Chandelier-assisted pars plana vitrectomy decreases the rate of retinal re-detachment following silicone oil removal

Abstract

Background Recurrent retinal detachment is one of the major complications after silicone oil (SO) removal. Therefore, finding ways to decrease its incidence would be of great significance. Purpose The aim of this study was to compare the rate of retinal re-detachment following SO removal in eyes that underwent scleral self-indentation during chandelier-assisted vitreous base shaving compared to the eyes that underwent scleral indentation by an assistant. Patients and methods This is a retrospective study that included 381 eyes of 381 consecutive patients who underwent SO removal between December 2017 and December 2021, after a successful pars plana vitrectomy for primary rhegmatogenous retinal detachment. Scleral self-indentation (group A) was performed in 186 eyes, while scleral indentation by an assistant (group B) was performed in 195 eyes. The primary outcome measure was the rate of retinal re-detachment after SO removal. The secondary outcome measures were the rate of iatrogenic peripheral retinal tears and intraoperative complications. Results Retinal re-detachment occurred in 21 (11.29%) eyes in group A compared to 38 (19.49%) eyes in group B, with a statistically significant difference (P=0.027). Iatrogenic retinal tear during vitreous base shaving occurred in two (1.08%) eyes in group A compared with 17 (8.71%) eyes in group B, with a statistically significant difference (P=0.001). Slipped infusion cannula during indentation occurred in two (1.02%) eyes in group B and resulted in serous choroidal detachment in one eye, a complication that was not reported in group A. Lens touch occurred in three (1.61%) eyes in group A versus eight (4.1%) eyes in group B, a statistically nonsignificant difference (P=0.065). Conclusion Scleral self-indentation during chandelier-assisted vitrectomy facilitated safe and satisfactory vitreous base shaving with a lower risk of retinal re-detachment after SO removal. It was also associated with a lower rate of iatrogenic retinal breaks and intraoperative complications.