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Silicone oil removal key to success in repeat vitrectomy for PVR
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NEW ORLEANS — Removal of silicone oil was one of the key elements for defining success in repeat vitrectomy following failure of surgery for proliferative vitreoretinopathy, according to a speaker.
In a retrospective case series of 51 eyes of 50 patients who underwent repeat vitrectomy by a single surgeon after failure of vitrectomy for PVR, Gary W. Abrams, MD, and colleagues deemed repeat vitrectomy to be successful in about one-third of eyes.
“An attached retina and even good visual acuity do not adequately describe success,” Abrams said at Retina Subspecialty Day preceding the American Academy of Ophthalmology meeting. “PVR is not stable until the silicone oil is removed. We defined success as the retina attached, visual acuity of 5/200 or better, and silicone oil removed.”
Mean age of patients in the series was 56 years, in a range of 8 to 81 years, and the mean number of prior vitrectomies was 2.21. Follow-up was at least 6 months for all eyes and more than 12 months in 37 eyes.
“Most [eyes] had a prior scleral buckle. There was retained silicone oil in about half of the eyes, and residual gas, or ... fluid filled, in about half,” Abrams said.
In 75% of cases, Abrams used 20-gauge vitrectomy, and in the remainder, he used 23 gauge.
“We removed epiretinal membranes in 98% of the eyes, subretinal membranes in one-third of the eyes. We did retinectomy in 88% of the eyes. We used silicone oil in 49 of the 51 eyes,” Abrams said. “The retina was attached in 84% of the eyes, and visual acuity was 5/200 or better in 43% of the eyes. The question to ask is, were these eyes successful?”
“Using our criteria, 17 eyes, or 33%, were successful,” he said.
The retina was attached in all successful cases and in three-quarters of the unsuccessful eyes. Silicone oil was removed in all successful eyes and in 15% of the unsuccessful eyes. Visual acuity was 20/400 in all successful eyes and in only 9% of unsuccessful eyes.
Magnitude of postoperative hypotony and visual acuity factored into the success of the surgery, in that unsuccessful eyes were more likely to have 2+ or more preoperative flare (P = .03) and postoperative IOP of 5 mm Hg or less (P = .005). Conversely, better preoperative visual acuity, closer proximity to the surgical center and less postoperative hypotony were indicators of more successful surgery, he said. – by Patricia Nale, ELS
Reference:
Abrams GW. Results of vitrectomy for eyes following failure of surgery for proliferative vitreoretinopathy. Presented at AAO Subspecialty Days; Nov. 10-11, 2017; New Orleans.
Disclosure: Abrams reports he is a consultant for RetroSense Therapeutics.