First operation anatomic success and other predictors of postoperative vision after complex retinal detachment repair with vitrectomy and silicone oil tamponade

PURPOSE: To evaluate the role of first operation anatomic success compared with success after reoperation and preoperative characteristics in achievin g ambulatory vision (greater than or equal to4/200) and good vision (greate r than or equal to 20/100) after repair of complex retinal detachment with vitrectomy and silicons oil tamponade. METHODS: A prospective, observational, multicenter study of patients who un derwent vitrectomy with silicone oil for retinal detachments associated wit h cytomegalovirus necrotizing retinitis or a non-cytomegalovirus necrotizin g retinitis etiology, including proliferative diabetic retinopathy, giant r etinal tear, proliferative vitreoretinopathy, and ocular trauma. RESULTS: A higher rate of ambulatory vision was achieved in the first opera tion anatomic success cases, compared with the reoperation cases, for eyes with cytomegalovirus necrotizing retinitis (72% vs 50%, P < 0.01) and eyes without cytomegalovirus necrotizing retinitis (51% vs 38%, P = 0.04), For e yes with cytomegalovirus necrotizing retinitis, preoperative ambulatory vis ion (RR = 2.3, P < 0.0001) and reoperation (RR = 0.4, P = 0.05) were indepe ndent predictors of postoperative ambulatory vision, For eyes without cytom egalovirus necrotizing retinitis, preoperative ambulatory vision (RR 4.0, p < 0.0001) and retinal detachment etiology (P = 0.02) were prognostic facto rs. Compared to eyes with trauma, eyes with giant retinal tear, proliferati ve vitreoretinopathy and proliferative diabetic retinopathy were 2.8 (P < 0 .003), 2.2 (P = 0.01) and 1.6 (P = 0.17) times as likely to achieve postope rative ambulatory vision, respectively. Within the giant retinal tear group , a higher rate of ambulatory vision was achieved in the first operation an atomic success cases compared with the reoperation cases (66% vs 31%, P = 0 .03). Although not statistically significant, similar out comes occurred in the proliferative diabetic retinopathy (48% vs 25%) and proliferative vitr eoretinopathy groups (54% vs 45%), Similar prognostic relationships were fo und for good visual acuity outcomes. CONCLUSIONS: First operation anatomic success, preoperative visual acuity, and giant retinal tear or proliferative vitreoretinopathy as the retinal de tachment etiology are important factors that predict visual outcome. (C) 20 00 by Elsevier Science Inc. All rights reserved.