Vitrectomy and silicone oil infusion in severe diabetic retinopathy.

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Vitrectomy and silicone oil infusion in severe
diabetic retinopathy.

• Alessandro Castellarin, MD
• Ruben Grigorian, MD
• Neelakshi Bhagat, MD
• Lucian DelPriore, MD, PhD
• Christopher Seery, MD
• Marco Zarbin, MD, PhD

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Purpose

• To determine the results of pars plana vitrectomy
  (PPV) and silicone oil infusion (SOI) in severe
  proliferative diabetic retinopathy (PDR).

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Methods

• The records of 22 eyes (18 patients) with PDR who
  had undergone PPV and SOI were reviewed
  retrospectively.
• Average follow-up was 5.2 months (range 1-18
  months).
• In 10 eyes (46), SOI was part of the initial
  operation in 12 eyes (54), SOI was performed
  after previous failed PPV.
• A complexity score (range 1 7) was defined to
  grade the complexity of membrane dissection.

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Complexity score

• The number of quadrants of fibrovascular
  proliferation (FVP, 1-4 quadrants, each quadrant
  involved corresponds to 1 point increase in the
  CS).
• The location of FVP anterior to the equator (0
  points), posterior to the equator (0 points),
  both anterior and posterior (1 point).
• Tractional retinal detachment (TRD, 1 point).
• Traction-rhegmatogenous retinal detachment (TRRD,
  2 points).
• The presence or absence of a posterior vitreous
  detachment (no PVD, 1 point).

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DemographicsAge 53.6 (Range 21-82)
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Surgical indications
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Cases per complexity score
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• In 10 eyes (46), SOI was part of the initial
  operation.
• In 12 eyes (54), SOI was performed after
  previous failed PPV.

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• Rubeosis iridis (RI) was present preoperatively
  in 4 eyes, 2 of which had NVG.
• Preoperatively 14 patients were phakic, 6
  pseudophakic and 2 aphakic.
• Eight of 14 phakic eyes underwent lensectomy (5
  were left aphakic). 3 of the pseudophakic eyes
  were left aphakic.

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Anatomic OutcomesAnatomic success of the
study was defined as a complete attachment of the
retina posterior to the equator or to the scleral
buckle, if present.
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Anatomic Outcomes
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Postoperative Visual Acuity
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Postoperative

• Rubeosis iridis (RI) was present preoperatively
  in 4 eyes, 2 of which had NVG.
• Postoperatively, 3 of 4 eyes had regressed RI. No
  eye had postoperative NVG.
• Only one eye developed RI postoperatively.
• SO was removed in 2 eyes (9), at 5 months and 8
  months respectively, without complication.

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Postoperative complications
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• In a previous study to compare whether membrane
  viscodissection results in fewer iatrogenic
  breaks than pick scissors dissection we
  reviewed 150 eyes that underwent vitrectomy and
  membrane peeling.
• Reattachment rate (gt 6 mos. follow-up)
  Viscodissection (V) 30/36 (84), No
  Viscodissection (NV) 38/42 (90).
• Average complexity score 3.5.
• In the SO study the reattachment rate was lower
  but the case complexity was significantly grater
  (4.5) than the previous study (Plt0.0058).

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Conclusions

• SO tamponade is a useful option in severely
  diseased eyes with PDR, even in the presence of
  RI and NVG or the fibrinoid syndrome.
• Retinal attachment was achieved in almost 70 of
  cases.
• The majority of patients had stable or improved
  VA.
• The use of SO in severely diseased eyes with PDR
  may be of benefit, especially in the presence of
  RI.
• Further study with a prospective study design and
  larger sample size may be needed to explore this
  issue further.

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