When the savior becomes a demon: Silicon oil synechia-induced glaucoma

Background: Silicon oil is an important adjunct for achieving internal tamponade in the treatment of retinal detachment. Silicone oil tamponade often leads to narrowing of the angle and development of adhesions between the iris and anterior chamber angle structures, with consequential elevation of the intraocular pressure. The video showcases the management of these challenging scenarios. Purpose: To highlight the management of early synechial closures due to silicon oil tamponade. Synopsis: The video highlights the management of early synechial closure following silicon oil tamponade. Surgical pupilloplasty has been demonstrated to break the peripheral anterior synechias on intraoperative gonioscopy as well as on anterior segment optical coherence tomography (AS?OCT). Performing pupilloplasty in the early phase of development of peripheral anterior synechias (PAS) helps to break the existing synechias and prevent angle closure and sequential deterioration of vision. Highlights: Surgical pupilloplasty helps to relieve the post silicon oil?induced secondary angle closure glaucoma by breaking the peripheral anterior synechias and significantly opening the anterior chamber angles.

Silicon oil removed combined with external-route microsurgery for retinal detachment in silicon oil tamponaded eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the efficacy of silicon oil removal combined with external-route microsurgery in treating of retinal detachment in selected eyes with silicone oil tamponaded. <p>METHODS: This was a retrospective observational case series. 21 cases(21 eyes)had undergone minimally invasive vitrectomy combined with silicone oil tamponade for various vitreoretinal diseases firstly. Because of retinal detachment recurrent, external-route microsurgery combined with oil extracted was performed between July 2014 and July 2018 secondly. The retinal reattachment rate, visual outcome, intraocular pressure and postoperative complications were investigated. <p>RESULTS: After 4 to 12(5.48±1.53)mo follow-up period, the retinal reattachment rate was 90%(19/21 cases). Further vitrectomy surgeries were needed for other 2 eyes. The final best corrected visual acuity(BCVA)≥0.4 was in 4 eyes, 0.06-0.3 was in 9 eyes and ≤0.05 was in 8 eyes, which had significant difference contrasted to that of preoperation(<i>t</i>=3.58, <i>P</i><0.05). Macular epiretinal membrane, second glaucoma and complicated cataracts were found in 1, 2 and 5 eyes respectively. There hadn't other serious complications postoperatively. <p>CONCLUSION: The external-route microsurgery was also suitable for retinal detachment in silicone oil filled eyes which were PVR≤C1 and the roles located in the equator region or front even. This way was simple, convenient and effective. The rate of secondary vitrectomy with silicone oil tamponade also can be reduced.

Staphylococcus lugdunensis endophthalmitis following dexamethasone intravitreal implant

We present a unique case of endophthalmitis with Staphylococcus lugdunensis following dexamethasone intravitreal implant for branch retinal vein occlusion associated with cystoid macular edema. Patient did not show favorable clinical response after vitrectomy and intravitreal antibiotics; so, we decided to repeat vitrectomy, remove the steroid implant and fill the eye with silicon oil, and repeat intravitreal vancomycin. Vision has improved from hand movements at presentation to counting fingers at 1.5 m after second vitrectomy and final visual acuity 3 months later after silicon oil removal was 6/36.

Comparative study of silicone oil and heavy silicone oil to rabbit retinal electrophysiology / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of silicon oil and heavy silicone oil as two kinds of intraocular stuffing to the retinal electrophysiology of the rabbits in the medium and long term. <p>METHODS: Totally 28 standard rabbits were selected with right eyes operated for vitrectomy, and then, they were randomized into three groups: Group A 12 rabbis, Group B 12 rabbits, Group C 4 rabbits. Group A: vitreous body was cut-down and filled with silicon oil; Group B: vitreous body was cut-down and filled with heavy silicon oil; Group C: vitreous body was cut-down and filled with BSS. Taken into account were the experimental animals' different periods thickness of the retinal, intraocular pressure and ERG b-wave amplitude for statistical analysis. <p>RESULTS: Comparison between any two means of Group A, B or C surgery eyes' preoperative and postoperative at different time points: measured IOP showed no significant difference(<i>P</i>> 0.05); the retinal thickness mean value measured by OCT had statistically significant(<i>P</i><0.05)at the postoperative 24wk; there was a conspicuous statistically significant(<i>P</i><0.01)of ERG'sb-wave amplitude at the postoperative 24wk. <p>CONCLUSION: As the stuffing of vitreous cavity, the silicone oil or heavy silicone oil has no obvious difference to the influence of intraocular pressure for medium to longer term. But heavy silicone oil has more serious negative impact of retinal visual information transmission function, more significantly reduce of retinal thickness than ordinary silicone oil in the longer term.

Utilidad del sistema Scheimpflug por Pentacam para la cuantificación de la opacidad de la cápsula posterior en pacientes pseudofáquicos con aceite de silicona / Usefulness of Pentacam Scheimflug system for quantification of the posterior capsule opacity in pseudophakic patients with silicon oil-filled eyes

Objetivo: determinar si el sistema Scheimpflug por Pentacam tiene utilidad en la cuantificación objetiva de la opacidad de la cápsula posterior en los pacientes pseudofáquicos con aceite de silicona. Métodos: se realizó un estudio descriptivo, prospectivo y observacional en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre abril del año 2012 y abril de 2014. Se evaluó, mediante sistema Scheimpflug del Pentacam para la cuantificación de la opacidad de cápsula posterior, a un grupo de 31 pacientes seudofáquicos sometidos a una vitrectomía previa con aceite de silicona y se compararon los resultados con los obtenidos en 26 pacientes operados solo de cirugía del cristalino con lente intraocular, para lo cual se utilizaron las variables edad, sexo, opacidad en grados por lámpara de hendidura y la intensidad media de píxeles en un área circular de 3 mm centrales seleccionada en los tomogramas, analizadas por el software Image J 1.42 q. Resultados: en los pacientes pseudofáquicos con aceite de silicona el sistema Scheimpflug no fue capaz de discernir entre los diferentes grados de opacidad de la cápsula posterior(p= 0,210) y no existió concordancia entre ambas mediciones (p= 0,120). Las mediciones realizadas en los pacientes pseudofáquicos con aceite de silicona con la lámpara de hendidura por dos observadores fueron similares (p= 0,042), al igual que existió buena correlación en las realizadas con el sistema Scheimpflug (r= 0,981). Cuando se compararon las mediciones realizadas con el sistema Scheimpflug en los dos grupos de pacientes se observó que las medias de intensidad en los grados 1 y 2 eran superiores a las halladas en los pacientes no vitrectomizados previamente, no así en los grados 3; solo en este último caso la diferencia fue significativa (p= 0,001). Conclusiones: el sistema Scheimpflug no es útil para cuantificar la opacidad de la cápsula posterior en los pacientes vitrectomizados previamente que aún tienen aceite de silicona(AU)

Objective: to determine whether the Pentacam Scheimpflug imaging system is useful for objective quantification of the posterior capsule opacity in pseudophakic patients with silicon oil-filled eyes. Methods: observational, prospective and descriptive study conducted in Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period of April 2012 through April 2014. With the Pentacam Scheimpflug imaging system for the quantification of the posterior capsule opacity, 31 pseudophakic patients, who had undergone previous vitrectomy with silicon oil, were evaluated and their results were then compared with those of patients operated on through crystalline lens surgery and intraocular lens implantation (26 patients). To this end, the analyzed variables were age, sex, opacification degrees measured with slit lamp and average intensity in pixels in a 3mm round area selected from tomographs and analyzed by Image J 1.42 q software. Results: in pseudophakic patients with silicon oil-filled eyes, the Scheimpflug system could not differentiate the different levels of the posterior capsule opacity (p= 0.210) and there was no agreement between both measurements (p= 0.120). The measurements taken by two observers in pseudophakic patients using silicon oil and slit lamp were similar (p= 0.042) and good correlation in those taken with the Scheimpflug system (r= 0.981). When comparing the Scheimpflug system measurements taken in the two groups of patients, it was observed that the intensity means in grades 1 and 2 were higher than those found in non-vitrectomized patients, but in grade 3, the difference was significant (p= 0.001). Conclusions: Scheimpflug system is not useful to measure the posterior capsule opacity in previously vitrectomized patients who still have silicon oil-filled eyes(AU)

Nitric oxide levels in the anterior chamber of vitrectomized eyes with silicon oil / Níveis de óxido nítrico na câmara anterior em olhos vitrectomizados com óleo de silicone

PURPOSE: To investigate the nitric oxide levels in the anterior chamber of eyes who underwent pars plana vitrectomy (PPV) with silicone oil. METHODS: Patients who underwent PPV with silicon oil injection, from february 2005 to august 2007, were selected. Nine patients (nine eyes) participated in the study (five women and four men). Nitric oxide concentration was quantified after the aspiration of aqueous humor samples during the procedure of silicon oil removal. Data such as: oil emulsification; presence of oil in the anterior chamber; intraocular pressure and time with silicone oil were evaluated. Values of p <0.05 were considered to be statistically significant. RESULTS: A positive correlation between nitric oxide concentration and time with silicon oil in the vitreous cavity (r=0.799) was observed. The nitric oxide concentration was significantly higher (p=0.02) in patients with silicon oil more than 24 months (0.90µmol/ml ± 0.59, n=3) in the vitreous cavity comparing to patients with less than 24 months (0.19µmol/ml ± 0.10, n=6). CONCLUSION: A positive correlation linking silicone oil time in the vitreous cavity with the nitric oxide concentration in the anterior chamber was observed.

OBJETIVO: Investigar os níveis de óxido nítrico na câmara anterior de olhos submetidos à vitrectomia via pars plana (VPP) com óleo de silicone. MÉTODOS: Foram selecionados pacientes que se submeteram à VPP com injeção de óleo de silicone, de fevereiro de 2005 a agosto de 2007. Nove pacientes (nove olhos) participaram do estudo (cinco mulheres e quatro homens). Durante o procedimento de remoção do óleo de silicone, foi coletado uma amostra de humor aquoso para quantificar a concentração de óxido nítrico. Foram avaliados os seguintes dados: emulsificação de óleo, presença de óleo na câmara anterior, pressão intraocular, tempo com o óleo de silicone. Valores de p <0,05 foram considerados estatisticamente significativos. RESULTADOS: Foi observada uma correlação positiva entre a concentração de óxido nítrico e tempo com óleo de silicone na cavidade vítrea (r = 0,799). A concentração de óxido nítrico foi significativamente maior (p = 0,02) em pacientes com óleo de silicone por mais de 24 meses (0,90µmol/ml + 0,59, n = 3) na cavidade vítrea em comparação com pacientes com menos de 24 meses (0,19µmol/ml + 0,10, n = 6 ). CONCLUSÃO: Foi observada correlação positiva entre tempo de óleo de silicone na cavidade vítrea com a concentração de óxido nítrico na câmara anterior.

Evaluation of the clinical effectiveness of silicone oil removal in high myopia with macular hole by optical coherence tomography / 中华实验眼科杂志

Background The recurrent rate of retinal detachment is much higher after silicone oil removal in high myopia with macular hole.How reduce the recurrence is a hot topic.Whether optical coherence tomography (OCT)-assisted examination is helpful for the improvement of surgery successful rate is in clinical observation ObjectiveThis study was to observe macular retinal status before silicone oil removal in eyes with macular holerelated retinal detachment in highly myopic eyes by OCT and evaluate the factors that influence successful silicone oil removal.MethodsFifty-five eyes of 49 consecutive patients who received vitreoretinal surgery for highly myopic retinal detachment caused by macular hole from January 2005 to December 2008 were involved,and 45 eyes of 40 patients who underwent silicone oil tamponade were retrospectively analyzed.Three to six months after vitreoretinal surgery combined with silicone oil tamponade,removal of silicone oil was performed based on the macular appearance on the OCT and the patients were followed up for over 1 year.The OCT manifestation of macular hole and the best corrected visual acuity (BCVA) were compared between before vitrectomy combined with silicone oil tamponade surgery,and after removal of silicone oil.The healing of the macular hole was classified into type Ⅰ and Ⅱ healing according to the OCT results.ResultsThe retina at the macular area completely reattached in 40 eyes(88.89％ )before removal of silicone,and the margin of the macular hole had disappeared in 2 of the 40 eyes,showing type Ⅰ heal.Thirty-eight eyes were determined to exhibit type Ⅱ healing,presenting with a visible hole margin and local defection of nervous fiber layer.Two years after the removal of silicone,retinal detachment reappeared in 1 eye with type Ⅱ heal.The BCVAs were 1.93±0.06 and 1.16±0.07 before and 1 year after removal of silicone,respectively,showing a significant difference between them(P =0.00).ConclusionsOCT is a useful tool for the prediction of anatomic outcomes in macular hole-related retinal detachment eyes with high myopia.Silicone oil removal can be performed in macular hole closure eye or attached-well hole edge eye based on OCT examination.However,attachedwell hole edge eye should receive longer follow-up time.

Heavy silicon oil tamponade in vitreoretinal surgery for traumatic proliferative vitreoretinopathy / 眼科

Objective To study clinical application and complication of heavy silicon oil (Densiron68) in the treatment of traumat- ic proliferative vitreoretinopathy.Design Non-comparatives,retrospective case series.Participants Twenty patients with proliferative vitreoretinopathy resulting from ocular trauma were recruited,whose retinal detachment arising from inferior or posterior retinal breaks. Methods Heavy silicon oil was applied to patients during vitrectomy.Silicone oil or gas was applied to patients with redetachment after heavy silicon oil was removed.Main Outcome Measures The rate of retinal attachment,vision,intraocular pressure,inflammatory re- action of anterior segment and silicone oil emulsification period.Results The rate of retinal attachment with one operation using heavy silicon oil was 50%(10/20 eyes)and 15%(3/20 eyes)with further surgery.The average follow-up time was 3.90?1.41 months.At the end of the follow-up,all tamponade agents were removed in 50% patients.Patients' logMAR vision after the surgery was 2.19?0.86,which was better than before the surgery (2.63?1.00) (P=0.037).There was little evidence of high intraocular pressure,excessive inflammatory reaction of anterior segment and cornea endothelial cell damage,but cataract became more serious without exception.Emulsification rate was 100% and the average emulsification period was 2.18?0.87 months.Conclusions Heavy silicon oil tamponade in vitreoretinal surgery for traumatic proliferative vitreoretinopathy has good efficacy and relatively few complications.However,its emulsification period is relatively short,which may constraint its application to a certain extent.

Analysis of the therapeutic effects of cataract extraction and intraocular lens implantation in silicon oil stored eyes with proliferative diabetic retinopathy / 眼科

Objective To compare the postoperative effect of pars plana vitrectomy,phacoemulsification and intraoeular lens (IOL)implantation with silicon oil removed,phacoemulsification and IOL implantation.Design A retrospective case-control study.Par- ticipants 91 cases(104 eyes)of proliferative diabetic retinopathy with tractive retinal detachment or vitreous hemorrhage were per- formed cataract surgery with IOL implantation.Methods All patients were followed up average 6 months,in whom 52 eyes with pars plana vitrectomy,phacoemulsification and IOL implantation(combined group),and the other 52 eyes with silicon oil removed,pha- coemulsification and IOL implantation(sequential group).The differences of the postoperative visual acuity and inflammatory reactions of the anterior chamber between the two groups were analyzed.Main outcome measures Visual acuity and inflammatory reactions of the anterior chamber.Results There were 14/52 eyes with best corrected visual acuity more than 0.1 in combined group and 8/52 eyes in the sequential group after the surgeries(X~2=-6.87,P=0.07) .Corneal edema happened in 16/52 eyes in combined group and 6/52 eyes in sequential group 1 week after the surgeries(X~2=11.53,P=0.001).Keratic precipitate happened in 20/52 eyes in combined group and 9/52 eyes in sequential group after the surgeries(X~2=5.79,P=0.019) .Conclusions The incidence of postoperative anterior chamber in- flammation is higher in Phacoemulsification combined with pars plana vitrectomy group.