Long-term results of pars plana vitrectomy and silicone oil for giant tears.

Abstract

To evaluate the long-term results of pars plana vitrectomy (PPV) and silicone oil implantation (SOI) for giant retinal tears (GT). PPV with SOI was performed for GT in 50 eyes of 46 patients. Thirty-one eyes (62%) of 27 patients suffered from idiopathic GT. A direct injury of the eye preceded GT in 19 eyes (38%), a contusion in 14 and perforation of the sclera in five. The patients were followed up for 12 to 96 months, with a mean of 33 months. At the end of follow-up, anatomical success with a flat macula was achieved in 39 eyes (78%). Functional success with visual acuity 0.02 or better was obtained in 37 eyes (74%). The final functional results did not depend on the size of the GT, and were better in post-traumatic GT (success in 84%) than in idiopathic ones (success in 68%). The functional success rate by life table analysis decreased from 81% after one year and 79% after three years to 55% after five or more years. Silicone oil was removed from 22 eyes (44%). After removal, the retina redetached in seven eyes (30%), and the redetachment caused final failure in two (9%). PPV with SOI proved highly effective in GT. Proliferative vitreoretinopathy was the main cause of surgical failure and a frequent obstacle to silicone oil removal. The risks of redetachment have to be evaluated especially carefully when dealing with the only eye.