Pars plana lensectomy, pars plana vitrectomy, and silicone oil tamponade as initial management of cataract and combined traction/rhegmatogenous retinal detachment involving the macula associated with severe proliferative diabetic retinopathy

BACKGROUND AND OBJECTIVES: To evaluate visual acuity and anatomic outcomes, and complications, following pars Plana lensectomy, pars Plana vitrectomy, and silicone oil tamponade (PPL/PPV/ SO) in the initial management of cataract and combined traction/rhegmatogenous retinal detachment involving the macula associated with severe proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Retrospective, noncomparative, consecutive case series including all patients who underwent PPL/PPV/SO for the initial management of cataract and traction/rhegmatogenous retinal detachment involving the macula associated with severe PDR at Bascom Palmer Eye Institute between 1989 and 2000. Main outcome measures included visual acuity and rates of retinal reattachment and reoperation. RESULTS: The study included 22 eyes of 22 patients. The mean follow-up was 15.2 months. Preoperatively, 13 of 22 (59%) fellow (non-study) eyes had vision of light perception or worse, and 7 (32%) had vision of no light perception. The number of study eyes with a best-corrected vision of 20/400 or better increased from 5 (23%) preoperatively to 12 (55%) at 6 months (P< .05) and 15 (68%) at final follow-up (P < .05). The macula was attached at final follow-up in 20 (91%) eyes. In 14 (64%) eyes, silicone oil was removed at a mean of 8.4 months following retinal detachment repair; postoperative vision was 20/400 or better in 11 (79%) of these eyes at 6 months and 13 (93%) at final follow-up. In contrast, only 1 of 8 (13%) eyes with retained silicone oil achieved a postoperative vision of 20/400 or better (P < .05). CONCLUSIONS: Initial management with PPL/PPV/SO can achieve favorable anatomic and visual outcomes in selected patients with cataract and traction/rhegmatogenous retinal detachment involving the macula associated with severe PDR. This surgical approach should be especially considered in patients with traction/rhegmatogenous retinal detachment involving the macula in one eye and poor vision in the fellow eye.