Proliferative Retinopathy: Key Questions and Answers

Proliferative Retinal Disease

Hello, Director.
I have developed proliferative retinopathy and retinal detachment in both eyes due to diabetes.
I underwent vitrectomy in March and April of last year, and silicone oil was injected into both eyes, which has not yet been removed.
I would like to ask the following questions:
1) Currently, I have approximately +500 diopters of hyperopia that requires correction with glasses.
After the silicone oil is removed, will the visual clarity (naked eye) be the same as what I see with glasses?
2) Since my retinal detachment was not surgically repaired until nearly a year later (the detachment was extensive, nearly total), what is the likelihood of recurrence of detachment under the condition of good blood sugar control?
3) With good blood sugar control, what is the likelihood of developing retinal vascular leakage (red spots) and proliferation again?
4) When the silicone oil is removed, could its viscosity affect the degree of retinal reattachment?
5) I would like to know how long it typically takes for silicone oil to emulsify.
If it emulsifies, is there a way to manage it? What are the implications for vision before and after this occurs?
6) Is there a risk of silicone oil migrating, for example, blocking the drainage of aqueous humor and causing increased intraocular pressure leading to glaucoma? What is the likelihood of silicone oil migrating? If it does block the drainage, is there a way to address this? What are the implications for vision before and after this occurs?
Thank you.

Cai Xiansheng, 40~49 year old female. Ask Date: 2024/01/21

Dr. He Jianxian reply Ophthalmology

Dear Mr.
Tsai,
1.
Whether vision will return to pre-operative levels after silicone oil removal depends on the post-operative condition.
If the retina does not undergo subsequent changes (such as detachment) due to the removal of silicone oil, we can optimistically expect corrected vision to improve.
2.
There is a possibility of re-detachment after removal, with reported rates varying between studies, ranging from 10% to 40%.
3.
It is sometimes difficult to determine if good blood sugar control can prevent complications such as proliferation.
This is because we typically monitor a single point in time or the average blood sugar over three months.
While the numbers may appear good, the actual condition could involve significant fluctuations in blood sugar throughout the day, with the monitoring point coincidentally showing favorable results.
4.
The timing of silicone oil emulsification can vary depending on the type of silicone oil used and the individual’s condition.
If there are any concerns about changes, it is essential to remove it as soon as possible.
5.
Silicone oil can potentially migrate, causing an increase in intraocular pressure.
If it obstructs the aqueous outflow pathways, the management of this situation will depend on your surgeon's guidance.
Sincerely,
Dr.
He Jianxian
Department of Ophthalmology, Nantou Hospital

Reply Date: 2024/01/21

More Info

Proliferative retinopathy, particularly in the context of diabetes, can lead to significant complications, including retinal detachment and the need for surgical interventions such as vitrectomy. Your questions reflect a deep concern for your vision and the potential outcomes following your surgeries. Let’s address each of your inquiries in detail.

1. Visual Clarity Post-Silicone Oil Removal: After the removal of silicone oil, the clarity of your vision without glasses (naked vision) may not necessarily match what you experience with corrective lenses. The degree of visual improvement depends on various factors, including the extent of retinal damage prior to surgery, the success of the retinal reattachment, and any residual effects from the silicone oil itself. Many patients report that their vision improves after silicone oil removal, but it may still require glasses for optimal clarity, especially if there was significant pre-existing damage.

2. Risk of Retinal Detachment Recurrence: Given that your retinal detachment was extensive and you had surgery nearly a year after the initial detachment, there is a risk of recurrence, even with good blood sugar control. The likelihood of re-detachment can be influenced by factors such as the quality of the surgical repair, the presence of any residual traction on the retina, and ongoing diabetic changes. Regular follow-up with your ophthalmologist is crucial to monitor for any signs of recurrence.

3. Risk of Vascular Complications: With well-controlled blood sugar levels, the risk of developing new vascular complications, such as hard exudates or neovascularization, can be reduced but not eliminated. Diabetic retinopathy is a progressive disease, and even with good control, there can be fluctuations in retinal health. Regular eye examinations are essential to catch any changes early.

4. Silicone Oil and Retinal Attachment: When silicone oil is removed, it should not adversely affect the retinal attachment if the retina has healed properly. However, if the silicone oil has caused any changes to the retinal surface or if there are residual issues from the detachment, this could potentially complicate the situation. Your surgeon will assess the condition of the retina during the removal procedure.

5. Silicone Oil Emulsification: The emulsification of silicone oil can occur over time, typically within weeks to months after surgery. If emulsification occurs, it can lead to complications, including inflammation or changes in intraocular pressure. If emulsified silicone oil is present, it may require further surgical intervention to manage any resultant issues. The impact on vision can vary, and your surgeon will provide guidance on the best course of action.

6. Silicone Oil Migration: Silicone oil can migrate within the eye, but it is designed to remain in the vitreous cavity. However, if it were to migrate into the anterior chamber or block the trabecular meshwork, it could potentially lead to increased intraocular pressure and glaucoma. This is a rare occurrence, but if it happens, it can usually be managed surgically or with medications to lower eye pressure.

In summary, managing proliferative retinopathy and its complications requires ongoing monitoring and collaboration with your healthcare team. Regular follow-ups with your ophthalmologist are essential to ensure that any changes in your condition are addressed promptly. Maintaining good blood sugar control is crucial in minimizing the risk of further complications. If you have any additional concerns or symptoms, do not hesitate to reach out to your healthcare provider for personalized advice and management.

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