OSLI Retina

May 2019

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274 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Perfluorodecalin Versus Densiron 68 Heavy Silicone Oil in the Management of Inferior Retinal Detachment Recurrence Tomaso Caporossi, MD; Ruggero Tartaro, MD; Lucia Finocchio, MD; Francesco Barca, MD; Fabrizio Giansanti, MD; Fabrizio Franco, MD; Stanislao Rizzo, MD BACKGROUND AND OBJECTIVE: To assess the effica- cy of perfluorodecalin (PFD) or Densiron 68 heavy silicone oil (HSO) in the management of inferior complex retinal detachment recurrence. PATIENTS AND METHODS: A retrospective, compara- tive consecutive case series study. Twenty-four eyes of 24 patients affected by inferior complex ret- inal detachment recurrence underwent pars plana vitrectomy with PFD or HSO as endotamponade. All patients recruited were affected by complicated inferior retinal detachments and had already un- dergone at least one vitreoretinal procedure. The primary endpoint was anatomical success with pri- mary and secondary surgery. The secondary end- points were functional outcome and inflammatory complications. RESULTS: Out of 24 cases of inferior retinal detach- ment recurrence, 12 were tamponed with PFD (PFD group) and 12 with HSO (D68 group). Retinal reat- tachment rate at first surgery was 50% for the D68 group and 66.6% for the PFD group. Final reattach- ment rate after two or more surgical operations was 91.6% for the PFD group and 83.3% for the D68 group. Best-corrected visual acuity improved in both groups from a mean of 1.00 logMAR (20/200; standard deviation [SD]: 1) to 0.60 logMAR (20/80; SD: 0.3), and from a mean of 1.81 logMAR (20/2000; SD: 1.1) to a mean of 2.00 logMAR (20/2,000; SD:1) for the PFD and D68 groups, respectively. CONCLUSION: Both the endotamponades used showed good results in solving inferior retinal de- tachment recurrence with a slightly better rate in the PFD group, but it was not statistically signifi- cant (P > .05). [Ophthalmic Surg Lasers Imaging Retina. 2019;50:274-280.] INTRODUCTION Inferior retinal detachment recurrence remains a challenge even for expert vitreoretinal surgeons. Pro- liferative vitreoretinopathy (PVR) remains the major complication associated with retinal detachment surgery and the main reason for unsatisfactory ana- tomical and functional outcomes. 1 Advanced infe- rior PVR can be managed with pars plana vitrectomy (PPV) and silicone oil, and moreover, a scleral buckle (SB) combined with PPV could also be carried out. Conventional lighter-than-water tamponades, such as standard silicone oil (SSO) or gas, support the superi- or retinal periphery and posterior pole; however, they do not tampon the lower retinal periphery, where a mixture of aqueous humor and growth factors ("PVR soup") may gather. Heavier-than-water intraocular tamponades have many advantages over convention- al tamponades, especially in the treatment of inferior retinal detachments with PVR of the lower-retinal pe- riphery. A heavy endotamponade can efficiently tam- ponade breaks and retinotomy in the lower periphery in the upright position. It interrupts open communi- cation between the subretinal space/retinal pigment epithelial (RPE) cells and the pre-retinal space, low- ering the risks of PVR development and a reopening of the break. It displaces the proliferative mixture of residual aqueous, inflammatory, and RPE cells away from the lower retina and the posterior pole. The tamponade effect at the posterior pole may lead to a faster and lasting reattachment of the macula. Re- detachments are likely to occur predominantly in the From the Department of Translational Surgery and Medicine, Ophthalmol- ogy, University of Florence, Careggi, Florence, Italy. Originally submitted July 27, 2018. Revision received October 5, 2018. Accepted for publication November 6, 2018. The authors report no relevant financial disclosures. Address correspondence to Tomaso Caporossi, MD, Azienda Ospedaliero- Universitaria Careggi, Largo Piero Palagi 1, Florence, Italy 50139; email: tomaso.caporossi@gmail.com. doi: 10.3928/23258160-20190503-03

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