First Author: N.Vila CANADA
Co Author(s): R. Ajlan A. Dirani F. Rezende
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To identify intraoperative treatable findings associated with risk of redetachment during silicone oil removal surgery using endoscopy-assisted pars plana vitrectomy (E-PPV). This study was designed to determine if the use of E-PPV, which enables a 360° vitreous cavity evaluation, adds a benefit during oil removal to prevent recurrence post-surgery.
Single-centre retrospective study – Hôpital Maisonneuve-Rosemont (Université de Montréal).
Medical records and surgical OR reports of 32 consecutive eyes were reviewed. Patients who underwent vitrectomy for silicone oil removal after rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) between July 2009 and January 2017 were included. Diabetic tractional detachments and ocular trauma were excluded. After 2013, endoscopic visualization system (E2 MicroProbe™; EndoOptiks, Little Silver,USA) was used alone or in combination with the wide-angle viewing system in a non-randomized fashion. Data collection included reattachment rate at final follow up, intraoperative endoscopic findings and phthisis rate. E-PPV group and PPV only group were compared using Chi-square or Fisher’s exact test.
Thirty-two eyes of 31 patients were included. The median participant age was 63 years old (range 23 – 78) and 71.9% (n=23) were males. The median follow up post oil removal was 17 months. E-PPV was performed in 59.3% (n=19) of the patients; 94.7% (n=18) of the cases were performed in combination with the wide-angle visualization system. The intraoperative surgical management was modified after endoscopy examination in 57.9% (n=11) of the cases. Additional benefits during E-PPV were the following: extension of retinectomy (n=4), anterior hyaloid / vitreous base peeling (n=2), anterior PVR peeling (n=2), dissection ciliary body traction and capsular fibrosis connections (n=1) and overcoming media opacity (n=2). Reattachment at final follow up in E-PPV was 100% and 72.7% in PPV only group (p = 0.05). No phthisis was observed in the E-PPV group while 18.2% (n =2) occurred in the non-endoscopy group (p = 0.15).
Endoscopy-assisted vitrectomy seems to be advantageous to prevent recurrence in retinal detachment after oil removal and eliminate evolution to phthisis. A thorough examination is facilitated by endoscopic visualization and contributory factors for anterior PVR can be identified and treated. Better accessibility and visualization might be an adjunct in the evaluation and management of complicated retinal detachments.