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Advantages:

The dead space below tamponade, permits concentration of cells of the surgery. So that after a light tamponade is always obtain some small liquid are below the tamponade bubble that facilitates the concentration of inflammatory cells and therefore, the stimulus to proliferate. As a matter of fact is that most proliferative recurrence overcome in the anterior segment.

If proliferative relapse may depend of the concentration of the cells in the dead space, it is good to move the dead space in the superior segment. In this way the use heavy silicon inhibits the creation of the dead space in the inferior segment allowing the proliferative recurrence to be easily re-created in the superior segment.

When a second surgery is done it is possible to use a light tamponade system air or light silicon that may tamponade the superior segment, the location of the recurrence. That is why is so important to block the inferior recurrence since later, in a second surgery it is possible to stop the proliferative due to the concentration of cells in the dead space.

To show our strategy in complicated R.D., with high possibility of developing PVR and R.D. recurrence. In such cases, our first choice is to use HSO as tamponading agent to ensure an efficient tamponade of the inferior sectors and to reallocate to the top an eventual recurrence to be treated at a later 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 degree; PFCL or air-HSO exchange. All scleral-accesses are always sutured at the end of the operation, with transconjunctival 8-0 suture. HSO is maintained for a period of between 60 to 90 days. The removal is performed through active aspiration (vacuum 500-600 mmHg) with 20 or 23-gauge transconjunctival system.

Effectiveness:

Recurrence at the superior retina was present in 7 cases (30%) between 9 and 3 o’clock, at the moment of the second procedure performed among 60-90 days from the first operation. In 3 cases it was used 1000 cs oil, in 4 cases gas mix (C2F6 15%). Of the 3 cases were tamponade with 1000cs oil 2 cases had to be re-operated with the use of 1000 cs oil. 4 cases are highlighted of exudation in anterior chamber over the anterior and posterior surface of the IOL, associated to increase of intraocular pressure, all well controlled with medical therapy.

The 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.