New insight into silicone oil in the era of minimally invasive vitrectomy / 中华眼底病杂志

Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.

Comparison of clinical characteristics and factors affecting prognosis vision of idiopathic and myopic macular hole / 中华眼底病杂志

Objective:To compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH).Methods:A cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age ( Wald=34.507) and logMAR BCVA ( Z=-7.703) between two groups ( P<0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C 3F 8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ 2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. Results:In IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA ( Z=-6.803, P<0.005), but no difference in visual success rate ( χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant ( χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio ( OR)=2.941, 95% confidence interval ( CI) 1.341-6.447, P<0.05], MH diameter ( OR=1.003, 95% CI 1.001-1.005, P<0.05), silicon oil filling ( OR=3.481, 95% CI 1.594-7.605, P<0.05); MMH, baseline BCVA ( OR=2.549, 95% CI 1.344-4.834, P<0.05), C 3F 8 filling ( OR=18.131, 95% CI 1.505-218.365, P<0.05) and silicon oil filling ( OR=7.796, 95% CI 0.997-60.944, P<0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA ( OR=213.329, 95% CI 46.123-986.694, P<0.05), MH diameter ( OR=0.995, 95% CI 0.992-0.997, P<0.05), silicon oil filling ( OR=0.326, 95% CI 0.115-0.926, P<0.05) and duration ( OR=1.036, 95% CI 1.005-1.067, P<0.05); MMH, baseline BCVA ( OR=13.316, 95% CI 2.513-70.565, P<0.05) and duration ( OR=1.022, 95% CI 1.001-1.044, P<0.05). Conclusions:MMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.

Manejo quirúrgico de biopolímeros en punta nasal: reporte de caso y revisión de la literatura / Surgical Management of Biopolymers in Nasal Tip: Case Report and Literature Review

Introducción: los rellenos faciales han sido ampliamente utilizados a nivel mundial. Existen rellenos temporales, semipermanentes y permanentes. En cuanto a los rellenos permanentes, la silicona es la más utilizada y está aprobada por la agencia gubernamental de los Estados Unidos, la Administración de Alimentos y Medicamentos (FDA), en dos presentaciones para el desprendimiento de la retina. En 1997 se autorizó el uso off-label de Adatosil y Silicon 100, ambas prescritas durante la relación médico-paciente. Se han descrito múltiples eventos adversos secundarios a la inyección de silicona como relleno facial, principalmente síntomas inflamatorios, reacción a cuerpo extraño, sepsis y migración del producto, que por lo general se presentan por una aplicación inapropiada por personal sin entrenamiento. Caso clínico: se presenta el caso de un paciente masculino en la quinta década de la vida, a quien le aplicaron silicona en aceite a nivel de la punta nasal; posteriormente, presenta dermatopatía secundaria sin respuesta al manejo médico, por lo cual requiere manejo quirúrgico para el retiro del material alogénico y reconstrucción nasal secundaria. Se dan recomendaciones para el manejo quirúrgico de estos pacientes.

Introduction: Injectable facial fillers have been widely used worldwide. There are temporary, semipermanent, and permanent fillers. Regarding permanent fillers silicone is the most widely used, approved by the Food and Drug Administration (FDA) in two presentations Adatosil and Silicon 100 for retinal detachment. In 1997 the FDA allows for the off-label use prescribed within the doctor-patient relationship. There have been reported multiple adverse events, mainly inflammatory symptoms, foreign body reactions, sepsis, and product migration generally occurring by inappropriate application by untrained personnel. Case report: We present the case of a male patient in the fifth decade of life who underwent the application of silicone oil at the level of the nasal tip, and later presented secondary dermatopathy without response to medical management, which requires surgical management to remove the allogeneic material and secondary nasal reconstruction

Glaucoma e óleo de silicone / Glaucoma and silicone oils

RESUMO O óleo de silicone é um importante tampão utilizado na retinopexia cirúrgica de casos graves de descolamento de retina. O aumento da pressão intraocular e o desenvolvimento de glaucoma secundário são frequentes complicações da sua utilização. A depender do período de aparecimento, diversos mecanismos justificam a ocorrência de tais complicações. Compreender os fatores de riscos e a patogênese do aumento da pressão intraocular associada a aplicação de óleo de silicone em cirurgia retiniana ajuda a orientar o tratamento adequado para cada paciente. O objetivo deste artigo é revisar a literatura sobre a patogenia, a incidência, os fatores de risco e o tratamento desta condição clínica.

ABSTRACT Silicone oil has been an important intraocular tamponade in retinopexy in cases of complicated retinal detachment surgery. The increase of intraocular pressure and development of secondary glaucoma are a known complication of its use. A variety of mechanisms have been proposed for the pathogenesis, depending on the onset. This article aims to review the literature about pathogenesis, the incidence and risk factors, as well as the treatment of this pathology.

O papel da ressonância magnética na avaliação da gluteoplastia: aspectos habituais e complicações / The role of magnetic resonance in the evaluation of gluteoplasty: habitual aspects and complications

RESUMO Introdução: Os procedimentos estéticos na região glútea têm ganhado evidência nas últimas décadas, com aumento da procura e aparecimento de novas técnicas. Somado ao desenvolvimento e maior facilidade de acesso aos métodos de imagem, assim como a crescente judicialização da medicina, tornam-se cada vez mais frequentes os exames de imagem nos pacientes submetidos a gluteoplastia, com destaque atualmente para a avaliação por ressonância magnética desta região. Dessa forma, a imagem entra cada vez mais na prática clínica diária do cirurgião plástico, requerendo do mesmo conhecimentos sobre conceitos básicos em relação à solicitação e interpretação dos exames. Neste artigo, revisamos aspectos de imagem por ressonância magnética de procedimentos estéticos da região glútea, bem como suas complicações. O objetivo é ilustrar através de estudos de ressonância magnética os achados habituais nos procedimentos de gluteoplastia, bem como algumas de suas complicações, além de propor um protocolo de exame por ressonância magnética da região. Foram selecionados selecionados casos ilustrativos de pacientes que se submeteram a procedimentos de gluteoplastia, sejam eles aprovados, off-label ou mesmo ilícitos, e que fizeram estudo de ressonância magnética em nosso serviço. Foi realizada ainda revisão bibliográfica sobre o tema.

ABSTRACT Introduction: Aesthetic procedures in the gluteal region are increasingly in evidence in recent decades with the augment in demand and the emergence of new techniques. This fact, coupled with the development and easier access to imaging methods and the increasing judicialization of medicine, makes imaging exams more frequent in patients undergoing gluteoplasty, with an emphasis currently on magnetic resonance imaging in this region. Thus, the image increasingly enters the plastic surgeon's daily clinical practice, requiring knowledge of basic concepts regarding the request and interpretation of the exams. In this article, we reviewed aspects of magnetic resonance imaging of aesthetic procedures in the gluteal region and their complications. The objective is to, through magnetic resonance studies, the usual findings in gluteoplasty procedures, as well as some of their complications, in addition to proposing an examination protocol for magnetic resonance imaging in the region. Illustrative cases of patients who underwent gluteoplasty procedures, whether approved, off-label or even illicit, were selected, in which we conducted a magnetic resonance study in our service. A bibliographic review was also done on the topic.

Effects of simethicone combined with compound polyethylene glycol for bowel cleaning on the detection rate of colon polyps / 中华消化内镜杂志

To explore the effects of simethicone combined with compound polyethylene glycol for bowel cleaning on the detection rate of intestinal polyps. A total of 300 patients undergoing colonoscopy from May to July 2020 were randomly divided into group A and B. Patients in group A only used 2 packets of compound polyethylene glycol electrolyte powder for bowel cleaning. Patients in group B took simethicone combined with compound polyethylene glycol for intestinal cleaning. The time, method and dosage of compound polyethylene glycol were the same as those of group A. Intestinal cleanliness, intestinal defoaming degree, intestinal polyp detection rate and incidence of adverse reactions in group A and B were compared respectively. The scores of intestinal cleaning, the rate of intestinal foam removal and the detection rate of large and small polyps in group B were higher than those in group A. There was no significant difference in the incidence of short-term adverse reactions between the two groups. However, the incidence of postoperative abdominal distension in group B was significantly reduced. Simethicone combined with compound polyethylene glycol for bowel cleaning can significantly improve the degree of intestinal cleaning and improve postoperative abdominal distension. It has obvious effects on improving the detection date of intestinal polyps and preventing the occurrence of certain intestinal tumors. The method is simple, feasible and economical, which is worth promoting.

Migración intracraneal de aceite de silicona a través del nervio óptico post-vitrectomía / Intracranial migration of silicone oil through the optic nerve post-vitrectomy

La migración intracraneal del aceite de silicona intraocular es una complicación rara en el tratamiento de las complicaciones de la retinopatía diabética. Se han postulado varios posibles mecanismos etiopatogénicos para explicar este fenómeno de migración. El aceite de silicona se presenta hiperdenso en la tomografía, siendo un desafío distinguirlo de la hemorragia subaracnoidea, resaltando la utilidad de la resonancia magnética. En pacientes con evidencia de retinopexia de silicona previa, la visualización de una lesión intraventricular con un artefacto de desplazamiento químico asociado aumenta la posibilidad de que se trate de una migración del aceite de silicona. Presentamos el caso de un paciente con antecedente de retinopexia con aceite de silicona y cefalea intensa, identificándose migración del aceite de silicona al sistema ventricular con estudios de tomografía y resonancia.

The intracranial migration of intraocular silicone oil is a rare complication in the treatment of complications of diabetic retinopathy. Several possible etiopathogenic mechanisms have been published to explain this phenomenon of migration. Silicone oil appears hyperdense on tomography, being a challenge to distinguish it from subarachnoid hemorrhage, highlighting the usefulness of magnetic resonance imaging. In patients with evidence of previous silicone retinopexy, the visualization of an intraventricular lesion with a chemical displacement device presents the possibility that it is a migration of the silicone oil. To present the case of a patient with a history of retinopexy with silicone oil and intense headache, identifying the migration of silicone oil in the ventricular system with tomography and resonance studies.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction / Comparação da sensação de dor durante a extração de óleo de silicone sob anestesia tópica e retrobulbar

ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.

The comparison of immersion B-scan guided with respective sonic velocity and Lenstar LS900 onmeasurement of axial length in silicone oil-filled eyes / 中华眼底病杂志

Objective To evaluate the accuracy of the biometry using immersion B scan and partial coherence interferometry (Lenstar LS900) for the axial length (AL) of silicone oil-filled eyes respectively.Methods Thirty-five silicone oil-filled eyes (38 patients) were included in the study.All of these eyes underwent silicone oil removal,cataract extraction and intraocular lenses implantation.The AL of all the silicone oil-filled eyes was measured with A/B-scan ultrasound and Lenstar LS900 before operation and with Lenstar LS900 after operation.The measured distance was compared respectively.The method of immersion B-scan guided with respective sonic velocity.AL was the sum of corneal thickness,anterior chamber depth,lens thickness,the apparent length of oil bubble (velocity values 996 m/s),the depth of the water layer beneath the oil bubble.Results Thirty-one eyes were measured with Lenstar LS900 before silicone oil removal,and the mean AL was (24.12± 1.70) mm,7 eyes failed to get the results before the operation;36 eyes were measured with Lenstar LS900 after silicone oil removal,and the mean AL was (24.45±1.89) mm.All eyes were measured with B-scan before silicone oil removal,and the mean AL was (24.87±2.52) mm.The difference (31 eyes) of AL measurement before silicone oil removal by two methods was (-0.00±0.09) mm;the difference (31 eyes) between pre-and post-surgical AL measurement with Lenstar LS900 was (0.02±0.07) mm;the difference (36 eyes) between pre-surgical AL measured with B-scan and post-surgical AL measured with Lenstar LS900 was (-0.02±0.11) mm.All the differences were not statistically significant (t=-0.205,1.752,-1.280;P＞ 0.05).The consistency of the results measured by two methods was well in Bland-Ahamn analysis.Conclusions Measurement results of AL between immersion B-scan guided with respective sonic velocity and Lenstar LS900 are high repeatability on silicone oil-filled eyes.The AL of silicone oil-filled eyes can be measured reliably by immersion B-scan guided with respective sonic velocity.

Comparison of IOL refractive power caculation using different apparatus and various formulas in cataract eyes with silicon oil tamponade / 中华实验眼科杂志

Background Silicon oil tamponade eyes following vitrectomy accelerate and induce lens opacification,so the accurate measurement and calculation of intraocular lens (IOL) diopter before cataract extraction+ IOL implantation is very important for the recovery of visual function.Objective This study was to compare the differences of IOL powers measured and calculated by different apparatus and different IOL power formulas before cataract extraction + IOL implantation silicon oil tamponade combined with cataractous eyes.Methods A prospective,consecutive,nonrandomized study was performed.Thirty-six silicon oil tamponade with cataract eyes of 36 patients were included in the Second Affiliated Hospital of Soochow University from August 2011 to October 2013.Patients with silicone oil emulsification for 4 months to 2 years prepared to treat by cataract extraction + IOL implantation+silicon oil removal.Axial length (AL),corneal curvature (CC) and anterior chamber depth (ACD) were measured with IOLMaster and A-scan with manual kerameter (MK) in the eyes for the prediction of IOL power by SRK-Ⅱ,SRK/T,Hoffer Q,Holladay 1 and Haigis formulas under the oral informed consent.The mean predictive error (MPE) and mean absolute refractive error (MAE) between predictive IOL diopters before operation and actual IOL diopters after operation were evaluated.Results The AL and ACD values measured by IOLMaster was (25.43± 0.90)mm and (3.22±0.38)mm,which were significantly higher than (25.21±1.02)mm and (3.07±0.62) mm by A-scan+ MK respectively,the difference between the two measure methods was statistical significance (both at P =0.000).No significant difference was found in measured CC values between IOLMaster and A-scan+MK ([44.58±1.57] D vs.[44.56±1.62] D) (P=0.568).When the parameters measured by IOLMaster were used,the MAE from SRK/T formula was smaller than that from SRK-Ⅱ,Hoffer Q,Holladay 1 and Haigis formulas (P =0.017,0.009,0.012,0.001),and the MAE from Haigis formula was significantly larger than that from SRK-Ⅱ,Hoffer Q and Holladay 1 formulas (P =0.026,0.035,0.021).When measured by A-scan + MK,the MAE from Haigis formula was significantly larger than that from SRK-Ⅱ,SRK/T,Hoffer Q and Holladay 1 formulas (P=0.007,0.004,0.018,0.006).There was no significant difference in the number of eyes with MAE ≤ 1.0 D between IOLMaster and A-scan+MK measurements under the calculation of SRK-Ⅰ,SRK/T,Hoffer Q and Holladay 1 formulas (x2 =0.107,2.250,0.845,0.084,all at P＞0.05).However,the number of eyes with MAE ≤ 1.0 D was significantly increased in IOLMaster measurement compared with A-scan+MK under the calculation of Haigis formula (x2 =4.431,P =0.035).Conclusions In silicon oil-filled cataract eyes,SRK/T formula appears to have a more accurate predictive value of IOL power than that of other formulas when employ IOLMaster;when use A-scan+MK measurement,the predictive value of IOL power seems to be better by using SRK-Ⅱ,SRK/T,Holladay 1 or Hoffer Q formulas.

Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy

PURPOSE: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.

The accuracy of ultrasonography in 5500 mPas silicone-tamponade eyes / 中华实验眼科杂志

Background The ultrasonography for silicone tamponade eye is a problem in diagnosis and treatment of eye diseases,especially for the calculation of intraocular lens (IOL) power.IOL Master is usually used to the biometric measurement of the silicone tamponade eye in well-equipped hospital,but it is still disabled in serious cataractous eyes.Corrective B or A-type ultrasound methods have been used for a fewer years,but these measured results are incomparable probably due to the difference of viscosity of silicone oils.Objective This study attempted to investigate the accuracy of B-type ultrasonography for ocular axial length (AL) measurement in silicone tamponade eyes.Methods The transmitting speed of ultrasonic wave in the silicone oil was determined by comparing the outcomes between balance solution mesuring and 5 500 mPas silicone oil,and a calculating formula for corrective ocular AL in 5 500 mPas silicone filled eyes was further established.Thirty-two eyes of 30 patients who received 5 500 mPas silicone oil tamponade due to complex retinal detachment were enrolled in Qingdao Hiser Medical Group from May 2012 to March 2014.The eyes were assigned to the AL＜26 mm group (18 eyes of 16 patients) and AL≥26 mm group (14 eyes of 14 patients).B-scan ultrasound and IOL Master were used to measure the AL before the removal of the silicone oil,and the Als were measured again using A-scan ultrasound and B-scan ultrasound 3 months after the removal of the silicone oil.The outcomes were compared and the correlations were evaluated among different measuring methods.The vitrous length values before and after removal of the oils,and the diopters before and after intraocular pressure (IOP) implantation were compared to varify the results of B-type sonography for 5 500 mPas silicone-tamponade eyes.Results The transmitting speed of sound wave in 5 500 mPas silicone oil was 1 023 m/second with the conversion factor 0.668 between silicon oil eyes and vitreous cavity,and the corrected formula for AL measurement was:the length form cornea apex to the posterior pole of lens or the center of the capsular membrane+ 0.668×the length form posterior pole of lens or the center of the capsular membrane to the macular area.No significnant differences were found in the AL values among the corrective-B scan,IOL Master method,postoperative Bscan method and A-scan method both in the AL＜26 mm group and the AL≥26 mm group (AL＜26 mm:F=0.108,P =0.955;AL ≥ 26 mm:F =0.011,P =0.998),and the AL values by corrective B-scan was significantly correlated with that by IOL Master,postoperative B-scan and A-scan,respectively (AL＜26 mm group:r =0.876,0.921,0.809,all at P＜0.01;AL ≥ 26 mm group:r =0.943,0.956,0.955,all at P＜0.01).The vitreous cavity depth was (20.78 ±2.13)mm by corrective B-scan in 1 day before the removal of silicone,and that in 3 months after removal of silicone was (20.89±2.16) mm,without statistical diference between them (t =0.795,P =0.219).The actual postoperative refraction in 16 eyes with IOL was (-1.25 ± 1.69) D,and preoperative refrection was (-1.50 ±0.00) D,the difference was not statistically significant (t =0.585,P =0.284).Conclusions The biometry of B-scan ultrasonography for silicone-tamponade eye is accurate and simple,with a good feasibility in clinical measurement.

Case of Atrophied Retina after Retinal Detachment Reoperation

PURPOSE: To report a case of visual deterioration and atrophied retina after pars plana vitrectomy (PPV) and silicone oil tamponade for the treatment of retinal detachment with previous encircling scleral buckling. CASE SUMMARY: A 29-year-old female visited for treatment of rhegmatogenous retinal detachment (RRD) in the right eye which was not completely resolved after encircling scleral buckling. Logarithm of minimal angle of resolution (log MAR) and best corrected visual acuity (BCVA) was 0.3. Retinal detachment from 3 to 8 O'clock without macular involvement was identified. Pars plana vitrectomy, endophotocoagulation and silicone oil tamponade were performed. During the operation, retinal dialysis and retinal break at the superonasal periphery were observed. The patient complained of central scotoma at 2 days postoperatively and hyper-reflection of the inner retina was identified on optical coherence tomography (OCT). At 2 weeks postoperatively, the OCT image revealed a thin retina and impending macular hole. After 2 months, the silicone oil was removed. Although the retina was well attached, the retina remained atrophied and the log MAR BCVA was 0.16. CONCLUSIONS: We report a rare case with deteriorated visual acuity after PPV and silicone oil tamponade for the retreatment of RRD in an atopic dermatitis patient.

Comparative study of the influence of silicone oil and heavy silicone on ultrastructure of rabbits' retina / 中华眼底病杂志

Objective To investigate the medium and long-term influence of silicon oil versus heavy silicone oil on rabbit retinas.Methods 28 health standard rabbits were randomly divided into A,B and C groups,with 12,12 and 4 rabbits respectively.All rabbits received routine vitrectomy and tamponade with silicone oil (group A),or heavy silicone oil (group B) or balanced salt solution (group C).After 4,8,12 and 24 weeks,the retinal b-wave amplitude was measured by ERG,posterior retinal thickness was measured by optical coherence tomography (OCT).Retinal ultrastructure and tissue morphology were observed by transmission electron microscopy and optical microscopy.Results Compare to group C,the b-wave amplitude decreased at 4 weeks after surgery,and decreased at 8 weeks after surgery for group B,and decreased at 8 weeks after surgery,and decreased at 24 weeks after surgery for group A.The decreases were greater in group B than group A at 8,12,24 weeks after surgery,the difference was statistically significant (P＜0.05).The posterior retinal thickness of group A and B was thinner than group C at 24 weeks after surgery (P＜0.05).The decreases were greater in group B than group A,the difference was statistically significant (P＜0.05).Transmission electron microscopy and optical microscopy revealed severe pathological changes of retinal ultrastructure and morphology in group A and B rabbit eyes,at 12 weeks and 8 weeks after surgery respectively.The changes were more severe in group B and group A,including edema and necrosis in cone/rod cells,in disk membranes,mitochondria,cytoplasm,nucleus and other organelles.The morphological changes were also more severe in group B and group A,including degenerations of ganglion cell layer,inner nuclear layer changes.Those changes became more severe when the tamponade time extended.Conclusion The heavy silicone influence on visual function,ultrastructures,histomorphology of rabbit retinas is much worse than the silicon oil,and the effect is more significant with its time prolong.

Effects of C3 F8 or silicon oil tamponade on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy / 中华眼底病杂志

Objective To compare the effects of intravitreal tamponade of C3 F8 with silicon oil on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy (PDR).Methods The clinical data of 121 patients (127 eyes)who underwent primary vitrectomy due to PDR were analyzed retrospectively.All the patients were divided into two groups according to different intravitreal tamponade, including C3 F8 tamponade group (53 patients with 56 eyes ) and silicone oil tamponade group (68 patients with 71 eyes).There was no difference of gender (χ2 = 0.956 ),age (t =1.122),duratiion of diabetes (t=0.627),fasting blood glucose (t=1.049),systolic pressure (t=1.056), diastolic pressure (t = 0.5 1 7 ), history of hypertension (χ2 = 0.356 ), nephropathy (χ2 = 1.242 ), preoperative laser photocoagulation (χ2 = 1.225 )and All the patients underwent three port pars plana vitrectomy.The mean follow-up was 2 years ranging from 6 months to 4 years.And then the incidence and onset time of postoperative vitreous hemorrhage and postoperative BCVA of the two groups were compared. Results Postoperative vitreous hemorrhage occurred in 14 of 56 eyes (25.00%)in C3 F8 tamponade group. The average onset time of postoperative vitreous hemorrhage were (64.64 ± 59.09)days ranging from 7 -225 days and mostly were within 30-60 days (35.71%,5/14).Postoperative vitreous hemorrhage also occurred in 7 of 71 eyes (9.89%)of silicone oil tamponade group after silicone oil removal with an average onset time of (25.29±20.46)days ranging from 3-65 days and were mostly within 1 5-30 days (42.86%, 3/7).There was a significant difference in the incidence of postoperative vitreous hemorrhage between the two groups (χ2 = 5.200,P <0.05 ).BCVA of the two groups was improved significantly after operation (Z =2.472,3.1 14;P <0.05).Postoperative BCVA of silicone oil tamponade group was poorer than C3 F8 tamponade group (Z =1.968,P <0.05).Conclusion Both C3 F8 and silicone oil tamponade can improve the visual acuity after vitrectomy for PDR.Compared with C3 F8 ,silicone oil tamponade had lower incidence and late onset of postoperative vitreous hemorrhage after vitrectomy for PDR.

Etiology study of retinal detachment after silicone oil removal / 中华眼底病杂志

Objective To evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil.Methods The clinical data of 821 patients (858 eyes) who underwent removal of silicone oil in General Hospital of PLA during 2008-2012 were retrospectively analyzed.The patients included 518 males and 303 females.The age was ranged from 1 to 79 years old,with an average of 44.03 years.All patients underwent removal of silicone oil after vitrectomy combined with silicone oil tamponade (the tamponade period was ranged from 40 days to 13 years,with an average of 6.82 months).The incidence,time and causes of retinal re-detachment were analyzed.Results Retinal re-detachment occurred in43 patients (44 eyes,5.13％).Among these retinal re-detachment in 44 eyes,23 eyes (52.27％) occurred in 1 week,13 eyes (29.55％) in 1-4 weeks,4 eyes (9.08％) in 4-8 weeks,2 eyes (4.55％) in 8-12 weeks,and 2 eyes (4.55％) more than 12 weeks after silicone oil removal.Possible reasons of retinal re-detachment included activated original retinal holes (7 eyes),residual peripheral vitreous (3 eyes),traction of epiretinal proliferative membrane (18 eyes),new retinal hole (9 eyes),non-closure of original retinal holes (5 eyes) and traction of retinal incarceration in the scleral incision (2 eyes).Conclusions The incidence of retinal re-detachment after silicone oil removal is 5.13 ％.The incidence reduced gradually with the extension of time after removal silicone oil.

Effects of selective laser trabeculoplasty on silicone oil eye with secondary glaucoma / 中国基层医药

Objective To investigate the selective laser trabeculoplasty on silicone oil eye with secondary glaucoma.Methods Silicone oil eye secondary glaucoma patients in our hospital were chosen as the experimental group,and the same treatment as the control group 72 cases,the two groups of patients using selective laser trabeculo-plasty[selective laser trabeculoplasty(SLT)]treatment on vision,visual acuity,and intraocular pressure,complications were compared in the two groups of patients after treatment .Results There were complications compared two groups of patients with complications was no significant difference ( P>0.05);and the two groups of patients had no obvious visual acuity ,corneal edema ,extensive peripheral anterior synechia ,sustained elevation of intraocular pressure ,glauco-ma optic progress and other serious complications;IOP before treatment of (25.73 ±3.32) mmHg of the experimental group after treatment was (18.21 ±2.23) mmHg;control group before and after treatment were (25.18 ±5.40) mm-Hg,and (17.82 ±2.93)mmHg.Two groups patients showed no significant difference;comparison of the two groups of patients with vision,the experimental group before and after treatment were (0.65 ±0.23) and (0.89 ±0.32);control group were (0.71 ±0.33) and (0.87 ±0.41).Conclusion Silicone oil eye in patients with secondary glaucoma treatment using selective laser trabeculoplasty can get the treatment the other glaucoma same clinical efficacy.

Complicações locais após a injeção de silicone líquido industrial: série de casos / Local complications after industrial liquid silicone injection: case series

OBJETIVO: analisar uma série de casos de pacientes submetidos à injeção de silicone líquido industrial de maneira clandestina e por pessoas não habilitadas. MÉTODOS: análise retrospectiva de prontuários de pacientes atendidos no período de setembro de 2003 a dezembro de 2010. Foram avaliados: sexo, idade, local e volume de silicone injetado, tempo decorrido entre a aplicação e as manifestações clínicas, complicações, tratamento e evolução. Definiu-se como precoce as manifestações ocorridas até 30 dias da injeção e manifestações tardias após este período. RESULTADOS: Foram atendidos 12 pacientes, oito eram do sexo masculino, sendo sete transexuais. O volume injetado variou de 5ml a 2000ml, sendo desconhecido em três casos. Os locais mais frequentemente utilizados para injeção foram a região de coxas e glúteos. Oito casos apresentaram manifestações precoces, com quadros de inflamação e/ou infecção. Foi necessária a realização de desbridamento cirúrgico em cinco casos. Três pacientes com histórico de injeção na região mamária foram submetidas à adenomastectomia. Houve um óbito por quadro de choque séptico refratário. CONCLUSÃO: O uso do silicone líquido industrial deve ser totalmente contraindicado como material de preenchimento e modificação do contorno corporal, podendo apresentar graves complicações e até mesmo óbito.

OBJECTIVE: To analyze a case series of patients who underwent injection of industrial liquid silicone in a clandestine manner and by unauthorized persons. METHODS: We conducted a retrospective analysis of medical records of patients treated between September 2003 and December 2010. Data regarding gender, age, location and volume of silicone injected, time between application and clinical manifestations, complications, treatment and outcome were collected. Early manifestations were defined as occurring within 30 days of injection and late manifestations, the ones arising after this period. RESULTS: We treated 12 patients, eight were male, seven transsexuals. The volume injected ranged from 5ml to 2000ml, being unknown in three cases. The most often used injected sites were the thighs and buttocks. Eight patients had early manifestations, with inflammation and/or infection. Surgical debridement was necessary in five cases. Three patients with a history of injection in the breast region underwent adenomastectomy. There was one death due to refractory septic shock. CONCLUSION: The use of industrial liquid silicone should be completely contraindicated as a filling material and modification of body contouring, and may have serious complications, even death.

Causes and risk factors of recurrent retinal detachment after silicone oil removal / 中华眼底病杂志

Objective To investigate the main causes and risk factors of recurrent retinal detachment (RRD) after silicone oil removal (SOR) in eyes with complex retinal detachment.Methods It was a retrospective case series study.A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study.All patients underwent vitrectomy operation.Additionally,they were given heavy water,membrane peeling,retinotomy or partial cutting,intraocular laser photocoagulation or frozen,gas-liquid exchange or direct oil exchange operation accordingly.Ninety-eight eyes with multiple holes,old retinal detachment,hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously.Intravitreal silicone oil was padded at the end of operation.Cutting,stripping or resection and 360° preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR.Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation.One week after SOR and during follow-up,the visual acuity,intraocular pressure (IOP),slit lamp microscope,and ophthalmoscope examination were examined with the same technique and methods as preoperation.The eyes were divide into two groups based on the attachment status of retina after SOR,which were reattached group (419 eyes) and redetached group (39 eyes) respectively.The following data were recorded.,the age of patients,ocular axial length,logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and IOP before vitrectomy operation and before and after SOR,the number of retinal breaks,the duration of silicone oil filling,the duration of follow-up,and the related factors during vitrectomy operation and SOR.The relation of age,sex,high myopia,the size and location of holes,aphakic eye,proliferative vitreoretinopathy (PVR) C3 level and above,previous history of failed retinal detachment operation,360° preventive laser photocoagulation,assistant scleral buckling surgery,SOR via corneal puncture to RRD after SOR were analyzed.Odds ratio (OR) and its 95％ confidence interval (CI) were calculated for the age ＜40 years old and gender.High myopia,assistant scleral buckling surgery and SOR via corneal puncture were further analyzed by multiple regression equation.Results After SOR operation,the total average logMAR BCVA was 0.86 ± 0.63.The average logMAR BCVA was 0.82 ± 0.59 and 0.99 ± 0.70 respectively for the reattached and redetached groups,which was not statistically different (F=1.559,P＞0.05).The number of high myopia eyes in the reattached and redetached groups were 116 and 22 eyes,respectively,accounted for 27.7 ％ and 56.4 ％,and the difference was statistically significant (x2=13.984,P＜0.01).Three eyes underwent vitrectomy with scleral buckling occured RRD,accounting for 3.1％; while 36 eyes underwent vitrectomy without scleral buckling occured RRD,accounting for 10.0％.The incidence of RRD between them was statistically significant (x2 =4.761,P＜0.05).The incidence of RRD was not retated to the PVR levels before the operation,previous history of failed retinal detachment operation,aphakic eye and preventive laser photocoagulation (OR=1.626,1.699,1.986,0.709; 95％ CI:0.836-3.162,0.832-3.658,0.921-4.279,0.268-1.875; P＞0.05).RRD had a close relation with high myopia and assistant scleral buckling surgery (OR=3.380,0.284; 95％CI:1.733-6.595,0.086-0.944; P＜0.05).The raise of risk derived from SOR via corneal puncture had no statistical significance (OR=2.119; 95％CI:1.043-4.306; P＞0.05).The incidence of RRD after SOR was 8.5％; of which,35.9％ originated from new breaks and 69.2％ were related to new breaks,in contrast,only 5.1％ originated from PVR but 51.3％ were related to PVR.Conclusions High myopia is an independent prognostic risk factor of RRD after SOR.Combined scleral buckling surgery is a protective factor of RRD after SOR.To the well reattached eyes before SOR,the new breaks seems to be the main cause of RRD,wheras PVR was probably a secondary phenomenon.

Effectiveness of premedication with pronase for visualization of the mucosa during endoscopy: a double-blinded, multi-center, prospective, randomized study / 中华消化内镜杂志

Objective To assess the efficacy and safety of premedicaton with pronase before upper gastrointestinal endoscopy (UGI).Methods A total of 440 outpatients from 5 centers were randomly assigned to receive endoscopy with one of three premedications as follows:dimethylpolysiloxane (DMPS) and pronase (group A,n =170) ; DMPS and sodium bicarbonate (group B,n =170) ; DMPS,pronase and sodium bicarbonate (group C,n =100).Six endoscopists,who were unaware of the premedication types,calculated the visibility scores (range,1 to 4) of the antrum,gastric body,and fundus.The sum of the scores from the three locations was defined as the total visibility score.Results With regards to routine white light endoscopy,the total visibility score of group C was significantly higher than that of group A (P =0.0001),and the score of group A was significantly higher than that of group B (P =0.0019).Concerning chromoendoscopy,the total visibility score of group C was significantly higher than that of group A (P =0.0054),and the score of group A was also significantly higher than that of group B (P ＜ 0.0001).Conclusion Combined application of pronase,dimethylpolysiloxane,and sodium bicarbonate before UGI endoscopy significantly improves endoscopic visualization.