The combined use of heavy and light silicone oil in the treatment of complicated retinal detachment with 360º retinal breaks: tamponade effect or filling effect?

INTRODUCTION: This study aims to report the safety and effi cacy of the combined use of 70% Densiron®-68 and 30% polydimethysiloxane as a temporary vitreous substitute after pars plana vitrectomy (PPV) in selected cases of retinal detachment with superior and inferior retinal breaks. MATERIAL AND METHODS: Fifty consecutive eyes of 50 patients affected by complicated retinal detachment with retinal breaks of the superior and inferior quadrants associated with proliferative vitreoretinopathy (PVR) of grade C2 or more, underwent a pars plana vitrectomy and a combination internal tamponade with 70% Densiron®-68 and 30% silicone oil. The main outcome measures were visual acuity, retinal attachment, intraocular pressure (IOP) and incidence of complications. RESULTS: The mean best-corrected visual acuity rose from 1.4 logMAR to 0.7 logMAR (P <0.01). Initial retinal reattachment was achieved in 48 (96%) patients. In 15 patients (30%), IOP increased over 21 mmHg. The main complications were redetachment at the 3 month follow-up in 12/48 cases (25%) and cataract formation in 13/21 phakic eyes (62%). CONCLUSION: This combination tamponade comprised lighter and heavier oil compounds was well tolerated and effective. It may be a useful tool for the treatment of retinal detachment complicated with breaks and PVR involving the upper and lower quadrants.

Ocular tolerance and efficacy of short-term tamponade with double filling of polydimethyloxane and perfluoro-n-octane.

OBJECTIVE: The aim of the study was to evaluate the ocular tolerance and efficacy of double filling with perfluoro-n-octane (n-C8F18) (PFO) and polydimethyloxane (PDMS) as a temporary vitreous substitute in patients with retinal detachment complicated by proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS: Tamponade was performed in 30 eyes of 30 patients by double filling with 30% PFO and 70% PDMS for an average of 23 (standard deviation 2.2) days. The follow-up visits were scheduled 1 week, 1 month, and 3 months after surgery. The main outcome measures were visual acuity, intraocular pressure (IOP), PVR reproliferation, and electrophysiological parameters. RESULTS: The primary success rate was 80% (24/30). Fourteen patients (46.7%) had a postoperative improvement in visual acuity, 12 patients (40.0%) maintained their preoperative visual acuity, and four patients (13.3%) experienced a reduction in visual acuity. The mean postoperative IOP was 19.7 mm Hg (11-32 mm Hg); nine cases (30.0%) developed an IOP increase that was treated with topical drops and/or systemic carbonic anhydrase inhibitors. The electroretinogram (ERG) and the bright flash electroretinogram (bf ERG) parameters showed a statistically significant difference of means between 4- and 8-week follow-up visits. CONCLUSION: Our experience with double filling in selected cases of retinal detachment has been positive. No electroretinographic signs of retinal toxicity and a low incidence of PVR reproliferation were observed.

Individualised treatment of proliferative diabetic retinopathy: optimal surgical timing improves long-term outcomes.

Ocular treatment of progressing proliferative diabetic retinopathy is based on retinal laser photocoagulation and pars plana vitrectomy. Improvements in instrumentation and advances in techniques and procedures have increased indications for vitrectomy. These include vitreous haemorrhage preventing laser photocoagulation, severe nonclearing vitreous haemorrhage, subhyaloid and premacular haemorrhage, tractional retinal detachment involving or threatening the macula, combined tractional and rhegmatogenous retinal detachment, progressive fibrovascular proliferation, clinically significant macular oedema and rubeosis iridis. Together with the increasing number of indications, timing for vitrectomy has also changed. The beneficial effect of early vitrectomy for these indications has been clinically shown and supported by several studies. The benefit is evident in case of type I diabetes and when the duration of the diabetes is less than 20 years. Long-term outcomes can therefore be improved when individualised treatment algorithms are applied.