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The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
ABSTRACT
The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
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@#Recurrent retinal detachment in silicone oil-filled eyes after vitrectomy is a special type of recurrent retinal detachment. Some patients require reoperation, which brings challenges for clinical work. The diagnosis and treatment of retinal detachment in silicone oil eyes have some characteristics. More attention should be paid to the identification of high-risk factors. Adequate doctor-patient communication and rational selection of treatment plan are essential for the prognosis of this disease.
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@#AIM: To compare the efficacy of air versus silicone oil tamponade for management of rhegmatogenous retinal detachment(RRD)following 25G pars plana vitrectomy(PPV).<p>METHODS: A prospective, randomized comparative study. 146 eyes from 146 patients who underwent 25G transconjunctival sutureless vitrectomy to repair rhegmatogenous retinal detachment were performed. Totally 60 eyes used air tamponade but 86 eyes used silicone oil tamponade. The follow-up time ranged from 6-12mo. The best corrected visual acuity(LogMAR), intraocular pressure, retinal reattachment rate, intraoperative and postoperative complications were compared.<p>RESULTS: One month after surgery, the mean BCVA was 0.45±0.5 in the air tamponade group and 0.78±0.65 in the silicone oil tamponade group, it were both evidently improved in comparison with before surgery, what's more, air tamponade had significantly better BCVA than those in the silicone oil tamponade(both <i>P</i><0.05). 3mo after surgery, the reattachment rate of patients in air group was lower than that of silicone oil group(93.3% <i>vs</i> 97.7%), but had no significant differences between the two groups. 6mo after surgery, the anatomical success rate were 100% in both groups. The main intraoperative complication was iatrgenic retinal breaks in 10 eyes(6.8%). The main postoperative complication was high intraocular pressure, the intraocular pressure 1wk after surgery in the silicone oil tamponade group was evidently higher than that air tamponade group(<i>P</i><0.001). No serious complication such as endophthalmitis and choroidal hemorrhage were observed in both groups.<p>CONCLUSION: For the simple early RRD, air tamponade had equivalent reattachment rate to silicone oil tamponade after 25G PPV. In the early postoperative, the visual acuity of air group was better comparing with silicone oil group, and was lower incidence of high intraocular pressure.
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·AIM:To discuss the clinical efficacy of 27-gauge (27G) vitrectomy with proliferative membrane cutting in situ for late proliferative diabetic retinopathy (PDR). ·METHODS: Collecting 10 cases (15 eyes) with late PDR from January 2017 to August 2017 which underwent 27G microincision vitrectomy with cutting proliferative membrane in situ, we observed the rate of intraoperative iatrogenic retinal hole ( IRH ), the rate of silicone oil tamponade, the best corrected visual acuity ( BCVA) and intraocular pressure (IOP) before and after operation. ·RESULTS: IRH occurred in 4 eyes (27%, 4/15); Silicone oil was tamponaded in 6 eyes (40%, 6/15); BCVA was improved in 13 eyes and only 2 eyes unchanged 3mo after operation. The best visual acuity (VA) was 0. 6. There was significant difference on BCVA between preoperative and postoperative 7d(P<0. 05). The same was found between preoperative and postoperative 1mo, even 3mo(P<0. 05). The average preoperative IOP was 16. 95 ± 6. 87mmHg and postoperative 3mo was 15. 27 ± 4. 57mmHg. There was no significant difference between them (P>0. 05). · CONCLUSION: The 27G vitrectomy with cutting proliferative membrane in situ method is markedly superior in the treatment of late PDR, and the curative effect is specific. It can be given preference to late PDR.
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@#Silicone oil, as a temporary vitreous substitute, has been widely applied to the treatment of various complex vitreoretinal disease. However, silicone oil tamponade also causes a variety of postoperative complications, the most common of which is temporary or permanent elevated intraocular pressure(IOP). A number of studies have shown that intraocular pressure after silicone oil filling is affected by a variety of factors. In this paper, the progress on the risk factors and pathogenesis of secondary high intraocular pressure after silicone oil tamponade are reviewed, which might provide a reference for the timely and effective control of IOP.
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Objective To explore the characteristics and surgical managements of recurrent retinal detachment in silicone oil tamponade eyes.Methods The records of consecutive series of 134 patients (134 eyes) with recurrent retinal detachment in silicone oil tamponade eyes from January 2012 to December 2015 in our hospital were reviewed retrospectively,the vitrectomy combined with silicone oil replacement or scleral buckling procedure were performed.The follow-up time was 6 months,the surgical efficient was evaluated.Results 101 eyes underwent vitrectomy combined with silicone oil replacement.Retina was completely reattached in 79 eyes,and vitrectomy was reperformed in the left 22 eyes,the successful rate was 78.2％ (79/101);The visual acuity improved in 16 eyes,unchanged in 56 eyes,decreased in 29 eyes;The intraocular pressure of 31 eyes increased more than 25 mmHg (1 kPa =7.5 mmHg).33 eyes underwent scleral buckling procedure.Retina was completely reattached in 23 eyes,and vitrectomy combined with silicone oil replacement was performed in the left l0 eyes,the successful rate was 69.7％ (23/33);The visual acuity improved in 5 eyes,unchanged in 16 eyes,decreased in 12 eyes;The intraocular pressure of 14 eyes increased more than 25 mmHg.Conelusion For limited retinal detachment caused by inferior or peripheral holes,proliferative vitreoretinopathy in the A or B-class,the refractive medium does not affect the fundus examination,scleral buckling surgery is preferred;For the hole in the posterior pole or extensive retinal detachment caused by giant retinal holes,proliferation or retinal fixed fold formation,vitrectomy combined with silicone oil replacement is a better option.
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· AlM:To investigate the effect of compound anisodine on fundus blood circulation after vitrectomy with face-down position. · METHODS: Sixty patients ( 60 eyes ) with rhegmatogenous retinal detachment received vitrectomy with silicone oil tamponade operation, who were randomized divided into treatment group ( 30 eyes ) and control group ( 30 eyes ) .The patients in the treatment group received the subcutaneously injection of compound anisodine hydrobromide by the superficial temporal artery once daily for 14d since postoperative first day.Retinal microcirculation blood flow parameters were recorded with Heidelberg retinal flowmeter postoperative 1d, 1 and 2wk, and were compared between two groups. ·RESULTS: The blood flow parameters ( Vol, Flw, Vel) of control group postoperative 1 and 2wk were significantly less than those postoperative 1d.Otherwise the parameters of treatment postoperative 1 and 2wk were significantly more than those postoperative 1d. The parameters between two groups were significant different ( P · CONCLUSlON: Facing down after vitrectomy with silicone oil tamponade may reduce retinal blood supply, consequently lead to retinal ischemia; compound anisodine can effectively improve the retinal and choroidal microcirculation after vitrectomy with face-down posture, reduce retinal ischemia, and enhance the visual function.
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PURPOSE: To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation. METHODS: A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed. RESULTS: Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 +/- 0.66 and logMAR 1.51 +/- 0.66, respectively (p < 0.05). CONCLUSIONS: This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Drainage/methods , Follow-Up Studies , Injections , Retinal Detachment/diagnosis , Retrospective Studies , Silicone Oils/administration & dosage , Subretinal Fluid , Treatment Outcome , Visual Acuity , Vitrectomy/methodsABSTRACT
PURPOSE: To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation. METHODS: A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed. RESULTS: Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 +/- 0.66 and logMAR 1.51 +/- 0.66, respectively (p < 0.05). CONCLUSIONS: This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Drainage/methods , Follow-Up Studies , Injections , Retinal Detachment/diagnosis , Retrospective Studies , Silicone Oils/administration & dosage , Subretinal Fluid , Treatment Outcome , Visual Acuity , Vitrectomy/methodsABSTRACT
PURPOSE: To report a case of delayed sealing of full-thickness macular hole associated with diabetic retinopathy after vitrectomy with silicone oil tamponade. CASE SUMMARY: A 63-year-old woman visited our clinic complaining of decreased visual acuity in her left eye. Fundoscopy showed a full-thickness macular hole with vitreomacular traction in the left eye and bilateral proliferative diabetic retinopathy. The patient underwent uncomplicated phacoemulsification and pars plana vitrectomy with silicone oil tamponade because her vision in the contralateral eye was only light perception. She was unable to maintain a prone position postoperatively due to anterior chamber hyphema. At 1.5 months after surgery, vitreomacular traction was removed but the hole was not sealed as observed on optical coherence tomography. Approximately 3 months after vitrectomy, the macular hole was sealed with minimal subfoveal fluid. At 6 months after vitrectomy, the macular hole was closed completely with no subfoveal fluid.
Subject(s)
Female , Humans , Anterior Chamber , Diabetic Retinopathy , Eye , Hyphema , Light , Phacoemulsification , Prone Position , Retinal Perforations , Silicone Oils , Tomography, Optical Coherence , Traction , Vision, Ocular , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To report a case of macular hole after surgery in macular serous detachment associated with optic disc pit in a child, which was treated with silicone oil as an intraocular substitute. CASE SUMMARY: A 12-year-old boy was referred for examination due to visual disturbance in his left eye for the last 1 week. Corrected visual acuity at presentation was 0.08 in the left eye. The anterior part of the left eye was normal on slit lamp examination. Funduscopic examination revealed optic disc pit associated with macular detachment. The patient was treated with vitrectomy, internal limiting membrane (ILM) peeling and gas tamponade. One week after treatment, the patient presented with central visual disturbance and showed a full thickness macular hole in the left eye. Extensive ILM peeling and silicone oil instillation were performed and after 2 months, silicone oil removal was performed. The macular hole appeared to be closed and visual acuity improved to 0.2. Recurrence was not observed until 20 months after treatment. CONCLUSIONS: After surgical treatment due to macular detachment associated with optic disc pit in a child, occurrence of a macular hole is possible. Regarding macular hole treatment, silicone oil instillation and fast removal could be a beneficial option.
Subject(s)
Child , Humans , Eye , Membranes , Recurrence , Retinal Perforations , Silicone Oils , Visual Acuity , VitrectomyABSTRACT
Aim: To investigate factors having implications on re-retinal detachments (reRD) after silicone oil removal (SOR). Materials and Methods: A retroprospective study of 412 eyes (with attached retina after vitrectomy with silicone oil for rhegmatogenous RD) which underwent SOR was conducted and were followed up for six months after SOR. They were studied for various factors like encirclage, 360° retinopexy, oil emulsification at the time of SOR, duration of oil tamponade and previous retinal surgeries prior to SOR with their implications on reRD after SOR. Results: Encirclage, 360 laser barrage, both, emulsification of oil (P=0.021, P=0.001, P=0.001, P=0.001, respectively) were associated with lower risks of reRD after SOR whereas duration of tamponade (P=0.980) was not. Conclusion: Factors like encirclage, 360 retinopexy, their combination, oil emulsification reduced the incidence of re RD after SOR whereas duration of tamponade does not have statistical significant correlation with re RD after SOR.
Subject(s)
Emulsions/adverse effects , Humans , Laser Therapy , Retinal Detachment/etiology , Retinal Detachment/surgery , Silicone Oils/adverse effects , Tampons, SurgicalABSTRACT
PURPOSE: To compare the surgical outcomes of 23-gauge transconjunctival sutureless vitrectomy (TSV) with silicone oil tamponade versus 20-gauge PPV with sclera buckling (SB) and SF6 gas tamponade for the repair of rhegmatogenous retinal detachment (RRD) with inferior breaks. In addition, silicone oil tamponade was evaluated as an alternative option for patients with inferior RRD. METHODS: Two different types of surgery were performed on two groups of patients with inferior RRD: 23-gauge TSV with silicone oil tamponade (group 1) and 20-gauge PPV with SB and SF6 gas tamponade (group 2). The preoperative clinical features, anatomical success rate, complications, functional outcomes (visual acuity, VA, intraocular pressure, IOP), and surgical time were retrospectively evaluated. RESULTS: The primary surgical success rates were 94% and 78% in groups 1 and 2, respectively. The final success rate was 100% in both groups. Therefore, in terms of success rate, there was no difference between the two groups. No statistically significant difference in IOP change or complication rate was observed between the two groups. VA change was significantly better and surgical time was shorter in group 1. CONCLUSIONS: No statistically significant difference of anatomical success rate or complication rate between 23-gauge TSV with silicone oil tamponade and 20-gauge PPV with SB and SF6 gas tamponade was found for inferior RRD. However, surgical time was shorter in group 1. A 23-gauge TSV with silicone oil tamponade could be an alternative to 20-gauge PPV with SB and SF6 gas tamponade for patients with inferior RRD, especially patients who cannot maintain a prone posture.
Subject(s)
Humans , Intraocular Pressure , Operative Time , Posture , Retinal Detachment , Retinaldehyde , Retrospective Studies , Sclera , Scleral Buckling , Silicone Oils , VitrectomyABSTRACT
Background Combination of cataractopiesis with intraocular lens (IOL) is believed to improve the patient' s quality of life. However, 1OL power and axial length measured by traditional method in silicone-filled eye is normally bias to the actual levels. The optical coherence biometry technology has been widely used in the measurement of IOL, but little studies have been conducted to demonstrate the IOL power difference between those methods. Objective This study was to evaluate the predictability of IOL power calculations using the IOLMaster and adjusting contact ultrasound A-scan method in silicone oil-filled eyes. Methods Forty-four silicone-filled eyes of 42 patients were divided into 2 groups according to the intraocular pressure (IOP) ( group A: ≥ 10 mmHg group,29 eyes;group B:＜10 mmHg group, 15 eyes). IOLMaster and ocular ultrasonic measurement were used to measure the axis length before and after silicone oil was removed. The preoperatively measured eye axis and cornea curve were used to calculate the theoretical IOL. Results In normal IOP group ( T≥ 10 mmHg,29 eyes), the precision and stability of IOLMaster for axial length ( AL ) measurements and IOL power calculations were better than adjusted ultrasound A-scan( ZIOLMasterdependent = -2. 236, P = 0. 025 ), although in low IOP group ( T＜ 10 mmHg, 15 eyes),there were too much differences in axial length mesurement and IOL power calculation between the IOLMaster and adjusted ultrasound A-scan, so the post-operative imformation was not predicted accurately. Conclusion For anticipatory normal postoperative IOP eyes, the refractive outcome in cataract surgery in silicone oil-filled eyes can be predicted reliably and accurately with IOLMaster. But for complicated or anticipatory unstable postoperative IOP eyes,secondary implantation of IOL would be better.
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Objective To evaluate the effect of using serf-designed facial support in prone position for patients after vitrectomy and silicone oil tamponade. Methods 100 patients with vitrectomy and sili-cone oil tamponade were randomly divided into the experimental group and the control group with 50 pa-tients in each group. The self-designed facial support in prone position was used in the experimental group, while the routing nursing measure was used in the control group. The ocular adverse effect and re-lapse rate were compared between the two groups. Results The incidence rate of corneal edema, in-creased intraocular pressure and retinal redetachment in the experimental group was higher than those in the control group, the time of keeping position in the experimental group was longer than that in the con-trol group. Conclusions Self-designed facial support in prone position can decrease discomfort and pain caused by compulsive position, reduce the incidence of complications, improve retinal attachment and increase the successful rate for the patients with vitrectomy and silicone oil tamponade.
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PURPOSE: To determine the results of pars plana vitrectomy and silicone oil tamponade to treat retinal detachment caused by macular holes in highly myopic eyes. METHODS: Eighteen highly myopic patients with spontaneous retinal detachment due to macular holes underwent vitrectomy and primary silicone oil tamponade. Preoperative statuses and postoperative results were reviewed. All patients had high myopia with axial lengths longer than 28 mm or had definite staphyloma. The average follow-up period was 24 months. RESULTS: Successful retinal attachment of the retina was achieved in 17 eyes, though 1 eye had redetached. Of the 17 eyes, 13 eyes achieved anatomical macular hole closure and 7 eyes showed improved visual acuity. CONCLUSIONS: Vitrectomy and silicone oil tamponade for retinal detachment due to macular holes in highly myopic eyes produce good anatomical and functional results.
Subject(s)
Humans , Eye , Follow-Up Studies , Myopia , Retina , Retinal Detachment , Retinal Perforations , Retinaldehyde , Silicone Oils , Visual Acuity , VitrectomyABSTRACT
PURPOSE: This study aimed to report anatomic and visual acuity outcomes after 5000-centistoke silicone oil was used as a retinal tamponade for the treatment of various causes of vitreoretinal diseases. METHODS: Two hundred ten eyes of 196 patients who had undergone vitrectomy with silicone oil between 1995 and 2004 were reviewed retrospectively. According to etiology, the eyes were divided into five groups : (1) Group 1 included 60 eyes associated with proliferative diabetic retinopathy, (2) Group 2 included 90 eyes associated with proliferative vitreoretinopathy, (3) Grouop 3 included 30 eyes associated with trauma, (4) Group 4 included 13 eyes associated with infection or other inflammatory disease, (5) Group 5 included 17 eyes associated with submacular hemorrhage or etc. Anatomic outcomes included complete retinal attachment and macular attachment. Visual acuity outcomes included ambulatory vision (> or =4/200) and preservation of preoperative visual acuity. RESULTS: At the last examination, the retina was completely attached in 98.1% of cases in Group 1, 98.9% Group 2, 82.6% Group 3, 83.3% Group 4 and 100% Group 5. The macula was attached in 98.1%, 98.9%, 87.0%, 100%, and 100% eyes, respectively. Ambulatory vision was achieved in 28 eyes (46.7%) in Group 1, 50 eyes (55.6%) in Group 2, 9 eyes (30.5%) in Group 3, 8 eyes (61.5%) in Group 4, and 6 eyes (35.3%) in Group 5. CONCLUSIONS: Vitrectomy with 5000-centistoke silicone oil tamponade is an effective method in the management of vitreoretinal diseases with multiple etiologies.