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November 1995

Silicone Oil in Repair of Retinal Detachments Caused by Necrotizing Retinitis in HIV Infection

Author Affiliations

From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami (Fla) School of Medicine (Dr Davis); Richard-James Inc, Peabody, Mass (Ms Serfass); Statistical Consultation and Research Center, Department of Preventive Medicine, University of Southern California, Los Angeles (Ms Lai and Dr Azen); and Department of Otolaryngology, University of Michigan, Ann Arbor (Dr Trask). The names of the participating investigators are included in a box at the end of this article. The authors are employees of (Ms Serfass and Dr Trask) and consultants for (Drs Davis and Azen) Richard-James Inc, which sponsored the collection of these data in preparation for a premarket approval application for silicone oil in the repair of retinal detachments caused by necrotizing retinitis.

Arch Ophthalmol. 1995;113(11):1401-1409. doi:10.1001/archopht.1995.01100110061026

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.

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