Endoscopy-Assisted Vitrectomy Outcomes During Silicone Oil Removal After Complex Retinal Detachment Repair

Abstract

Purpose: This retrospective study recorded intraoperative findings during silicone oil removal and postoperative anatomical outcomes comparing endoscopy-assisted pars plana vitrectomy (E-PPV) vs pars plana vitrectomy (PPV) alone after proliferative vitreoretinopathy (PVR)-related retinal detachment (RD) repair. Methods: This single-center retrospective study included patients who underwent PPV for silicone oil removal after RD with PVR from July 2009 to January 2017. Patients with diabetic tractional RD, history of trauma, uveitis, or endophthalmitis were excluded. After 2013, an endoscopic visualization system (E2 MicroProbe; Endo Optiks) was used in a nonrandomized fashion. Data collection included reattachment rate, intraoperative endoscopic findings and phthisis rate. Results: Fifty-four eyes of 54 patients were included. The mean participant age was 58.4 ± 12.9 years and 36 (65.5%) participants were male. The mean (± SD) follow-up duration after oil removal was 24.3 ± 20.1 months. E-PPV combined with wide-angle visualization system was performed in 26 (48.1%) of the patients; the surgical management was modified after endoscopic examination in 17 (65.4%) of the cases. Reattachment rate in the E-PPV group was 96.2% compared with 76.0% in the PPV-alone group ( P = .04). Conclusions: E-PPV for silicone oil removal appears to be advantageous for prevention of RD recurrence, thus achieving better reattachment rates. A thorough examination is facilitated by endoscopic visualization and contributory factors for anterior PVR can be identified and treated.

Endoscopy-assisted vitrectomy vs. vitrectomy alone: comparative study in complex retinal detachment with proliferative vitreoretinopathy

“…These findings could explain why in cases of posterior PVR the reattachment rate was higher in the E-PPV group. In addition, as seen in one of our previous studies [ 15 ], during silicone oil removal the most common intraoperative endoscopy finding was contraction of previous retinectomy in patients with anterior and/or posterior PVR.…”

Heads-up 3-Dimensional Visualization to Enhance Video Endoscopy During Vitreoretinal Surgery

“…17,[20][21][22][23] A recent retro spective study of 33 eyes with endophthalmitis managed with endoscopicassisted vitrectomy suggested that the use of the modality allowed for earlier intervention in cases with poor visualization, which likely reduces the organism load and helps contain the infection. 24 In RD repair, endoscopy is useful, 25 with some studies suggesting improvement in outcomes 26,27 and visualization of retinal breaks. 28 A retrospective study of 101 eyes found that endoscopyassisted vitrectomy achieved better reattachment rates in complex RD and advanced proliferative vitreoretinopa thy (PVR), 26 likely as a result of improved visualization of pathologic structures.…”

“…Another retrospective study of 54 eyes found that during silicone oil removal, a change from surgical to endoscopic management in 65.4% of cases was associated with a higher reattachment rate. 27 Endoscopy has been used to guide epiretinal membrane peeling 29 in cases of retained lens fragments, a dislocated lens, or retained silicone oil 30 and is useful during PVR removal. [31][32][33][34] In cases of a large subretinal hemorrhage and fibrovascular pigment epithelial detachment, including choroidal neovascu larization, endoscopy can be used for hemorrhage removal without the need for a large retinotomy.…”

“…51,52 Last, our understanding of the impact of endoscopy on vit reoretinal surgery is largely based on case reports and case series, 20,37 with only a small number of comparative studies, all of which have been retrospective but with promising results. 19,[26][27][28] More retrospective comparative studies with larger samples across a variety of surgical cases as well as a prospective multicenter study would be helpful in evaluating how ophthalmic endoscopy affects surgical decisionmaking, operative time, education, and visual and anatomic outcomes. Some studies have suggested that 3D visualization decreases case duration and improves outcomes compared with tradi tional microscopic surgery, [11][12][13][14] while other comparative studies found similar outcomes but no significant differences.…”