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Klin Monbl Augenheilkd 2024; 241(04): 472-476
DOI: 10.1055/a-2233-0971
Klinische Studie

Silicone Oil Tamponade for Therapy of Primary Retinal Detachment in Patients Who Live at High Altitudes

Silikonöltamponade zur Therapie der primären Netzhautablösung bei Patienten, die in großer Höhe leben
Tim Beltraminelli 
1   Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
,
Quentin Hessler
1   Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
2   School of Medicine, University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
,
Theodor Stappler
3   Retina Surgery, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
,
Jelena Potic
3   Retina Surgery, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
,
Thomas J. Wolfensberger
1   Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
,
Lazaros Konstantinidis
4   Vitreoretinal, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland
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Abstract

Background Uncomplicated rhegmatogenous retinal detachment (RRD) is mainly treated with vitrectomy and gas tamponade or, alternatively, scleral buckling surgery. However, gas tamponade inflates at high altitudes, causing significant complications. Silicone oil (SO) tamponade volume is unaffected by atmospheric pressure and may be used in patients who live or must undertake travel at high altitudes.

Purpose To determine the anatomical and functional outcomes after pars plana vitrectomy (PPV) with SO tamponade in primary uncomplicated RRD.

Methods Twenty-eight consecutive cases of patients operated between January 2017 and December 2022 in Jules-Gonin University Eye Hospital in Lausanne were included in this retrospective study. All patients had a follow-up of at least 3 months after SO removal.

Results Primary reattachment was achieved in all 28 eyes. Mean follow-up was 17.2 months (range: 3 – 51 months) after SO removal. Mean age at the time of intervention was 60 years (range: 21 – 80 years). Vision was stabilized or improved in 27 eyes (96%). One patient demonstrated a slight visual acuity decrease due to cataract formation at the last follow-up. In all patients, SO was removed 2 to 5 months after primary repair. In 14 of the 21 phakic patients, concomitant cataract surgery was performed. No surgical complications were encountered. Postoperatively, 5 (18%) patients had ocular hypertension, presumably steroid related, that was successfully controlled with topical treatment.

Conclusion PPV with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated RRD in patients living at high altitudes and was associated with good anatomical and functional outcome in our series. However, the need for a follow-up surgery to remove SO should be weighed in these cases.

Zusammenfassung

Hintergrund Die Behandlung von unkomplizierten Netzhautablösungen erfolgt hauptsächlich durch Vitrektomie mit Gastamponade oder, bei ausgedehnten Läsionen, durch eindellende Operationen. Bei Gastamponade ist der intraokulare Druck wesentlich abhängig von der Höhenlage oder der Kopfposition des Patienten. Für Patienten, die in Höhenlagen wohnen oder Flugreisen unternehmen müssen, bleibt somit als Tamponademöglichkeit nur das vom umgebenden atmosphärischen Druck unabhängige Silikonöl.

Zweck Wir berichten über die anatomischen und funktionellen Ergebnisse von Pars-plana-Vitrektomie (PPV) mit Silikonöltamponade (SO) in der Behandlung von unkomplizierten Netzhautablösungen.

Methode In dieser retrospektiven Studie wurden konsekutiv 28 Patienten eingeschlossen, die im Jules-Gonin-Universitätsspital in Lausanne zwischen Januar 2017 und Dezember 2022 operiert wurden. Alle Patienten wurden für mindestens 4 Monate nachverfolgt.

Resultat Die primäre Netzhautanlage wurde in allen 28 Fällen erreicht. Der mittlere Nachverfolgungszeitraum war 17,2 Monate (Range: 3 – 51 Monate) nach SO-Entfernung. Das mittlere Alter zum Operationszeitpunkt war 60 Jahre (Range: 21 – 80 Jahre). Die Sehkraft stabilisierte oder verbesserte sich für 27 Patienten (96%). Ein Patient beklagte eine leicht verminderte Sehkraft aufgrund von Katarakt. Die Silikonölentfernung erfolgte bei allen Patienten zwischen 2 und 5 Monaten nach der Erstoperation. In 14 Fällen wurde die Silikonölentfernung mit der Kataraktoperation kombiniert. Es wurden keine chirurgischen Komplikationen festgestellt. Eine transitorische Augendruckerhöhung, wahrscheinlich aufgrund einer Steroid-Response, konnte bei 5 (18%) der Patienten beobachtet werden, die alle mittels augendrucksenkenden Augentropfen erfolgreich behandelt werden konnten.

Fazit Pars-plana-Vitrektomie mit anschließender Silikonöltamponade erscheint uns als eine sichere und effiziente Operation in der Behandlung von unkomplizierten Netzhautablösungen für Patienten, die in Höhenlagen wohnen oder mit dem Flugzeug verreisen müssen. Obwohl die Notwendigkeit einer Zweitoperation besteht, kann diese Studie zufriedenstellende anatomische und funktionelle Ergebnisse belegen.

Key words

retinal detachment surgery - silicone oil - uncomplicated detachment - vitrectomy

Schlüsselwörter

Netzhautchirurgie - unkomplizierte Netzhautablösung - Silikonöl - Vitrektomie


Publication History

Received: 28 October 2023

Accepted: 14 December 2023

Article published online:
23 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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