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Vitrectomy With Silicone Oil or Long-Acting Gas in Eyes With Severe Proliferative Vitreoretinopathy: Results of Additional and Long-term Follow-up: Silicone Study Report 11

Vitrectomy With Silicone Oil or Long-Acting Gas in Eyes With Severe Proliferative... Abstract Background: The Silicone Study evaluated the outcomes of vitreoretinal surgery for retinal detachment with proliferative vitreoretinopathy (PVR). Objective: To evaluate short-term (up to 36 months) outcomes in eyes randomized to silicone oil or perfluoropropane gas and long-term (up to 72 months) outcomes in eyes with attached maculas at 36 months. Design: Prospective, randomized, multicentered surgical trial. Setting: Community- and university-based vitreoretinal practices. Patients: Two-hundred sixty-five eyes with PVR randomized to perfluoropropane gas and silicone oil with follow-up through 3 years (cohort 1) and 249 eyes with attached maculas at 36 months (121 eyes randomized to long-acting gas [either sulfur hexafluoride or perfluoropropane] and 128 eyes randomized to silicone oil) with follow-up up to 6 years (cohort 2). Both cohorts consisted of eyes that had and had not undergone vitrectomy for PVR (groups 1 and 2, respectively) before randomization. Of the 265 eyes in cohort 1, 24-month follow-up data were available for 218 eyes (82%) and 36-month follow-up data were available for 196 eyes (74%). Of 208 eyes in cohort 2, 48-month follow-up data were available for 146 eyes (70%), 60-month follow-up data for 119 eyes (57%), and 72-month follow-up data for 73 eyes (35%). Interventions: Vitrectomy surgery for PVR with a long-acting gas or silicone oil as the intraocular tamponade. Main Outcome Measures: Changes in visual acuity, recurrent retinal detachment, and incidence of complications. Results: In group 1 of cohort 1, compared with oiltreated eyes, gas-treated eyes had a higher rate of complete retinal reattachment from 18 to 36 months (P<.05). No other differences were found. In group 2 of cohort 1, no notable differences were found between treatment arms. In cohort 2, during 6 years of follow-up, attachment of the macula was maintained for all eyes. No notable differences in the rates of complete retinal attachment, visual acuity of 5/200 or better, or glaucoma were found between treatment groups. In contrast, gastreated eyes had more hypotony (P<.001). Silicone oil—treated eyes that underwent subsequent surgery were more likely to have the oil retained (P=.02). Compared with oil-retained eyes, oil-removed eyes had higher rates of complete posterior attachment (P=.01) and of a visual acuity of 5/200 or better (P<.001) and less keratopathy (P<.05). Compared with oil-removed eyes, gas-treated eyes had a worse visual acuity outcome (P<.05) and more hypotony (P<.01). Conclusion: The Silicone Study showed that silicone oil and perfluoropropane gas were equal in most respects for the management of retinal detachments with PVR. Success in the first surgery for PVR is paramount for obtaining better visual results. Overall, surgery for PVR had a high likelihood of retinal reattachment, and if anatomically and visually successful at 3 years, there is an excellent chance that the results will be maintained over the long-term. References 1. The Silicone Study Group. Vitrectomy with silicone oil or sulfur hexafluoride gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial: Silicone Study Report 1 . Arch Ophthalmol . 1992;110:770-779.Crossref 2. The Silicone Study Group. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial: Silicone Study Report 2 . Arch Ophthalmol . 1992;110:780-792.Crossref 3. McCuen BW, Azen SP, Stern W, et al. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results in group 1 versus group 2 (Silicone Study Report 3) . Retina . 1993;13:279-284.Crossref 4. Barr CC, Lai MY, Lean JS, et al. Postoperative introcular pressure abnormalities in the Silicone Study (Silicone Study Report 4) . Ophthalmology . 1993;100:1629-1635.Crossref 5. Blumenkranz MS, Azen SP, Aaberg TM, et al. Relaxing retinotomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy (Silicone Study Report 5) . Am J Ophthalmology . 1993;116:557-564. 6. Hutton WL, Lee MBF, Blumenkranz MS, et al. The effects of silicone oil removal in the Silicone Study (Silicone Study Report 6) . Arch Ophthalmol . 1994;112:778-785.Crossref 7. Abrams GW, Azen SP, Barr CC, et al. The incidence of corneal abnormalties in the Silicone Study . Arch Ophthalmol . 1995;113:764-769.Crossref 8. Cox MS, Azen SP, Barr CC, et al. Macular pucker after succesful surgery for proliferative vitreoretinopathy (Silicone Study Report 8) . Ophthalmology . 1995;102:1884-1891.Crossref 9. Diddie KR, Azen SP, Freeman HM, et al. Anterior proliferative vitreoretinopathy in the Silicone Study (Silicone Study Report 10) . Ophthalmology . 1996;107:1092-1099.Crossref 10. Lean J, Azen SP, Lopez P, Qian D, Lai MY, McCuen B, for the Silicone Study Group. The prognostic utility of the Silicone Study classification system: Silicone Study Report 9 . Arch Ophthalmol . 1996;114:286-292.Crossref 11. Azen SP, Boone DC, Barlow W, et al. Methods, statistical features, and baseline results of a standardized, multicentered ophthalmologic surgical trial: the Silicone Study . Control Clin Trials . 1991;12:438-455.Crossref 12. Watzke RC. Silicone retinopiesis for retinal detachment: a long-term clinical evaluation . Arch Ophthalmol . 1967;77:185-196.Crossref 13. Leaver PK, Grey RHB, Garner A. Silicone oil injection in the treatment of massive preretinal retraction, II . Br J Ophthalmol . 1979;63:361-367.Crossref 14. Okun E. Intravitreal surgery utilizing liquid silicone: a long-term follow-up . Trans Pac Coast Oto-Ophthalmol Soc . 1968;49:141-159. 15. Cibis PA, Becker B, Okun E, Canaan S. The use of liquid silicone in retinal detachment surgery . Arch Ophthalmol . 1962;68:590-599.Crossref 16. Beekhuis WH, van Rij G, Zivojnovic R. Silicone oil keratopathy: indications for keratoplasty . Br J Ophthalmol . 1985;69:247-253.Crossref 17. Cockerham WD, Schepens CL, Freeman HM. Silicone injection in retinal detachment . Arch Ophthalmol . 1970;83:704-712.Crossref 18. Lee PF, Donovan RH, Mukai N, Schepens CL, Freeman HM. Intravitreous injection of silicone; an experimental study, I . Ann Ophthalmol . 1969;1:15-25. 19. Mukai N, Lee PF, Oguri M, Schepens CL. A long-term evaluation of silicone retinopathy in monkeys . Can J Ophthalmol . 1975;10:391-402. 20. Hanneken A, Michels RG. Vitrectomy and scleral buckling methods for proliferative vitreoretinopathy . Ophthalmology . 1988;95:865-869.Crossref 21. Glaser BM. Surgery for proliferative vitreoretinopathy . In: Ryan SJ, ed. Retina . 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1994:2265-2280. 22. Morse LS, McCuen BW. The use of silicone oil in uveitis and hypotony . Retina . 1991;11:399-404.Crossref 23. Nguyen QH, Lloyd MA, Heuer DK, et al. Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments . Ophthalmology . 1992;99:1520-1526.Crossref 24. Burk LL, Shields MB, Proia AD, McCuen BW. Intraocular pressure following intravitreal silicone oil injection . Ophthalmic Surg Lasers . 1988;19:565-569. 25. Riedel KG, Gabel VP, Neubauer L, Kampik A, Lund OE. Intravitreal silicone oil injection . Graefes Arch Clin Exp Ophthalmol . 1990;228:19-23.Crossref 26. Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery . Ophthalmology . 1988;95:870-876.Crossref 27. Nowack C, Lucke K, Laqua H. Removal of silicone oil in treatment of so-called emulsification glaucoma . Ophthalmologe . 1992;89:462-464. 28. Diekert JP, O'Connor PS, Schacklett DE, et al. Air travel and intraocular gas . Ophthalmology . 1986;93:642-645.Crossref 29. Hanscom TA, Diddie KR. Mountain travel and intraocular gas bubbles . Am J Ophthalmol . 1987;104:546. 30. Lincoff H, Weinberger D, Stergiu P. Air travel with intraocular gas, II: clinical considerations . Arch Ophthalmol . 1989;107:907-910.Crossref 31. Lean JS. Use of silicone oil as an additional technique in vitreoretinal surgery . In: Ryan SJ, ed. Retina . 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1994:2158-2159. 32. Lewis H, Burke JM, Abrams GW, Aaberg TM. Perisilicone proliferation after vitrectomy for proliferative vitreoretinopathy . Ophthalmology . 1988;95:583-591.Crossref 33. Machemer R, Norton EWD. A new concept for vitreous surgery, III: indications and results . Am J Ophthalmol . 1972;74:1034-1056. 34. Machemer R. Massive periretinal proliferation: a logical approach to therapy . Trans Am Ophthalmol Soc . 1978;75:556-580. 35. Sternberg P Jr, Machemer R. Results of conventional vitreous surgery for proliferative vitreoretinopathy . Am J Ophthalmol . 1985;100:141-146. 36. Lewis H, Aaberg TM. Causes of failure after repeat vitreoretinal surgery for severe proliferative vitreoretinopathy . Am J Ophthalmol . 1991;111:15-19. 37. Lewis H, Aaberg TM, Abrams GW, Causes of failure after initial vitreoretinal surgery for severe proliferative vitreoretinopathy . Am J Ophthalmol . 1991;11:8-14. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Vitrectomy With Silicone Oil or Long-Acting Gas in Eyes With Severe Proliferative Vitreoretinopathy: Results of Additional and Long-term Follow-up: Silicone Study Report 11

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References (44)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150337005
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Abstract

Abstract Background: The Silicone Study evaluated the outcomes of vitreoretinal surgery for retinal detachment with proliferative vitreoretinopathy (PVR). Objective: To evaluate short-term (up to 36 months) outcomes in eyes randomized to silicone oil or perfluoropropane gas and long-term (up to 72 months) outcomes in eyes with attached maculas at 36 months. Design: Prospective, randomized, multicentered surgical trial. Setting: Community- and university-based vitreoretinal practices. Patients: Two-hundred sixty-five eyes with PVR randomized to perfluoropropane gas and silicone oil with follow-up through 3 years (cohort 1) and 249 eyes with attached maculas at 36 months (121 eyes randomized to long-acting gas [either sulfur hexafluoride or perfluoropropane] and 128 eyes randomized to silicone oil) with follow-up up to 6 years (cohort 2). Both cohorts consisted of eyes that had and had not undergone vitrectomy for PVR (groups 1 and 2, respectively) before randomization. Of the 265 eyes in cohort 1, 24-month follow-up data were available for 218 eyes (82%) and 36-month follow-up data were available for 196 eyes (74%). Of 208 eyes in cohort 2, 48-month follow-up data were available for 146 eyes (70%), 60-month follow-up data for 119 eyes (57%), and 72-month follow-up data for 73 eyes (35%). Interventions: Vitrectomy surgery for PVR with a long-acting gas or silicone oil as the intraocular tamponade. Main Outcome Measures: Changes in visual acuity, recurrent retinal detachment, and incidence of complications. Results: In group 1 of cohort 1, compared with oiltreated eyes, gas-treated eyes had a higher rate of complete retinal reattachment from 18 to 36 months (P<.05). No other differences were found. In group 2 of cohort 1, no notable differences were found between treatment arms. In cohort 2, during 6 years of follow-up, attachment of the macula was maintained for all eyes. No notable differences in the rates of complete retinal attachment, visual acuity of 5/200 or better, or glaucoma were found between treatment groups. In contrast, gastreated eyes had more hypotony (P<.001). Silicone oil—treated eyes that underwent subsequent surgery were more likely to have the oil retained (P=.02). Compared with oil-retained eyes, oil-removed eyes had higher rates of complete posterior attachment (P=.01) and of a visual acuity of 5/200 or better (P<.001) and less keratopathy (P<.05). Compared with oil-removed eyes, gas-treated eyes had a worse visual acuity outcome (P<.05) and more hypotony (P<.01). Conclusion: The Silicone Study showed that silicone oil and perfluoropropane gas were equal in most respects for the management of retinal detachments with PVR. Success in the first surgery for PVR is paramount for obtaining better visual results. Overall, surgery for PVR had a high likelihood of retinal reattachment, and if anatomically and visually successful at 3 years, there is an excellent chance that the results will be maintained over the long-term. References 1. The Silicone Study Group. Vitrectomy with silicone oil or sulfur hexafluoride gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial: Silicone Study Report 1 . Arch Ophthalmol . 1992;110:770-779.Crossref 2. The Silicone Study Group. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial: Silicone Study Report 2 . Arch Ophthalmol . 1992;110:780-792.Crossref 3. McCuen BW, Azen SP, Stern W, et al. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results in group 1 versus group 2 (Silicone Study Report 3) . Retina . 1993;13:279-284.Crossref 4. Barr CC, Lai MY, Lean JS, et al. Postoperative introcular pressure abnormalities in the Silicone Study (Silicone Study Report 4) . Ophthalmology . 1993;100:1629-1635.Crossref 5. Blumenkranz MS, Azen SP, Aaberg TM, et al. Relaxing retinotomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy (Silicone Study Report 5) . Am J Ophthalmology . 1993;116:557-564. 6. Hutton WL, Lee MBF, Blumenkranz MS, et al. The effects of silicone oil removal in the Silicone Study (Silicone Study Report 6) . Arch Ophthalmol . 1994;112:778-785.Crossref 7. Abrams GW, Azen SP, Barr CC, et al. The incidence of corneal abnormalties in the Silicone Study . Arch Ophthalmol . 1995;113:764-769.Crossref 8. Cox MS, Azen SP, Barr CC, et al. Macular pucker after succesful surgery for proliferative vitreoretinopathy (Silicone Study Report 8) . Ophthalmology . 1995;102:1884-1891.Crossref 9. Diddie KR, Azen SP, Freeman HM, et al. Anterior proliferative vitreoretinopathy in the Silicone Study (Silicone Study Report 10) . Ophthalmology . 1996;107:1092-1099.Crossref 10. Lean J, Azen SP, Lopez P, Qian D, Lai MY, McCuen B, for the Silicone Study Group. The prognostic utility of the Silicone Study classification system: Silicone Study Report 9 . Arch Ophthalmol . 1996;114:286-292.Crossref 11. Azen SP, Boone DC, Barlow W, et al. Methods, statistical features, and baseline results of a standardized, multicentered ophthalmologic surgical trial: the Silicone Study . Control Clin Trials . 1991;12:438-455.Crossref 12. Watzke RC. Silicone retinopiesis for retinal detachment: a long-term clinical evaluation . Arch Ophthalmol . 1967;77:185-196.Crossref 13. Leaver PK, Grey RHB, Garner A. Silicone oil injection in the treatment of massive preretinal retraction, II . Br J Ophthalmol . 1979;63:361-367.Crossref 14. Okun E. Intravitreal surgery utilizing liquid silicone: a long-term follow-up . Trans Pac Coast Oto-Ophthalmol Soc . 1968;49:141-159. 15. Cibis PA, Becker B, Okun E, Canaan S. The use of liquid silicone in retinal detachment surgery . Arch Ophthalmol . 1962;68:590-599.Crossref 16. Beekhuis WH, van Rij G, Zivojnovic R. Silicone oil keratopathy: indications for keratoplasty . Br J Ophthalmol . 1985;69:247-253.Crossref 17. Cockerham WD, Schepens CL, Freeman HM. Silicone injection in retinal detachment . Arch Ophthalmol . 1970;83:704-712.Crossref 18. Lee PF, Donovan RH, Mukai N, Schepens CL, Freeman HM. Intravitreous injection of silicone; an experimental study, I . Ann Ophthalmol . 1969;1:15-25. 19. Mukai N, Lee PF, Oguri M, Schepens CL. A long-term evaluation of silicone retinopathy in monkeys . Can J Ophthalmol . 1975;10:391-402. 20. Hanneken A, Michels RG. Vitrectomy and scleral buckling methods for proliferative vitreoretinopathy . Ophthalmology . 1988;95:865-869.Crossref 21. Glaser BM. Surgery for proliferative vitreoretinopathy . In: Ryan SJ, ed. Retina . 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1994:2265-2280. 22. Morse LS, McCuen BW. The use of silicone oil in uveitis and hypotony . Retina . 1991;11:399-404.Crossref 23. Nguyen QH, Lloyd MA, Heuer DK, et al. Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments . Ophthalmology . 1992;99:1520-1526.Crossref 24. Burk LL, Shields MB, Proia AD, McCuen BW. Intraocular pressure following intravitreal silicone oil injection . Ophthalmic Surg Lasers . 1988;19:565-569. 25. Riedel KG, Gabel VP, Neubauer L, Kampik A, Lund OE. Intravitreal silicone oil injection . Graefes Arch Clin Exp Ophthalmol . 1990;228:19-23.Crossref 26. Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery . Ophthalmology . 1988;95:870-876.Crossref 27. Nowack C, Lucke K, Laqua H. Removal of silicone oil in treatment of so-called emulsification glaucoma . Ophthalmologe . 1992;89:462-464. 28. Diekert JP, O'Connor PS, Schacklett DE, et al. Air travel and intraocular gas . Ophthalmology . 1986;93:642-645.Crossref 29. Hanscom TA, Diddie KR. Mountain travel and intraocular gas bubbles . Am J Ophthalmol . 1987;104:546. 30. Lincoff H, Weinberger D, Stergiu P. Air travel with intraocular gas, II: clinical considerations . Arch Ophthalmol . 1989;107:907-910.Crossref 31. Lean JS. Use of silicone oil as an additional technique in vitreoretinal surgery . In: Ryan SJ, ed. Retina . 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1994:2158-2159. 32. Lewis H, Burke JM, Abrams GW, Aaberg TM. Perisilicone proliferation after vitrectomy for proliferative vitreoretinopathy . Ophthalmology . 1988;95:583-591.Crossref 33. Machemer R, Norton EWD. A new concept for vitreous surgery, III: indications and results . Am J Ophthalmol . 1972;74:1034-1056. 34. Machemer R. Massive periretinal proliferation: a logical approach to therapy . Trans Am Ophthalmol Soc . 1978;75:556-580. 35. Sternberg P Jr, Machemer R. Results of conventional vitreous surgery for proliferative vitreoretinopathy . Am J Ophthalmol . 1985;100:141-146. 36. Lewis H, Aaberg TM. Causes of failure after repeat vitreoretinal surgery for severe proliferative vitreoretinopathy . Am J Ophthalmol . 1991;111:15-19. 37. Lewis H, Aaberg TM, Abrams GW, Causes of failure after initial vitreoretinal surgery for severe proliferative vitreoretinopathy . Am J Ophthalmol . 1991;11:8-14.

Journal

Archives of Ophthalmology – American Medical Association

Published: Mar 1, 1997

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