Hassan Mortada (Cairo, Egypt)

Advantages:

Recurrent RD in silicone oil filled eyes may occur early due to persistent retinal traction not adequately relieved or missed breaks, or late due to reproliferation. The aim of the present study is to describe the pathogenesis and management of recurrent Rd, following vitrectomy and silicone oil tamponade in eyes with RRD complicated with PVR.

Methods:

180 silicone oil filled eyes, with recurrent RD underwent reoperation between 2004 and 2010. The 1ry indication for surgery was rhegmatogenous Rd complicated with PVR. The surgical technique includes, evacuation of silicone oil, TA assisted search for residual posterior cortical vitreous, epiretinal membrane peeling, stabilization of posterior retina with PFCL, excision and dissection of basal vitreous gel and peripheral membrane, retinotomy/retinectomy (180 – 360 degrees), removal of subretinal proliferation, complete retinal reattachment with PFCL, endolaser and finally direct PFCL/Silicone oil exchange.

Effectiveness / Safety:

Complete retinal reattachment with visual improvement, following silicone oil removal, could be achieved in 89%. Relaxing retinotomy/retinectomy was necessary to eliminate persistent traction and/or retinal shortening in 80%. Persistent hypotony was encountered in 9%, increased IOP in 11% and corneal decompensation in 5%.

Take home message:

Recurrent RD in silicone oil filled eyes is managed with complete relieve of traction through removing epiretinal and subretinal proliferation, dissection and excision of peripheral basal gel and proliferation, appropriate use of retinotomy/retinectomy to relieve residual traction and use of silicone oil tamponade.