Advertisement

Deferred laser photocoagulation of relaxing retinotomies under silicone oil tamponade to reduce recurrent macular detachment in severe proliferative vitreoretinopathy

  • Marc VeckeneerEmail author
  • Kristel Maaijwee
  • David G Charteris
  • Jan C. van Meurs
Retinal Disorders

Abstract

Purpose

This study sought to investigate whether, in patients with retinal detachment complicated by proliferative vitreoretinopathy, we can re-attach the retina with a posterior relaxing retinotomy and silicone oil tamponade while postponing laser retinopexy for several months.

Methods

In 13 consecutive patients we applied laser coagulation of the retinotomy edge 15 ± 12 weeks after surgery. Silicone oil was removed 9 ± 6 weeks after laser application.

Results

After the retinotomy without laser, some degree of central shifting was seen in all patients, followed by obvious curling in 10 patients. The total follow-up was 24 ± 7 months after retinotomy and 13 ± 9 months after oil removal. The retina was attached in 12 patients at the last visit, with the oil still in situ in three patients. Seven patients, however, required additional surgery. Function remained stable with a mean preoperative and postoperative Snellen visual acuity of 0.09.

Conclusions

Not anchoring retinotomy edges with a laser at the time of surgery allows inward curling and central slippage of retinal edges under silicone oil. This appears to compensate for the retinal fibrosis occurring in the weeks following surgery and may result in less macula-off re-detachments under oil, and potentially, in better visual outcome.

Keywords

Inferior retinotomy Laser photocoagulation Retinal detachment Vitreoretinopathy 

References

  1. 1.
    Leiderman YI, Miller JW (2009) Proliferative vitreoretinopathy: pathobiology and therapeutic targets. Semin Ophthalmol 24:62–69PubMedCrossRefGoogle Scholar
  2. 2.
    Fekrat S, De Juan E Jr, Campochiaro PA (1995) The effect of oral 13-cis-retinoic acid on retinal redetachment after surgical repair in eyes with proliferative vitreoretinopathy. Ophthalmology 102:412–418PubMedCrossRefGoogle Scholar
  3. 3.
    Williams RG, Chang S, Comaratta MR, Simoni G (1996) Does the presence of heparin and dexamethasone in the vitrectomy infusate reduce reproliferation in proliferative vitreoretinopathy? Graefes Arch Clin Exp Ophthalmol 234:496–503PubMedCrossRefGoogle Scholar
  4. 4.
    Wiedemann P, Hilgers RD, Bauer P, Heimann K (1998) Adjunctive daunorubicin in the treatment of proliferative vitreoretinopathy: results of a multicenter clinical trial. Daunomycin Study Group. Am J Ophthalmol 126:550–559PubMedCrossRefGoogle Scholar
  5. 5.
    Asaria RH, Kon CH, Bunce C, Charteris DG, Wong D, Khaw PT (2001) PT Adjuvant 5-fluorouracil and heparin prevents proliferative vitreoretinopathy : Results from a randomized, double-blind, controlled clinical trial. Ophthalmology 108:1179–1183PubMedCrossRefGoogle Scholar
  6. 6.
    Charteris DG, Aylward GW, Wong D, Groenewald C, Asaria RH, Bunce C (2004) A randomized controlled trial of combined 5-fluorouracil and low-molecular-weight heparin in management of established proliferative vitreoretinopathy. Ophthalmology 111:2240–2245PubMedCrossRefGoogle Scholar
  7. 7.
    Wickham L, Bunce C, Wong D, Mc Gurn D, Charteris DG (2007) Randomized controlled trial of combined 5-Fluorouracil and low-molecular-weight heparin in the management of unselected rhegmatogenous retinal detachments undergoing primary vitrectomy. Ophthalmology 114:698–704PubMedCrossRefGoogle Scholar
  8. 8.
    Joussen AM, Rizzo S, Kirchhof B, Schrage N, Li X, Lente C et al (2011) Heavy silicone oil versus standard silicone oil in as vitreous tamponade in inferior PVR (HSO Study): interim analysis. Acta Ophthalmol 89:483–489CrossRefGoogle Scholar
  9. 9.
    Kirchhof B (2004) Strategies to influence PVR development. Graefes Arch Clin Exp Ophthalmol 242:699–703PubMedCrossRefGoogle Scholar
  10. 10.
    Sato Y, Berkowitz BA, Wilson CA, De Juan E Jr (1992) Blood-retinal barrier breakdown caused by diode vs argon laser endophotocoagulation. Arch Ophthalmol 110:277–281PubMedCrossRefGoogle Scholar
  11. 11.
    Smiddy WE, Fine SL, Quigley HA, Dunkelberger G, Hohman RM, Addicks EM (1986) Cell proliferation after laser photocoagulation in primate retina. An autoradiographic study. Arch Ophthalmol 104:1065–1069PubMedCrossRefGoogle Scholar
  12. 12.
    Zivojnovic R, Mertens DA, Peperkamp E (1982) Liquid silicone in amotio surgery (II). Report on 280 cases - further development of the technic. Klin Monbl Augenheilkd 181:444–452PubMedCrossRefGoogle Scholar
  13. 13.
    de Silva DJ, Kwan A, Bunce C, Bainbridge J (2008) Predicting visual outcome following retinectomy for retinal detachment. Br J Ophthalmol 92:954–958PubMedCrossRefGoogle Scholar
  14. 14.
    Charteris DG, Downie J, Aylward GW, Sethi C, Luthert P (2007) Intraretinal and periretinal pathology in anterior proliferative vitreoretinopathy. Graefes Arch Clin Exp Ophthalmol 245:93–100PubMedCrossRefGoogle Scholar
  15. 15.
    Hagimura N, Suto K, Iida T, Kishi S (2000) Optical coherence tomography of the neurosensory retina in rhegmatogenous retinal detachment. Am J Ophthalmol 129:186–190PubMedCrossRefGoogle Scholar
  16. 16.
    Nakanishi H, Hangai M, Unoki N, Sakamoto A, Tsujikawa A, Kita M, Yoshimura N (2009) Spectral-domain optical coherence tomography imaging of the detached macula in rhegmatogenous retinal detachment. Retina 29:232–242PubMedCrossRefGoogle Scholar
  17. 17.
    Gupta B, Mokete B, Laidlaw DA, Williamson TH (2008) Severe folding of the inferior retina after relaxing retinectomy for proliferative vitreoretinopathy. Eye 22:1517–1519PubMedCrossRefGoogle Scholar
  18. 18.
    Mietz H, Heimann K (1995) Onset and recurrence of proliferative vitreoretinopathy in various vitreoretinal disease. Br J Ophthalmol 79:874–877PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Lewis GP, Charteris DG, Sethi CS, Fisher SK (2002) Animal models of retinal detachment and reattachment: identifying cellular events that may affect visual recovery. Eye 16:375–387PubMedCrossRefGoogle Scholar
  20. 20.
    Yoon YH, Marmor MF (1988) Rapid enhancement of retinal adhesion by laser photocoagulation. Ophthalmology 95:1385–1388PubMedCrossRefGoogle Scholar
  21. 21.
    Veckeneer M, van Overdam K, Bouwens D, Feron E, Mertens D, Peperkamp E, Ringens P, Mulder P, Van Meurs J (2001) Randomized clinical trial of cryotherapy versus laser photocoagulation for retinopexy in conventional retinal detachment surgery. Am J Ophthalmol 1323:343–347CrossRefGoogle Scholar
  22. 22.
    Charles S (2013) Principles and techniques of vitreoretinal surgery. In: Ryan S. (ed) Retina, 5th edn, vol III, Elsevier, pp1706Google Scholar
  23. 23.
    Angunawela RI, Azarbadegan A, Aylward GW, Eames I (2011) Intraocular fluid dynamics and retinal shear stress after vitrectomy and gas tamponade. Invest Ophthalmol Vis Sci 52:7046–7051PubMedCrossRefGoogle Scholar
  24. 24.
    van Zeeburg EJ, Maaijwee K, van Meurs JC (2013) There is no relation between the occurrence of proliferative vitreoretinopathy and the location of the donor site after transplantation of a free autologous retinal pigment epithelium-choroid graft. Acta Ophthalmol. doi: 10.1111/aos.12178 PubMedGoogle Scholar
  25. 25.
    Blumenkranz M, Hernandez E, Ophir A, Norton EW (1984) 5-fluorouracil: new applications in complicated retinal detachment for an established antimetabolite. Ophthalmology 91:122–130PubMedCrossRefGoogle Scholar
  26. 26.
    de Bustros S, Michels RG (1984) Surgical treatment of retinal detachments complicated by proliferative vitreoretinopathy. Am J Ophthalmol 98:694–699PubMedCrossRefGoogle Scholar
  27. 27.
    Jalkh AE, Schepens CL (1985) Results of conventional vitreous surgery for proliferative vitreoretinopathy. Am J Ophthalmol 100:858–859PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Marc Veckeneer
    • 1
    Email author
  • Kristel Maaijwee
    • 1
  • David G Charteris
    • 2
  • Jan C. van Meurs
    • 1
    • 3
  1. 1.The Rotterdam Eye HospitalRotterdamThe Netherlands
  2. 2.Moorfield’s Eye HospitalLondonUnited Kingdom
  3. 3.Erasmus University Medical CenterRotterdamThe Netherlands

Personalised recommendations