Optimal choice of gas or silicone tamponade for surgical treatment of advanced stages of proliferative diabetic retinopathy patients

Purpose. Comparative analysis of effectiveness of silicone and gas tamponade in surgery for advanced stages of proliferative diabetic retinopathy (PDR). Material and methods. 320 operated patients (320 eyes) with stages 4 and 5 of PDR (ETDRS classification, 1991). The age of patients ranged from 18 to 82 years; 82 patients had type 1 diabetes; 238 patients had type 2 diabetes. In preoperative period, the stages of panretinal photocoagulation (PRP) were performed in 30 eyes of patients of the 1st group and in 23 eyes of the 2nd group. All patients underwent 25G vitrectomy with removal of the vitreous body and epiretinal membranes. In 198 eyes, surgery ended with gas tamponade (Group 1); in 122 eyes — silicone tamponade (Group 2). Both groups were comparable in terms of severity of PDR, age and gender. Results. In the postoperative period, preretinal hemorrhages formed in Groups 1 and 2 (59 and 53 eyes, respectively). In the Group 1, they were always combined with hemophthalmos; in the Group 2, silicone oil tamponade was prevented spread of blood into the vitreal cavity, which made it possible to perform PRP. On the 5–7th day, hemophthalmos occurred in 59 eyes of the Group 1, PRP was performed in 27 eyes (13.6%). In the Group 2, there were no cases of hemophthalmos, which allowed 89 patients (72.9%) to perform PRP in 3–4 weeks. After 6 months, diffuse hemophthalmos occurred in 71 eyes of the Group 1, in 46 eyes of them repeated endovitreal interventions with silicone tamponade of the vitreal cavity were performed; in 17 eyes, the presence of epiretinal membranes in the posterior pole was noted, in 8 eyes there was recurrent retinal detachment. In the Group 2 by 6 months, there were no cases of hemophthalmos, recurrent retinal detachment was in 3 eyes, epiretinal membranes formed in 5 eyes. Conclusion. Silicone tamponade is the preferred method in surgical treatment of severe stages of PDR. Key words: proliferative diabetic retinopathy, endovitreal surgery, gas tamponade, silicone tamponade