The principal finding of our study was that the use of a long-acting gas (C3F8) as an alternative tamponade agent in retinectomy provides encouraging results for severe cases of PVR, avoiding potential complications of silicone oil.
Retinectomy is typically considered a technique of ‘last resort’ and is usually used when previous surgery has failed and the existence of PVR is so extended that removal of ERMs is technically impossible, as retinal shortening is significant . When PVR is mainly located in the inferior retina, usually two options are present before considering retinectomy: either removal of the membranes and use of heavy silicone oil, or combine the vitrectomy with an external buckle technique. One can consider the above; however, given the reduction, on one hand, in buckling procedures as vitrectomy is essentially more commonly performed hence potentially lack of experience, while on the other the use of heavy silicone oil is as well less used due to its side effects, the sacrifice of the peripheral retina appears as the best option to achieve anatomical success . Silicone oil of various viscosities has been typically employed as a tamponading agent, providing a long-term tamponade. However, silicon oil has been associated with a great variety of complications and an additional surgery for its removal .
The surgical technique of retinectomy and laser photocoagulation of the retinal edge does not differ from the usual method of dealing with a mobilised rhegmatogenous retinal detachment (RRD) once all PVR elements have been eliminated. Therefore, the need for a long-term tamponade in excess of 4–6 weeks should not be needed. In addition, the surface tension of gas vs. oil is higher, and intravitreal gas will provide a better tamponade for the duration that is required for a full retinal adhesion . Given that gas is self-resorbing, further surgery to remove the tamponading agent is not necessary. The silicone oil study reported no difference in outcome between silicone oil and C3F8 in eyes that had retinotomies of various sizes . Our study showed that the primary success rate post retinectomy was 75%, and 83.3% after a second similar procedure at a mean follow up of 9.8 months (range 4–30). In the largest published series of 304 patients, the primary anatomical success after oil removal was 51.1%, and final success was in 72% of the cases , while the primary anatomical success rate in various smaller series ranged from 51% to 93% [2, 7,8,9,10].
It is also worth noting that there was a discrepancy between the anatomical and the structural outcomes in our series. Visual acuity was found to be low due to the macular status preoperatively with the presence of detachment in all cases, as well as due to the chronicity of the retinal detachment in the majority of cases. Also of note was that one patient had a preexisting macular hole. Moreover, an ERM was present postoperatively in four cases (33%), which is a common finding even after use of silicone oil. Two patients subsequently underwent a peeling procedure with visual improvement.
Potential limitations of this study pertain to its retrospective nature, to the lack of a control group and to the small sample size. Therefore, the results of this study should be interpreted taking into account the above-mentioned limitations.