Cesare Forlini, Matteo Forlini, Adriana Bratu, Paolo Rossini (Ravenna, Italy)

Objective:

Treatment of complex R.D: checkmate in two moves!

Purpose:

To show our strategy in complicated R.D, with high (risk to develop recurrent RD with PVR. In such cases, our first choice is to use HSO as tamponade agent to ensure an efficient tamponade of (the inferior retina), and to “reallocate to the (superior retina)” eventual recurrence to treat in a second time.

Methods:

24 selected patients, with high risk of PVR recurrence (>C3) were treated with heavy silicon oil (Densiron 68, Fluoron). A 23 gauge vitrectomy with ILM peeling, prior staining with ICG or Brilliant Peel; use of endolaser on present break(s) and at 360°; PFCL or air-HSO exchange. HSO is maintained within a period among 60 and 90 days. The removal is performed through the active aspiration (vacuum 500-600 mmHg) with 20 or 23-gauge transconjuntival system.
Recurrence at the superior retina, between 9 and 3 o’clock, was (encountered) in 7 cases (30%). Reoperation was performed 60-90 days following the primary operation. Silicone oil 1000 Cs was used in 3 cases and C2F6 15% gas mixture in 4 cases. Of the 3 cases, tamponade with 1000cs oil, 2 cases had to be re-operated with the use of 1000-cs oil. Exudation in anterior chamber, over the anterior and posterior surface of the IOL, associated to increase of intraocular pressure, was encountered in 4 cases. All were well controlled with medical therapy.

Conclusion:

This surgical strategy has allowed reducing further operations with reallocating critic area to superior sectors and to manage recurrence more easily (using different tamponade substances) and interrupting the multiple inferior recurrence chain. The strategy of using HSO as first choice in case of complicated R.D. allows ensuring the anatomical and functional success in two passages.