Silicone oil in repair of retinal detachments caused by necrotizing retinitis in HIV infection
J. L. Davis, M. S. Serfass, M. Y. Lai, D. K. Trask and S. P. Azen
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Fla., USA.
OBJECTIVE: To evaluate the safety and efficacy of 1000- and 5000-centistoke
silicone oil as retinal tamponades for the treatment of retinal detachments
secondary to necrotizing retinitis in patients with human immunodeficiency
virus (HIV) infection. DESIGN: A prospective observational study. SETTING:
Community and university-based ophthalmology clinics. PATIENTS: Three
hundred fifty patients with HIV infection, who had 407 eyes with retinal
detachments secondary to necrotizing retinitis. INTERVENTION: Vitrectomy
surgery for retinal detachment with 1000- or 5000-centistoke silicone oil
as the retinal tamponade. OUTCOME MEASURES: Efficacy was measured both by
anatomic success (defined as complete retinal attachment or macular
attachment) and by visual acuity success (defined as preservation of visual
acuity or ambulatory vision). Safety was determined by the rate of
complications, including abnormal intraocular pressure and corneal and lens
opacification. RESULTS: At the last follow-up examination, the retina was
completely attached in 287 (73%) of 393 eyes, the macula was attached in
370 eyes (94%), 268 eyes (68%) had ambulatory vision, and visual acuity was
preserved in 219 (56%) of 388 eyes. Corneal opacification, hypotony, and
silicone oil emulsification were present in 4%, 2%, and 1% of eyes,
respectively. One eye had elevated intraocular pressure. Of the 57 patients
who had both eyes treated, 35 died, of whom four (11%) had nonambulatory
vision in both eyes. Of the 293 patients who had one eye treated, 122 died,
of whom 44 (36%) died with nonambulatory vision in the treated eye. The
median time to cataract was 192 days; to nonambulatory vision, 474 days;
and to death, 204 days. CONCLUSIONS: Silicone oil repair of retinal
detachments in necrotizing retinitis is an efficacious and safe procedure
that delays or prevents loss of vision in advanced HIV disease.
