Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy

Retinal detachment (RD) remains a significant cause of vision loss. Most recurrent RDs are associated with varying degrees of proliferative vitreoretinopathy (PVR), or the growth of fibrous membranes (similar to scar tissue) along the surface of the retina. The only proven therapy for RD with PVR is surgery. Injection of a tamponade agent is performed at the time of surgery to reduce the rate of fluid flow through open retinal tears, which would cause recurrent RD. The major tamponade agents available today are various gases and silicone oils. One study consisting of two independently randomized clinical trials was included in this review. The Silicone Study compared the use of silicone oil tamponades to either sulfur hexafluoride (SF6) gas or perfluropropane (C3F8) gas tamponades in patients undergoing surgery to treat RD associated with PVR. When silicone oil was compared to SF6 gas, eyes randomized to receive silicone oil were more likely to achieve a final visual acuity of 5/200 or better at one year, and more likely to achieve macular attachment at one year; both of these differences were statistically significant. When silicone oil was compared with C3F8 gas, there were no statistically significant differences between the groups with respect to visual acuity or macular attachment at one year. The use of either C3F8 gas or silicone oil appears to offer similar benefits, in terms of their ability to reattach the retina and to preserve or improve visual function.