DefinePK

Research Objective

To evaluate the incidence of retinal redetachment after removal of silicone oil (ROSO) in patients with rhegmatogenous retinal detachment (RRD) treated via pars plana vitrectomy (PPV), comparing outcomes between those treated with 360-degree laser retinopexy and focal laser retinopexy.

Methodology

This retrospective study included 65 patients with primary RRD treated with PPV and silicone oil tamponade. Patients were divided into two groups: Group A (33 patients) who received 360-degree laser retinopexy, and Group B (32 patients) who underwent focal laser retinopexy. Data collected included demographics, baseline visual acuity, extent of RRD, PVR, duration of silicone oil tamponade, and intraoperative details. Outcomes analyzed included the incidence of retinal redetachment after ROSO and visual acuity. Statistical analyses included chi-square and logistic regression.

Methodology Flowchart

                        graph TD;
    A[Identify RRD Patients for PPV with Silicone Oil] --> B[Retrospective Data Collection];
    B --> C[Divide Patients into Groups];
    C --> D[Group A: 360-degree Laser Retinopexy];
    C --> E[Group B: Focal Laser Retinopexy];
    D --> F[Perform PPV and Silicone Oil Tamponade];
    E --> F;
    F --> G[Silicone Oil Removal ROSO];
    G --> H[Monitor for Retinal Redetachment and Visual Acuity];
    H --> I[Statistical Analysis Chi-square, Logistic Regression];
    I --> J[Compare Outcomes Between Groups];
    J --> K[Draw Conclusions];                    

Discussion

The study suggests that 360-degree laser retinopexy provides superior prophylaxis against redetachment by creating a continuous peripheral barrier, leading to better anatomical stabilization and improved visual outcomes compared to focal laser retinopexy. This technique is effective and safe, particularly in high-risk cases, and does not appear to increase the incidence of complications like macular edema or epiretinal membrane formation.

Key Findings

The incidence of retinal redetachment was significantly lower in the 360-degree laser retinopexy group (6.1%) compared to the focal laser retinopexy group (28.1%) (p = 0.03). Postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better in the 360-degree laser group (0.8 ± 0.2 logMAR) than in the focal laser group (1.1 ± 0.3 logMAR) (p = 0.04). Risk factors for redetachment included PVR Grade C or higher, focal laser retinopexy, and prolonged silicone oil tamponade (>6 months).

Conclusion

360-degree laser retinopexy significantly reduces the incidence of retinal redetachment after silicone oil removal in patients undergoing PPV for RRD compared to focal laser retinopexy. This technique offers superior anatomical stabilization and improved visual outcomes, especially in high-risk cases, and should be considered in surgical planning.

Fact Check

1. Incidence of Redetachment: Group A (360-degree laser) had 6.1% incidence of redetachment, while Group B (focal laser) had 28.1%. This difference was statistically significant (p = 0.03).
2. Postoperative BCVA: Postoperative BCVA at 12 months was 0.8 ± 0.2 logMAR for Group A and 1.1 ± 0.3 logMAR for Group B, with Group A showing better outcomes (p = 0.04).
3. Risk Factors: PVR Grade C or higher (OR 3.5, p=0.02), Focal Laser Retinopexy (OR 5.2, p=0.01), and Silicone Oil > 6 Months (OR 2.8, p=0.03) were identified as significant risk factors for redetachment.

Mind Map