Which is better for uncomplicated retinal detachment, pars plana vitrectomy with silicone oil or gas tamponade?

The study, published in the American Journal of Ophthalmology, revealed that PPV with gas tamponade is tied to better functional outcomes than PPV with silicone oil; however, both tamponades yielded comparable primary reattachment rates.

Retinal detachment, characterized by the separation of the retina from the underlying retinal pigment epithelium, poses a significant threat to vision if left untreated. PPV, a surgical procedure involving the removal of the vitreous gel and subsequent tamponade of the retina, serves as a primary intervention for retinal detachment. However, the choice of tamponade agent—silicone oil or intraocular gas—remains debatable among ophthalmologists.

Against the above background, Rajeev H. Muni, University of Toronto, Toronto, Ontario, Canada, and colleagues aimed to compare the efficacy of pars plana vitrectomy with silicone oil compared to gas tamponade for uncomplicated rhegmatogenous retinal detachment.

For this purpose, the research team conducted a systematic literature search on online databases from 2000 to 2023 for comparative studies evaluating the efficacy and safety of PPV with either silicone oil or gas tamponade in uncomplicated RRD.

The primary outcome was best-corrected visual acuity (BCVA) at the last study observation. Secondary outcomes included the rates of retinal reattachment, retinal thickness, and the incidence of adverse events. Meta-analysis was performed using a random-effects model.

The researchers reported the following findings:

· Nine observational studies reporting on 491 RRD eyes were included.

· The mean BCVA at the last study observation was significantly better in the gas tamponade group than in the silicone oil group (WMD=0.17 logMAR).

· Rates of primary retinal reattachment were similar between the silicone oil and gas tamponade groups.

· The ganglion cell layer was significantly thinner in the silicone oil group compared to the gas tamponade group (WMD=-3.70 µm, as was the inner plexiform layer (WMD=-2.45) and outer nuclear layer (WMD=-11.74 µm).

The meta-analysis showed that gas tamponade may be tied to improved final BCVA compared to silicone oil tamponade, although both tamponades yield comparable primary reattachment rates. The study observed a significant reduction in the thickness of the outer nuclear layer (ONL), inner plexiform layer (IPL), and ganglion cell layer (GCL) in the silicone oil group, indicating potential adverse effects on certain retinal layers that warrant further investigation.

“Overall, our results did not support the routine silicone oil use for uncomplicated RRDs; we suggest considering individualized approaches to care,” the researchers wrote.

“Future studies should aim to examine the long-term visual and anatomical outcomes of these tamponades and explore the patient-centered factors that impact the choice of tamponade in clinical practice more closely.”

Reference:

Huang RS, Mihalache A, Lau THA, Popovic MM, Kertes PJ, Muni RH. Pars plana vitrectomy with silicone oil or gas tamponade for uncomplicated retinal detachment: a systematic review and meta-analysis. Am J Ophthalmol. 2024 May 28:S0002-9394(24)00209-5. doi: 10.1016/j.ajo.2024.05.008. Epub ahead of print. PMID: 38815844.