Pars Plana Vitrectomy With Silicone Oil or Gas Tamponade for Uncomplicated Retinal Detachment: A Systematic Review and Meta-Analysis

Abstract

PurposeTo compare the efficacy of pars plana vitrectomy (PPV) with silicone oil compared to gas tamponade for uncomplicated rhegmatogenous retinal detachment (RRD). DesignSystematic review and meta-analysis. MethodsA systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to September 2023 for comparative studies evaluating the safety and efficacy of PPV with either silicone oil or gas tamponade in the setting of uncomplicated RRD. Our primary outcome was best-corrected visual acuity (BCVA) at last study observation. Secondary outcomes included the rates of retinal reattachment, retinal thickness, and the incidence of adverse events. We performed meta-analysis using a random-effects model. ResultsNine observational studies reporting on 491 RRD eyes were included. The mean BCVA at last study observation was significantly better in the gas tamponade group than in the silicone oil group (WMD=0.17 logMAR, 95%CI=[0.06, 0.27], p=0.002). Rates of primary retinal reattachment were similar between the silicone oil and gas tamponade groups (p=0.89). The ganglion cell layer was significantly thinner in the silicone oil group compared to the gas tamponade group (WMD=-3.70 µm, 95%CI=[-5.87, -1.53, p=0.0008), as was the inner plexiform layer (WMD=-2.45, 95%CI=[-4.50, -0.40], p=0.02) and outer nuclear layer (WMD=-11.74 µm, 95%CI=[-18.39, -5.10], p=0.0005). ConclusionPPV with gas tamponade was associated with better functional outcomes compared to PPV with silicone oil, although both tamponades yielded comparable primary reattachment rates. The absence of randomized trials and potential for selection bias underscore the importance of further investigation in diverse patient populations.