Surgical repair of retinal detachments due to Progressive Outer Retinal Necrosis (PORN)

Purpose. To describe the technique and results of vitreoretinal surgery for repair of retinal detachment secondary to PORN. Methods. Review of five eyes of four consecutive patients which underwent vitrectomy for repair of retinal detachment secondary to PORN. All patients had AIDS, necrotizing retinitis meeting the diagnostic criteria for PORN, and retinal detachment involving or threatening the macula. Eyes with total retinal necrosis or medically uncontrolled retinitis were excluded from surgery. Results. A standard 3 port vitrectomy technique was used in all eyes. Intraoperative findings included foreshortening of the peripheral atrophic retina. Large (270 to 360 degree) peripheral relaxing retinectomies were necessary to achieve retinal flattening in 3 eyes (60%). Laser retinopexy and long-term internal tamponade with silicone oil was used in all eyes. One eye (20%) required 2 procedures. Follow-up: 4 to 30 months following surgery (median 15 months). Retinal attachment was maintained in 4 eyes (80%). Three eyes later underwent lensectomy and IOL placement for silicone oil related cataracts. Final visual acuities were light-perception, 20/400, 20/200, 20/80, and 20/60. Conclusions. Vitrectomy and silicone oil tamponade achieved lasting anatomic and functional success in some patients with medically controlled PORN and retinal detachment. Peripheral relaxing retinectomy was a valuable technique for successful attachment.