Incidence of Postoperative Epiretinal Membrane Development Following 23-Gauge Pars Plana Vitrectomy for Complex Diabetic Tractional Retinal Detachment: A Comparative Study of Silicone Oil and Balanced Salt Solution Tamponade

Ahmed Abbas  Kadhim; Abeer Al Shalchi; Ameer Bananzada

doi:10.3889/oamjms.2024.11797

Authors

Ahmed Abbas Kadhim Department of Ophthalmology, The Royal College of Surgeons, Edinburgh, United Kingdom
Abeer Al Shalchi Department of Ophthalmology, The Royal College of Surgeons, Edinburgh, United Kingdom; Uveitis and Medical Retina, Ibn Al Haitham Teaching Eye Hospital, Baghdad, Iraq https://orcid.org/0009-0004-5594-2967
Ameer Bananzada Department of Ophthalmology, Ghazi Al Hariri Hospital for Surgical Specialties - Medical City, Baghdad, Iraq https://orcid.org/0009-0001-5378-5548

DOI:

https://doi.org/10.3889/oamjms.2024.11797

Keywords:

Epiretinal membrane, silicone oil, balanced salt solution, vitrectomy, tractional retinal detachment, diabetic retinopathy, postoperative complications, visual outcomes

Abstract

BACKGROUND: Tractional retinal detachment (TRD) poses a significant threat to vision in diabetic patients, necessitating surgical intervention. However, the choice of tamponade agent (silicone oil vs. balanced salt solution [BSS]) and the presence of incomplete hemostasis during surgery can influence postoperative complications, specifically the development of epiretinal membranes (ERMs).

METHODS: This prospective study involved 235 patients undergoing 23-Gauge pars plana vitrectomy for diabetic TRD with incomplete hemostasis. Patients were categorized into two groups based on tamponade agent used. ERM development was assessed clinically and through optical coherence tomography (OCT).

RESULTS: Among the cases with incomplete hemostasis and residual preretinal hemorrhage, 71.80% of those in the silicone oil group developed ERMs, in contrast to 11.76% in the BSS. Notably, 46.2% of silicone oil cases with ERMs required reoperation, whereas 47.4% remained ERM-free.

DISCUSSION: The choice of tamponade agent was a crucial determinant in ERM development, with silicone oil exhibiting a significantly higher incidence. Moreover, silicone oil cases with macular tractional effects had a substantial proportion of ERMs necessitating reoperation. These findings underscore the importance of vigilant postoperative monitoring.

CONCLUSION: In cases involving incomplete hemostasis during vitrectomy for diabetic TRD, the use of silicone oil as a tamponade agent is associated with a substantially increased risk of postoperative ERM development. Clinically, this highlights the need for meticulous patient management. Further research is warranted to validate these results and explore long-term outcomes.

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