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@#AIM: To investigate the clinical effect of posterior capsulotomy in diabetic retinopathy with silicone oil removal combined with cataract surgery.<p>METHODS: A retrospective analysis that collected clinical data of 83 cases(83 eyes)diagnosed as diabetic retinopathy and silicone oil filled eyes with cataract and treated in our hospitalfrom January 2019 to February 2020. They were randomly divided into two groups. The experimental group consisted 41 eyes received silicone oil removal and posterior capsulotomy combined with cataract surgery; The rest 42 eyes were in control group, who received silicone oil removal combined with cataract surgery. At 6mo after surgery, the best corrected visual acuity, posterior capsular opacification, and floaters were evaluated between the two groups to confirm the advantages of posterior capsulotomy in combined cataract surgery with silicone oil removal for diabetic retinopathy.<p>RESULTS: At 6mo after surgery, the best corrected visual acuity in experimental group was better than control group(<i>P</i><0.05); There were significant differences between the two groups in the posterior capsular opacification, and floaters,experimental group is lower than control group(<i>P</i><0.05). There was no significant difference in intraocular pressure compared to preoperative between the two groups, and no significant difference in retinal detachment, vitreous hemorrhage and intraocular lens deviationafter operation(<i>P</i>>0.05). <p>CONCLUSION: Posterior capsulotomy is safe and reliable in the application of silicone oil removal combined with cataract surgery for diabetic retinopathy, and can effectively avoid the occurrence of posterior capsular opacification.
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@#AIM: To observe the effect of modified minimally invasive 23G combined with standard 20G three-channel vitrectomy for silicone oil removal. <p>METHODS: The objects of study were 32 patients with silicone oil eyes hospitalized in Jingliang Eye Hospital from March 2018 to September 2019. Enrolled patients were provided with standard three-channel incision for vitrectomy, with 23G perfusion and lighting as well as 20G suction incision at 10 o'clock. Silicone oil removal was then conducted by using minimally invasive 23G vitrectomy instrument and modified 18G needle. Further examination was performed to observe the best corrected visual acuity(BCVA), intraocular pressure, pain comfort, silicone oil residue, choroidal detachment, retinal detachment 1d, 1wk, 1mo and 3mo after operation. <p>RESULTS: All the 32 patients underwent operation successfully, and there was stable intraocular pressure and no fluctuation during operation. The removal time of silicone oil was about 10-15min, and no complications occurred intraoperatively. Postoperative 3-month follow-up 3 revealed no vitreous hemorrhage, choroidal detachment and retinal reattachment. <p>CONCLUSION: The modified minimally invasive 23G combined with standard 20G three-channel vitrectomy is simple, safe, stable and effective for silicone oil removal.
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Purpose: To compare the intermediate-term refractive outcomes of a single-step and a two-step approach for silicone oil removal (SOR) and cataract surgery. Methods: Case records of patients who had SOR and phacoemulsification (PE) from 2011 to 2013 at a tertiary center in South India were retrospectively analyzed. A total of 135 eyes that underwent ultrasound biometry (UB) were studied. Eighty-seven eyes had SOR and PE at a single surgery (Group A), where as UB was done in a silicone oil (SO) filled eye. Forty-eight eyes had SOR followed by PE later (Group B), where UB was done in a fluid-filled eye. The refractive error (RE) and best-corrected visual acuity (BCVA) at postoperative day 45 (D45) and postoperative month 3 (M3) were compared. Results: Baseline axial length, intraocular lens (IOL) power, and RE in both groups were comparable. A myopic shift (4.18 ± 5.47 diopters [D]) was noted in 92% eyes at M3. Forty-nine percent eyes had a RE of ?±1.5D at M3. RE at D45 and at M3 was significantly lesser in Group B (?1.73 ± 2.04 vs. ?0.64 ± 1.75; P, 0.002). BCVA was significantly lesser in Group A at baseline, at D45, and at M3 (P < 0.01 for all). There was no difference in other baseline characteristics of eyes that had RE ?±1.5D and those that had RE >±1.5D at M3. Conclusion: SO-filled eyes had a myopic shift in refraction after SOR and PE. When UB is used for IOL power calculation, better refractive outcomes are obtained when SOR and PE are performed in a two-step approach.
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@#AIM: To explore the safe movement angle of a 23-gauge(G)cannula in double-channel silicone oil(SO)removal surgery.<p>METHODS: From March 2017 to September 2017, 15 patients with SO filled eyes were enrolled in this retrospective analysis. Based on ultrasound biomicroscopy(UBM), the distance from the front surface of the sclera at the 2 o'clock and the 10 o'clock positions to the SO bubble at 4 mm behind the corneal limbus was measured and defined as “A”. The length of the 23G cannula(4 mm)was defined as “C”. The width of the scleral inner wall at the maximum operating angle of the scleral trocar was defined as “B”. The safe movement angle of the 23G cannula was determined according to the trigonometric function table. Using the self-made SO removal device connected to the 23G puncture cannula, the SO was successfully removed from all patients.<p>RESULTS: The average SO removal time for all patients was 4.78±0.13min. The trigonometric function was used to work out the distance from the scleral front surface to the SO bubble, which was 0.82-2.81(1.62±0.41)mm at the 2 o'clock position, and 0.98-2.19(1.71±0.34)mm at the 10 o'clock position. Finally, the verification analysis using geometric model calculation showed that the optimal movement angle of the cannula was 52°.<p>CONCLUSION:Combining the trigonometric function and UBM measurement to calculate the safe movement angle of a 23G cannula can effectively guide the moving range of the trocar during SO removal. A movement angle of the cannula larger than 50° may avoid the occurrence of a retinal tear.
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Background Lensectomy with anterior capsule preserving is still advisable under specific conditions during vitrectomy.Although lens epithelial cells were polished off during surgery,opacification in varying degrees could be observed.Understanding the composition of proliferative anterior capsule membrane is of an important clinical significance for the prevention and manegement.Objective This study was to investigate the management and pathology of the pupillary area membranous opacity underling preserved anterior capsule after lensectomy in diabetic eyes with silicone oil tamponade.Methods Twenty-three eyes of 21 patients with proliferative diabetic retinopathy (PDR) and cataract received vitrectomy combined with lensectomy preserved anterior capsule in China-Japan Friendship Hospital from January to December 2013,and the proliferative anterior capsular membrane specimens with the opacification grade C or D were obtained.The fibrotic membrane underlying anterior capsules were removed in order to make a clear optical area during the operation of silicone oil removal.The proliferative membrane at pupillary area was cut off by cutter probe for the eyes with the membrane attaching tightly or partial capsule laceration occurred.The available specimens were examined under the optical microscope and polarized microscope respectively after hemotoxylin and eosin staining,Van Gieson collagen staining,Masson collagen staining and Picrosirius staining.Results The proliferative fibrosis membranes were pilled to get a clear pupillary area in 15 eyes,with the successfully rate 65.2％ (15/23).In 14 eyes with degree C opacity,the proliferative fibrosis membranes were pilled in 9 eyes,with the successfully rate 64.3 ％ (9/14),and 5 eyes received anterior capsule cutthrough by cutter in pupillary area,with a diameter of 3-4 mm,and available specimens were obtained in 3 eyes.In 9 eyes with degree D opacity,the proliferative membranes were pilled in 6 eyes,with the successfully rate of 66.7％ (6/9),and 3 eyes underwent cut-through by cutter,and available specimens were obtained in 7 eyes.The best corrected visual acuity was obviously improved in 20 eyes and unchanged in 3 eyes after surgery.The histopathological examination showed fibroblasts,pigment particles and intracellular and extracellular vacuolus formation by hemotoxylin and eosin staining,fibril tissue with the pinke staining by Van Gieson,collage formation with green color by Masson staining in the specimens.Picrosirius staining plus polarization microscopy observation revealed that the collagen consisted of abundant type Ⅰ collagen with stronger reddish yellow color and small amount of type Ⅲ collagen with green color.Conclusions A combination of silicon oil removal with proliferative mambrane pelling is a available way to restore pupillary transparency in the eyes of PDR with cataract and silicone oil tamponade eyes.Proliferative residual lens epithelial cells,pigment epithelial cells and silicon oil granules are the main composition of opacity mambrane.The type Ⅰ collagen is dominant in proliferative collagen tissue.
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AIM:To compare the clinical efficacy of three combined surgical treatments for cataract induced by silicone oil -filled eye. METHODS: The data of 75 eyes of 75 patients with cataract induced by silicone oil-filled eye were reviewed. Those patients were divided into group A, B, C. The patients in group A were treated by phacoemulsification combined with silicone oil removal through pupil and IOL implantation, the patients in group B were treated by phacoemulsification combined with silicone oil removal through 23G vitrectomy system and IOL implantation, the patients in group C were treated by phacoemulsification combined with silicone oil removal through 20G vitrectomy system and IOL implantation. The operation time, intraocular pressure, best corrected visual acuity ( BCVA ) , discomfort days and complications before and after the surgery were compared. RESULTS: The differences of the intraocular pressure were not statistically significant between the three groups after the surgery. The BCVA of the three groups were all improved, but the differences were not statistically significant between three groups. The differences in postoperative complications showed no statistically significant. Otherwise, group A and B cost less operation time. The discomfort days of group A were less than other groups. CONCLUSION: Three different surgical methods were safe and effective, appropriate surgical approach could be chosen according to the patients' clinical manifestations. For patients with cataract induced by silicone oil-filled eye whose retina recovered well, phacoemulsification combined with silicone oil removal through pupil and IOL implantation is a time-saving, safe and effective method.
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AlM: To observe the clinical effect of micro-incision phacoemulsification combined with silicone oil removal from pars plana in eyes with silicone oil tamponade after vitrectomy. METHODS:Forty-three patients (43 eyes) with cataract and silicone oiltamponade after vitrectomy underwent micro-coaxial phacoemulsification combined with silicone oil removal from pars plana between February 2013 and November 2013. lntraocular lens was implanted at stage l in all cases. The best corrected visual acuity was observed at 3mo after operation, and the complications were recorded. RESULTS: The best corrected visual acuity in 39 cases (91%) was improved at 3mo after operation, and the best outcome was 0. 6. There were still 4 cases (9%) without improvement of visual acuity. There was no incidence of complications such as posterior capsular rupture, residual silicone oil, corneal endothelial decompensation, hyphema, vitreous hemorrhage, intraocular lens dislocation, secondary glaucoma and ora serrata mutilation after operation in all patients. CONCLUSlON: Micro - invision phacoemulsification combined with silicone oil removal from pars plana is an effective and safe method for eyes with cataract and silicone oil tamponade after vitrectomy.
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PURPOSE: To determine the risk factors for transient hypotony after silicone oil removal in rhegmatogenous retinal detachment and to analyze changes in intraocular pressure and visual acuity after silicone oil removal. METHODS: The medical records of 54 eyes of 52 patients who underwent pars plana vitrectomy, silicone oil tamponade followed by silicone oil removal due to rhegmatogenous retinal detachment, were reviewed. RESULTS: The incidence of transient hypotony after silicone oil removal was 18.5%. Young age (p = 0.011) and axial length (p = 0.002) were risk factors for transient hypotony based on univariate analysis. In multivariate analysis, axial length longer than 26 mm was the only risk factor for transient hypotony (p = 0.005). Seven hypotony patients recovered to normal intraocular pressure spontaneously within 2 weeks. In 2 patients, intraocular pressure was normalized after intravitreal injection of C3F8 gas and 1 patient recovered after a balanced salt solution injection into the anterior chamber. Two weeks after silicone oil removal, there was no significant difference in intraocular pressure between the hypotony group and normal intraocular pressure group. Additionally, there was no statistically significant difference in best corrected visual acuity between the 2 groups after 2 weeks. CONCLUSIONS: Although transient hypotony after silicone oil removal in rhegmatogenous retinal detachment was frequently observed in the present study, the final best corrected visual acuity and intraocular pressure was not always affected. Ocular hypotony should be examined thoroughly in the early postoperative period.
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Humans , Anterior Chamber , Incidence , Intraocular Pressure , Intravitreal Injections , Medical Records , Multivariate Analysis , Ocular Hypotension , Postoperative Period , Retinal Detachment , Risk Factors , 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.
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Emulsions/adverse effects , Humans , Laser Therapy , Retinal Detachment/etiology , Retinal Detachment/surgery , Silicone Oils/adverse effects , Tampons, SurgicalABSTRACT
PURPOSE: To evaluate clinical analyses & risk factors for retinal detachment after silicone oil removal in the eyes with completely stable retinal state. METHOD: The authors retrospectively analyzed the clinical diagnosis, timing of retinal detachment, operative record, and final anatomic success of 10 consecutive eyes with retinal detachment after silicone oil removal. RESULTS: The retinal detachment group after silicone oil removal consisted of 3 eyes with proliferative vitreoretinopathy, 3 eyes with proliferative diabetic retinopathy, 3 eyes with the retinal detachment with macular hole and 1 eye with traumatic rhegmatogenous retinal detachment. Retinal detachment occurred from 1 to 17 weeks after the silicon oil removal surgery. The retinal detachments were associated with reopening of old breaks (5 eyes), new retinal breaks (3 eyes), vitreoretinal tractions (2 eyes). The retina was completely or partially reaatached after additional vitreoretinal surgery in 9 eyes, but total retinal detachment occurred in 1 eye due to reattachment operation rejection. CONCLUSIONS: The retinal break with remained vitreous traction and the proliferative membrane appeared to be an important factor in retinal detachments after silicone oil removal. Therefore, potential retinal breaks and complete removal of vitreous and tractional force during intraocular surgery should be considered.
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Diabetic Retinopathy , Eye , Membranes , Rejection, Psychology , Retina , Retinal Detachment , Retinal Perforations , Retinaldehyde , Retrospective Studies , Risk Factors , Silicone Oils , Traction , Vitreoretinal Surgery , Vitreoretinopathy, ProliferativeABSTRACT
PURPOSE: To evaluate the factors influencing clinical outcome after removal of intraocular silicone oil and the relationship of the factors to the postoperative visual prognosis. METHODS: The authors retrospectively analyzed clinical outcomes related to 76 patients (79 eyes) who underwent silicone oil tamponade. Prognostic factors were as follows: age, underlying pathologies, systemic diseases, range and type of retinal detachment (RD), type of RD, number of retinal tears, macular and lens status, and types of operation. The influence of these factors on visual acuity and anatomical success rates were studied. RESULTS: The 79 eyes that underwent silicone oil removal had preoperative diagnoses as follows: proliferative diabetic retinopathy in 32 eyes, primary rhegmatogenous RD in 12 eyes, RD with an intraocular foreign body in nine eyes, traumatic RD in eight eyes, RD with a macular hole in six eyes, RD development after other surgeries in six eyes, RD with endophthalmitis in three eyes, and RD with high myopia in three eyes. Anatomical success was achieved in 59 eyes (74.7%) after silicone oil removal. Thirty-two eyes (40.5%) had an increase in visual acuity, 28 eyes (35.4%) showed no changes and 19 eyes (24.1%) showed deteriorated conditions after silicone oil removal. The number of surgeries was an important factor related to anatomical and functional success rate. Postoperative visual improvement was observed when the number of surgeries was greater than two and in groups with no macular holes or degenerations. CONCLUSIONS: When considering prognostic factors for silicone oil removal, reducing complications and retinal redetachment after silicone oil removal may be helpful.
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Humans , Diabetic Retinopathy , Endophthalmitis , Eye , Foreign Bodies , Myopia , Prognosis , Retinal Detachment , Retinal Perforations , Retinaldehyde , Retrospective Studies , Silicone Oils , Visual Acuity , VitrectomyABSTRACT
PURPOSE: The purpose of this study was to compare the clinical results of silicone oil removal using a 23-gauge transconjunctival sutureless pars plana vitrectomy (TSVS) and the 20-gauge pars plana vitrectomy (PPV) system and to evaluate the clinical value of 23-guage PPV system in silicone oil removal. METHODS: Eight eyes of 8 patients who received removal of silicone oil using the 23-gauge TSVS and 6 eyes of 6 patients using the 20-gauge PPV system were included in this study. The total operation time, silicone oil removal time, intraoperative and postoperative advantages, shortcomings, and complications were compared. RESULTS: The operation time and silicone oil removal time were 44.6+/-14.1 minutes, 42.7+/-10.5 minutes and 2.0+/-0.9 min/cc, 1.4+/-0.6 min/cc when silicone oil removal was performed using 23-gauge TSVS and 20-gauge PPV system, respectively. They were not significantly different (p=0.80, 0.22). Attention for the complete removal of the oil is necessary because of the intraocular trocar length when the 23-gauge TSVS is used. There were no complications except transient hypotonies (2 eyes), transient hypertonies (2 eyes) in the 23-gauge system and transient hypertonies (2 eyes) in the 20-gauge system. CONCLUSIONS: The operation time for silicone oil removal using the 23-gauge TSVS was not different than that of the 20-gauge PPV system and can be performed safely without any particular complications. Care and precautionary measures are needed in order to remove silicone oil completely.
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Humans , Eye , Silicone Oils , Surgical Instruments , VitrectomyABSTRACT
PURPOSE: To evaluate the safety and efficacy of transpupillary silicone oil removal using posterior capsulorhexis (PCCC) combined with phacoemulsification and intraocular lens (IOL) implantation. METHODS: We retrospectively reviewed 25 eyes of 25 patients who had undergone silicone oil removal through PCCC from December 1998 to August 2004. IOLs were placed in the bag or in the sulcus after the silicone oil was removed using PCCC. Preoperative and postoperative best corrected visual acuity, refractive error, intraocular pressure (IOP), silicone oil removal time, slit lamp examination, and specular microscopy were evaluated. RESULTS: After the surgery, visual acuity improved in 23 eyes (92%) and a refractive error deviation of 0.5 diopter or more compared with targeted refractive error was found in 13 eyes (52%). Re-detachment of the retina occurred in 3 eyes (12%), increased IOP was observed in 4 eyes (16%), and transient corneal edema in 2 eyes (8%). Endothelial cell count decreased significantly after the operation (P<0.01). However, this change was not statistically significant compared to that of the control group, where only the phacoemulsification was performed. CONCLUSIONS: Silicone oil removal through PCCC after phacoemulsification may be one of the best surgical options for patients who need cataract surgery along with silicone oil removal, provided that the retina is stable and no additional procedures such as membrane peeling, are necessary.
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Humans , Capsulorhexis , Cataract , Corneal Edema , Endothelial Cells , Intraocular Pressure , Lens Implantation, Intraocular , Lenses, Intraocular , Membranes , Microscopy , Phacoemulsification , Refractive Errors , Retina , Retrospective Studies , Silicone Oils , Visual AcuityABSTRACT
PURPOSE: To evaluate clinical outcomes after silicone oil removal, we analyzed retinal redetachment, visual acuity, and postoperative complications. METHODS: 73 consecutive eyes who underwent silicone oil removal were studied in a retrospective fashion. 41 eyes with proliferative vitreoretinopathy, 20 eyes with proliferative diabetic retinopathy, 6 eyes with traumatic detachment, 6 eyes with high myopic macular hole were included. In addition to anatomic and visual results, associated complications were assessed. RESULTS: Anatomic success rate was 90.4% in 73 eyes. 64 eyes achieved attachment after oil injection combined vitrectomy and 8 of 64 eyes (12.5%) were redetached after oil removal. 37 eyes of the 64 eyes (57.8%) had an increase in visual acuity at least one Snellen line after oil removal. Glaucoma (21.9%), keratopathy (8.2%) and cataract (9.5%) were the complications. The mean duration of oil tamponade of detached group was 7.75 months and that of attached group was 7.14 months and there were no siginificant difference between two groups(P>0.05). CONCLUSIONS: The duration of the silicone oil tamponade had no siginificant effect on the redetachment rate. We recommend not to apply standard criteria for timing of silicone oil removal, but to decide individually, considering underlying disease and complications.
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Cataract , Diabetic Retinopathy , Glaucoma , Postoperative Complications , Retinal Perforations , Retinaldehyde , Retrospective Studies , Silicone Oils , Visual Acuity , Vitrectomy , Vitreoretinopathy, ProliferativeABSTRACT
PURPOSE: To evaluate the efficacy and safety of silicone oil (SO) removal through sutureless corneal incisions in aphakia. METHODS: We analyzed the records of the patients who underwent SO removal using clear corneal incisions in aphakia. RESULTS: Of 43 patients, there were 43 eyes, and 26 were male. The mean age was 41.5 years and followup period was 19.1 months. Indications for SO injection were ocular trauma in 15 eyes, macular hole retinal detachment in 3 eyes, proliferative diabetic retinopathy in 2 eyes, giant retinal tear in 2 eyes, pars planitis in 1 eye and other complex retinal detachment including proliferative vitreoretinopathy in 20 eyes. The viscosity of SO were 1,300 centistroke (cs) in 6 eyes and 5,700 cs in 37 eyes. Postoperative complications included emulsified silicone droplets in 2 eyes (4.7%), temporary increase of intraocular pressure in 5 eyes (11.6%) and recurrent retinal detachment in 2 eyes (4.7%). CONCLUSIONS: Sutureless corneal incisions in aphakia might be brief, effective and safe method to remove SO.