Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy
Abstract
Background
Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery. During surgery, a tamponade agent is needed to reduce the rate of recurrent retinal detachment.
Objectives
The objective of this review was to evaluate the benefits and adverse outcomes of surgery with various tamponade agents.
Search methods
We searched the Cochrane Controlled Register (CENTRAL), MEDLINE, EMBASE, Latin America and Carribbean Health Sciences (LILACS) and the UK Clinical Trials Gateway (UKCTG). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 9 July 2009.
Selection criteria
We included randomized clinical trials comparing patients treated with various tamponade agents.
Data collection and analysis
Two individuals screened the search results independently. One study with two trials was eligible for inclusion in the review.
Main results
One study with two trials was included in the review. The first trial randomized 151 eyes to receive either silicone oil or sulfur hexafluoride (SF6) gas tamponades; the second trial randomized 271 eyes to receive either silicone oil or perfluropropane (C3F8) gas tamponades. In patients with RD associated with PVR, pars plana vitrectomy and infusion of either silicone oil or perfluropropane gas appear comparable for a broad variety of cases. Sulfur hexafluoride gas was associated with worse anatomic and visual outcomes than either silicone oil or perfluropropane gas.
Authors' conclusions
The use of either C3F8 or silicone oil appears reasonable for most patients with RD associated with PVR. Because there do not appear to be any major differences in outcomes between the two agents, the choice of a tamponade agent should be individualized for each patient.
PICOs
Plain language summary
Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy
Retinal detachment (RD) remains a significant cause of vision loss. Most recurrent RDs are associated with varying degrees of proliferative vitreoretinopathy (PVR), or the growth of fibrous membranes (similar to scar tissue) along the surface of the retina. The only proven therapy for RD with PVR is surgery. Injection of a tamponade agent is performed at the time of surgery to reduce the rate of fluid flow through open retinal tears, which would cause recurrent RD. The major tamponade agents available today are various gases and silicone oils. One study consisting of two independently randomized clinical trials was included in this review. The Silicone Study compared the use of silicone oil tamponades to either sulfur hexafluoride (SF6) gas or perfluropropane (C3F8) gas tamponades in patients undergoing surgery to treat RD associated with PVR. When silicone oil was compared to SF6 gas, eyes randomized to receive silicone oil were more likely to achieve a final visual acuity of 5/200 or better at one year, and more likely to achieve macular attachment at one year; both of these differences were statistically significant. When silicone oil was compared with C3F8 gas, there were no statistically significant differences between the groups with respect to visual acuity or macular attachment at one year. The use of either C3F8 gas or silicone oil appears to offer similar benefits, in terms of their ability to reattach the retina and to preserve or improve visual function.
