January 08, 2020
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Endoscopy-assisted PPV improves retinal reattachment rate after silicone oil removal

Endoscopy helped to visualize findings not possible to identify with a traditional wide-field visualization system during pars plana vitrectomy.

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More than 96% of patients who underwent endoscopy-assisted pars plana vitrectomy for silicone oil removal after proliferative vitreoretinopathy-related retinal detachment repair experienced a successful retinal reattachment, according to the results of a retrospective study.

The rate of retinal detachment after silicone oil removal is relatively high, so by using endoscopy the researchers were able to visualize findings not possible with a traditional pars plana vitrectomy system, study co-author Natalia Vila, MD, PhD, FEBO, said.

“Endoscopy-assisted vitrectomy enables physicians to have access to the retroiridal space and identify possible potential causes of re-detachment after silicone oil removal in retinal detachments,” Vila told Ocular Surgery News.

Re-detachment rates can vary

Persistent proliferative vitreoretinopathy (PVR) remains one of the main risk factors for retinal re-detachment after silicone oil removal, with rates of removal ranging between 3% and 30% of patients. Researchers evaluated intraoperative findings during silicone oil removal and postoperative anatomical outcomes comparing endoscopy-assisted pars plana vitrectomy (E-PPV) with pars plana vitrectomy (PPV) alone after PVR-related retinal detachment.

The study included 54 eyes of 54 patients who underwent silicone oil removal after retinal detachment with PVR repair. E-PPV combined with a wide-angle visualization system (E2 MicroProbe, Endo Optiks) was performed in 26 patients, and 28 patients underwent PPV alone.

The intraoperative management was changed in 17 patients in the E-PPV group based on endoscopic revision performed during the surgical procedure, the most common of which was the extension of previous retinectomy in 50% of these patients followed by anterior peeling of the PVR in 23.1%.

All eyes in the E-PPV group had residual silicone oil droplets trapped in the anterior vitreous base, in between ciliary processes and in the posterior chamber. Drops were located between the anterior zonular fibers and the posterior iris surface. Using endoscopy during silicone oil removal can assure removal of more residual droplets trapped anteriorly, according to the study.

E-PPV improved attachment rate

The rate of retinas remaining attached after silicone oil removal in the E-PPV group was 96.2%, a statistically significant difference compared with the 73% rate in the PPV group (P = .03). The Kaplan-Meier estimated time to retinal re-detachment was significantly longer in the E-PPV group at 38.6 months compared with 30.8 months in the PPV group (P = .038).

“The rate of re-detachment after silicone oil removal is relatively high. It could mean that we are not identifying some of the problems during the surgery. Using endoscopy, we identified findings that we would not have seen with the traditional system, and it actually changed the intraoperative management,” Vila said.

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Vila noted the E-PPV procedures were endoscopy assisted, not endoscopy guided. Endoscopy-guided procedures are typically used when the cornea is opaque and the endoscope is used to see inside the eye. Endoscopy-assisted procedures are used with wide-field visualization when the cornea is clear, allowing the user to have the camera behind the iris to give a completely different view.

“Currently, the only technique that allows us to have access to the retroiridal space is endoscopy,” Vila said. – by Robert Linnehan

Disclosures: The authors report no relevant financial disclosures.