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document
Vitrectomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy : results of additional and long-term follow-up . Silicone Study report 11 . BACKGROUND The Silicone Study evaluated the outcomes of vitreoretinal surgery for retinal detachment with proliferative vitreoretinopathy ( PVR ) . OBJECTIVE To evaluate short-term ( up to 36 months ) outcomes in eyes randomized to silicone oil or perfluoropropane gas and long-term ( up to 72 months ) outcomes in eyes with attached maculas at 36 months . DESIGN Prospective , randomized , multicentered surgical trial . SETTING Community- and university-based vitreoretinal practices . PATIENTS Two-hundred sixty-five eyes with PVR randomized to perfluoropropane gas and silicone oil with follow-up through 3 years ( cohort 1 ) and 249 eyes with attached maculas at 36 months ( 121 eyes randomized to long-acting gas [ either sulfur hexafluoride or perfluoropropane ] and 128 eyes randomized to silicone oil ) with follow-up up to 6 years ( cohort 2 ) . Both cohorts consisted of eyes that had and had not undergone vitrectomy for PVR ( groups 1 and 2 , respectively ) before randomization . Of the 265 eyes in cohort 1 , 24-month follow-up data were available for 218 eyes ( 82 % ) and 36-month follow-up data were available for 196 eyes ( 74 % ) . Of 208 eyes in cohort 2 , 48-month follow-up data were available for 146 eyes ( 70 % ) , 60-month follow-up data for 119 eyes ( 57 % ) , and 72-month follow-up data for 73 eyes ( 35 % ) . INTERVENTIONS Vitrectomy surgery for PVR with a long-acting gas or silicone oil as the intraocular tamponade . MAIN OUTCOME MEASURES Changes in visual acuity , recurrent retinal detachment , and incidence of complications . RESULTS In group 1 of cohort 1 , compared with oil-treated eyes , gas-treated eyes had a higher rate of complete retinal reattachment from 18 to 36 months ( P < .05 ) . No other differences were found . In group 2 of cohort 1 , no notable differences were found between treatment arms . In cohort 2 , during 6 years of follow-up , attachment of the macula was maintained for all eyes . No notable differences in the rates of complete retinal attachment , visual acuity of 5/200 or better , or glaucoma were found between treatment groups . In contrast , gas-treated eyes had more hypotony ( P < .001 ) . Silicone oil-treated eyes that underwent subsequent surgery were more likely to have the oil retained ( P = .02 ) . Compared with oil-retained eyes , oil-removed eyes had higher rates of complete posterior attachment ( P = .01 ) and of a visual acuity of 5/200 or better ( P < .001 ) and less keratopathy ( P < .05 ) . Compared with oil-removed eyes , gas-treated eyes had a worse visual acuity outcome ( P < .05 ) and more hypotony ( P < .01 ) . CONCLUSION The Silicone Study showed that silicone oil and perfluoropropane gas were equal in most respects for the management of retinal detachments with PVR . Success in the first surgery for PVR is paramount for obtaining better visual results . Overall , surgery for PVR had a high likelihood of retinal reattachment , and if anatomically and visually successful at 3 years , there is an excellent chance that the results will be maintained over the long-term .
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Intervention_Pharmacological
silicone oil
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Intervention_Pharmacological
long-acting gas
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Intervention_Pharmacological
silicone oil
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Intervention_Pharmacological
perfluoropropane gas
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Intervention_Pharmacological
perfluoropropane gas
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Intervention_Pharmacological
silicone oil
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Intervention_Pharmacological
( 121 eyes randomized to long-acting gas [ either sulfur hexafluoride or perfluoropropane ] and 128 eyes randomized to silicone oil ) with follow-up up to 6 years ( cohort 2 ) .
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Intervention_Pharmacological
long-acting gas
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Intervention_Pharmacological
silicone oil
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Intervention_Pharmacological
Silicone oil-treated
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Outcome_Physical
Changes in visual acuity
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Outcome_Physical
recurrent retinal detachment
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Outcome_Adverse-effects
incidence of complications
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Outcome_Physical
complete retinal reattachment
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Outcome_Physical
attachment of the macula
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Outcome_Physical
rates of complete retinal attachment
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Outcome_Physical
visual acuity of 5/200 or better
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Outcome_Physical
glaucoma
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Outcome_Physical
hypotony
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Outcome_Physical
subsequent surgery
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Outcome_Physical
rates of complete posterior attachment
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Outcome_Physical
visual acuity of 5/200 or better
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Outcome_Physical
keratopathy
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Outcome_Physical
visual acuity outcome
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Outcome_Physical
hypotony
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Participant_Condition
eyes with severe proliferative vitreoretinopathy :
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Participant_Condition
retinal detachment with proliferative vitreoretinopathy ( PVR ) .