Transcript Vitrectomy and silicone oil infusion in severe diabetic

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
Purpose
To determine the results of pars plana vitrectomy
(PPV) and silicone oil infusion (SOI) in severe
proliferative diabetic retinopathy (PDR).
Methods
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The records of 22 eyes (18 patients) with PDR who had undergone
PPV and SOI were reviewed retrospectively.
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Average follow-up was 5.2 months (range 1-18 months).
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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.

A complexity score (range: 1 – 7) was defined to grade the complexity
of membrane dissection.
Complexity score
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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).
Demographics
Age 53.6 (Range 21-82)
61%
44%
56%
39%
Males (10)
Females (8)
Hispanics (7)
African Americans (11)
Surgical indications
5%
5%
14%
40%
27%
9%
TRD
TRD+VH+NVG
TRD+RRD
TRD+NVG
TRD+VH
TRD+FS
Cases per complexity score
6
5
4
eyes 3
2
1
0
1
2
3
4
5
6
complexity score (Average=4.5)
7

In 10 eyes (46%), SOI
was part of the initial
operation.
 In 12 eyes (54%), SOI
was performed after
previous failed PPV.
43%
57%
First time PPV
SOI after failed PPV

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.
Anatomic Outcomes
Anatomic success of the study was defined as a complete attachment of the retina posterior to
the equator or to the scleral buckle, if present.
32%
68%
Flat (15/22)
Detached (7/22)
Anatomic Outcomes
First time PPV with
SOI (CS=4.5)
SOI after previous failed
PPV (CS=4.5)
33%
30%
70%
Flat (7/10)
Detached (3/10)
67%
Flat (8/12)
Detached (4/12)
Postoperative Visual Acuity
14%
41%
45%
improved
worsened
no changes
Postoperative

Rubeosis iridis (RI) was present preoperatively in 4
eyes, 2 of which had NVG.
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Postoperatively, 3 of 4 eyes had regressed RI. No eye
had postoperative NVG.
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Only one eye developed RI postoperatively.
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SO was removed in 2 eyes (9%), at 5 months and 8
months respectively, without complication.
Postoperative complications
1
2
2
1
1
Band Keratopathy (2/22)
SO in A/C (1/22)
Rubeosis (1/22)
Cataract (1/22)
Fibrinoid syndrome (2/22)
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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 (> 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 (P<0.0058).
Conclusions
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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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