicated by vitreoretinal traction. Oftal’mokhirurgiya 1997; 1: 28–34.
12. Takhchidi Kh.P., Kazaykin V.N. Silicon tamponade in modern surgery of retinal detachment. Vestnik oftal’mologii 2004; 2: 41–45.
13. Goezinne F., La Heij E.C., Berendschot T.T., Liem A.T., Hendrikse F. Risk factors for redetachment and worse visual outcome after silicone oil removal in eyes with complicated retinal detachment. Eur J Ophthalmol 2007; 17(4): 627–637.
14. Zakharov V.D., Khusseyn M.I. Vitreoretinal surgery in retinal detachment, complicated by anterior proliferative vitreoretinopathy. Oftal’mokhirurgiya 2007; 1: 38–41.
15. Rapoport A.A., Kazaykin V.N. Intravitreal gas injection after ineffective scleral buckling for retinal detachment. Oftal’mokhirurgiya 2012; 2: 18–21.
16. Li H., Zhu X., Jiang D. Risk factors of retinal detachment after expected silicone oil removal. Yan Ke Xue Bao 2005; 21(2): 92–98.
17. Chen J.X., Nidecker A.E., Aygun N., Gujar S.K., Gandhi D. Intravitreal silicone oil migration into the subarachnoid space and ventricles: a case report and review of literature. European Journal of Radiology Extra 2011; 78(2): e81–e83, http://dx.doi.org/10.1016/j.ejrex.2011.02.004.
18. Hwang J.-F., Chen S.-N., Lin C.-J. Treatment of inferior rhegmatogenous retinal detachment by pneumatic retinopexy technique. Retina 2011; 31(2): 257–261, http://dx.doi.org/10.1097/iae.0b013e3181e586f9.
19. Malyatsinskiy I.A., Zakharov V.D., Khodzhaev N.S., Gorshkov I.M. Results of surgical treatment for an inferior localized retinal detachment recurrence by partial retinotomy using 25 G microinvasive endovitreal surgery. Prakticheskaya meditsina. Oftal’mologiya 2012; 4(12 Suppl 2). URL: http://pmarchive.ru/rezultaty-xirurgicheskogo-lecheniya-recidiva-otslojki-setchatki-v-nizhnem-segmente-s-provedeniem-chastichnoj-retinotomii-na-osnove-mikroinvazivnoj-endovitrealnoj-xirurgii-25-g/.
20. Bartz-Schmidt U., Szurman P., Wong D., Kirchhof B. New developments in retinal detachment surgery. Der Ophthalmologe 2008; 105(1): 27–36, http://dx.doi.org/10.1007/s00347-007-1662-2.

Chuprov А.D., Demakova L.V. Management of Pseudophakic Retinal Detachments by Endovitreal Surgery with Vitreal Cavity Tamponade by Silicone Oil and Air-Gas Mixture. Sovremennye tehnologii v medicine 2016; 8(1): 153, https://doi.org/10.17691/stm2016.8.1.21