Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

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.

Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

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.

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.

Retinal detachment and gyrate atrophy of the choroid and retina: case report / Descolamento de retina e atrofia girata da coroide e retina: relato de caso

To report a case of gyrate atrophy of the choroid and retina associated with retinal detachment. Hyperornithinemia confirmed the diagnosis of gyrate atrophy. Pars plana vitrectomy with silicone oil infusion was performed with good anatomical results, despite the persistence of low visual acuity. Retinal detachment is a rare complication of gyrate atrophy and can be managed with pars plana vitrectomy and silicone oil. We discuss the possible mechanisms that led to low visual acuity.

Descrever um caso de atrofia girata da coroide e retina associado com descolamento de retina. Altos níves de ornitina sérica confirmaram o diagnóstico de atrofia girata. Vitrectomia via pars plana com infusão de óleo de silicone foi realizada, com bom resultado anatômico, apesar da baixa acuidade visual persistente. Descolamento de retina é uma rara complicação da atrofia girata e pode ser manejada com vitrectomia via pars plana e óleo de silicone. Discutiremos os possíveis mecanismos que levaram à baixa acuidade visual.

Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection.

AIMS: To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases. SETTINGS AND DESIGN: Ege university hospital ophthalmology department. Retrospective case series. MATERIALS AND METHODS: Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated. STATISTICAL ANALYSIS USED: Paired Student's t-test. RESULTS: Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (+/-2.7). Pre- and postoperative mean visual acuity was 2.22+/-0.91 logMAR and 1.11+/-0.8 logMAR, respectively ( P< 0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 +/-3.2 versus 14.0 +/-2.4 mmHg) ( P< 0.001). CONCLUSIONS: Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.

Pars plana vitrectomy and silicone oil tamponade for acute endophthalmitis treatment / Vitrectomia pars plana e tamponamento por óleo de silicone para o tratamento de endoftalmite aguda

PURPOSE: To evaluate the outcomes of pars plana vitrectomy and silicone oil injection for the treatment of infectious endophthalmitis. METHODS: 35 cases of endophthalmitis secondary to phacoemulsification (20 patients), trabeculectomy (8 patients), perforating trauma (2 patients), trauma (2 patients), corneal transplantation (1 patient), vitrectomy (1 patient) and corneal ulceration (1 patient) were retrospectively studied. Patients were separated into two groups: Group 1 (n=24): intravitreal antibiotic injection, associated with topical and oral antibiotics; Group 2 (n=11): vitrectomy with intravitreal antibiotic injection and silicone oil injection. The follow-up ranged from 1 to 48 months (mean of 16 months). RESULTS: From 24 patients in group 1, 11 patients (45.83 percent), had infection controlled with intravitreal antibiotic injection only; 13 patients (54.15 percent) regressed to uncontrolled endophthalmitis, in which two patients (8.33 percent) were submitted to evisceration and one patient (4.16 percent) had corneal melting. The remaining 10 patients (41.66 percent) with uncontrolled endophthalmitis were submitted to pars plana vitrectomy and silicone oil injection. Six patients (25 percent) from Group I had retinal detachment during the first month of follow-up and also required pars plana vitrectomy and silicone oil injection. In Group 2 patients (n=11), all of them had controlled infection at the first procedure. In one case (9.09 percent), a severe proliferatative vitreoretinopathy induced loss of vision. CONCLUSION: These results suggest that silicone oil tamponade might be beneficial in the treatment strategy of infectious endophthalmitis.

OBJETIVO: Avaliar os resultados da vitrectomia pars plana com tamponamento com óleo de silicone no tratamento de endoftalmite aguda. MÉTODOS: Trinta e cinco pacientes com endoftalmite, sendo 20 secundário à facoemulsificação, 8 por trabeculectomia, 2 por trauma perfurante, 2 por trauma, 1 por transplante de córnea, 1 por vitrectomia, e 1 por úlcera de córnea, foram estudados retrospectivamente. Os pacientes foram separados em dois grupos. Grupo 1 (n=24): injeção de antibiótico intravítreo (AIV), associado com antibióticos oral e sistêmico; Grupo 2 (n=11): vitrectomia com AIV e óleo de silicone. O seguimento variou de 1 a 48 meses (média de 16 meses). RESULTADOS: Dos 24 pacientes no Grupo 1, 11 (45,83 por cento) tiveram controle da infecção apenas com injeção AIV, 13 (54,15 por cento) não controlaram a endoftalmite, sendo que, dois destes (8,33 por cento) foram submetidos à evisceração e um (4,16 por cento) evoluiu para "melting" corneano. Os outros 10 (41,66 por cento) pacientes foram submetidos à vitrectomia pars plana e óleo de silicone. Seis pacientes (25 por cento) do Grupo 1 tiveram descolamento de retina e também necessitaram de vitrectomia pars plana e óleo de silicone. No Grupo 2 (n=11), todos tiveram controle da infecção no primeiro procedimento e não necessitaram de mais intervenções, exceto pela remoção do óleo de silicone três meses depois. CONCLUSÃO:Os resultados sugerem que o tamponamento por óleo de silicone parece ser benéfico na estratégia de tratamento da endoftalmite infecciosa aguda.

Retinal detachment surgery with silicone oil injection in transconjunctival sutureless 23-gauge vitrectomy

PURPOSE: To report a surgical technique for retinal detachment surgery using transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection. METHODS: Thirty-one patients with retinal detachment underwent vitreoretinal surgery using a transconjunctival sutureless 23-gauge vitrectomy system. At the end of the procedure silicone oil was injected into all eyes through a microcannula. After removing the microcannula, a bipolar cautery was used in the conjunctiva over the wound to prevent silicone oil reflux. RESULTS: In all patients retinal reattachment and injection of silicone oil through transconjunctival sutureless 23-gauge vitrectomy system was possible. Retinal re-detachment occurred in 8 patients (25.80 percent) who were submitted to a new vitreoretinal surgery by the technique described above, however, more extensive retinotomy was necessary in all cases, specially inferiorly. Three patients (9.67 percent) presented silicone oil leakage in subconjuntival compartment. Another surgical procedure was necessary to remove the subconjuntival silicone oil. CONCLUSIONS: The retinal detachment surgery with silicone oil injection in transconjunctival sutureless 23-gauge vitrectomy is a safe and efficient technique to repair retinal detachment and it has the advantage of being minimally invasive.

OBJETIVOS: Relatar técnica cirúrgica para descolamento de retina utilizando sistema de 23-gauge com injeção de óleo de silicone. MÉTODOS: Trinta e um pacientes com descolamento da retina foram submetidos a cirurgia vitreorretiniana usando o sistema 23-gauge de vitrectomia transconjuntival sem sutura. Ao final do procedimento o óleo de silicone foi injetado em todos os olhos através de uma microcânula. Após a retirada da microcânula, foi utilizado cautério bipolar na incisão conjuntival para prevenir o vazamento do óleo de silicone. RESULTADOS: Em todos os pacientes foi possível reaplicar a retina e injetar o óleo de silicone através do sistema 23-gauge de vitrectomia transconjuntival. Redescolamento da retina ocorreu em 8 pacientes (25,80 por cento) os quais foram submetidos a uma nova cirurgia vitreorretiniana com a mesma técnica, entretanto, uma retinotomia mais extensa foi necessária em todos estes casos especialmente na parte inferior que foi mais comprometido. Em 3 casos (9,67 por cento) houve extravasamento do óleo de silicone para o compartimento subconjuntival. Novo procedimento foi necessário para remover o silicone subconjuntival. CONCLUSÕES: A cirurgia do descolamento da retina com injeção de óleo de silicone utilizando o sistema 23-gauge de vitrectomia transconjuntival é uma técnica segura e eficiente para o reparo do descolamento da retina e oferece a vantagem de ser um sistema minimamente invasivo.

Vitrectomy for circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy.

We report successful surgical management of a circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy (TTT). A 33-year-old man with symptomatic serous macular detachment in the left eye (Snellen acuity: 20/200) secondary to a paramacular choroidal hemangioma was treated with TTT. The nonresponsive detachment was subsequently managed by vitrectomy, endophotocoagulation and silicon-oil tamponade. It resulted in complete resolution of the tumor and the detachment. Silicon oil was removed at four months. Visual acuity improved to 20/80 by the last follow-up visit at 10 months without any recurrence.

Pars plana vitrectomy with silicone oil or gas endotamponade in HIV-related rhegmatogenous retinal detachments in Thai patients.

OBJECTIVE: To evaluate the efficacy and results of pars plana vitrectomy with endotamponade for retinal detachments caused by necrotizing retinitis in HIV patients. MATERIAL AND METHOD: The data of patients with HIV-related retinal detachment who underwent pars plana vitrectomy with silicone oil or gas endotamponade between January 2003 and June 2005 were retrospectively reviewed The outcome measures were demographic data, anatomical, and visual results. RESULTS: Of all 24 eyes from 20 patients, 19 eyes underwent pars plana vitrectomy with silicone oil tamponade and 5 eyes with long-acting gas tamponade. Mean follow up time was 13 months (range 2-33 months). The overall anatomical success was 83% (84% and 80% with silicone oil and gas tamponade, respectively). Final best corrected visual acuity was equal or better than 5/200 in 12 eyes (50%). Forty-six percent had stabled or improved vision at the end of follow-up. CONCLUSION: Pars plana vitrectomy with silicone oil or gas tamponade gives the high anatomical success rate in the repair of retinal detachments caused by necrotizing retinitis in HIV patients. There were the same reattachment rate and visual results between the two tamponade groups. However, the use of gas tamponade may be effective in patients with highly active antiretroviral therapy (HAART).

Estudo macular em olhos com óleo de silicone por meio da tomografia de coerência óptica / Optical coherence tomography macular study on eyes filled with silicone oil

OBJETIVO: Demonstrar a eficácia da tomografia de coerência óptica na avaliação da estrutura anatômica macular em olhos com a cavidade vítrea preenchida por óleo de silicone. MÉTODOS: Estudo observacional descritivo de 28 (vinte e oito) pacientes submetidos a vitrectomia com utilização de óleo de silicone como substituto vítreo. Estes pacientes foram avaliados pela biomicroscopia, oftalmoscopia indireta e pela tomografia de coerência óptica. RESULTADO: Todos os pacientes apresentaram retina aplicada no pós-operatório. A realização da tomografia de coerência óptica não apresentou dificuldade técnica na sua execução. O "cisto" de retina, membrana epi-retiniana e buraco lamelar foram apenas detectados na tomografia de coerência óptica. CONCLUSÃO: A tomografia de coerência óptica demonstrou boa eficácia para detectar alterações maculares em olhos com óleo de silicone. Assim, evidenciamos que é factível a execução deste exame e que este pode nos ajudar a diagnosticar alterações subclínicas no pós-operatório nestes pacientes.

PURPOSE: To demonstrate optical coherence tomography efficacy to evaluate macular anatomical outcomes, in eyes with silicone oil-filled vitreous cavity after vitrectomy. METHODS: A descriptive observational study of 28 (twenty-eight) patients submitted to pars plana vitrectomy having silicone oil as vitreous substitute. The macular findings were observed by means of indirect binocular ophthalmoscope, biomicroscopy and optical coherence tomography examinations. RESULTS: During the follow-up period the retina remained attached in all patients. In some cases, intraretinal cysts, epiretinal membrane and lamellar macular hole were observed only by optical coherence tomography examination. CONCLUSION: Optical coherence tomography provided improved imaging of finer retinal structures in eyes with silicone oil-filled vitreous cavity. Therefore, optical coherence tomography examination should be systematically performed in eyes filled with silicone oil to recognize changes in retinal morphology.

Does internal limiting membrane peeling in macular hole surgery improve reading vision?

PURPOSE: To document the effect of internal limiting membrane (ILM) peeling in macular hole closure and reading vision. METHOD: Fifty-four patients with idiopathic and traumatic macular hole underwent standard vitreous surgery and received either ILM peeling (n=25) or no ILM peeling (n=29). The hole closure, and Snellen acuity (distant and near) were recorded 12 weeks after surgery and statistically analysed. RESULTS: The macular hole closure rate was 96% (24 of 25) and 72.4% (21 of 29) with and without ILM peeling respectively (P = 0.028). Distant vision improvement of two or more lines was recorded in 64% (16 of 25) and 51.7% (15 of 29) eyes (P = 0.417) with and without ILM peeling respectively. Near vision improvement of two or more lines was seen in 68% (17 of 25) and 41.2% (12 of 29) eyes (P = 0.048) with and without ILM peeling respectively. CONCLUSION: ILM peeling in macular hole surgery improves the macular hole closure rate and reading vision.

Droplets on posterior surface of intraocular lens in silicone oil filled eye.

Silicone oil adherence to silicone IOLs after silicone oil removal is a known complication in pseudophakic patients. Droplet removal is difficult and may require IOL exchange. We describe two cases in which silicone oil droplets were observed early in the postoperative period in PMMA pseudophakic eyes and disappeared during silicone oil-fluid exchange--a phenomenon that has not been reported earlier in human PMMA pseudophakic eyes.

Subconjunctival cysts following silicone oil injection: a clinicopathological study of five cases.

PURPOSE: To study the occurrence, risk factors and management of subconjunctival cysts formed following the use of intraocular silicone oil as a tamponade. METHODS: We analyzed 5 cases of single and multioculated subconjunctival oil cysts between 1986 and 1996. RESULTS: Cysts were observed 15 days to 4 months following silicone oil injection. Clinically they showed minimal inflammatory signs but histopathology of removed cysts showed emulsified silicone oil globules with chronic inflammatory cellular infiltration. CONCLUSION: Though silicone oil is considered to be nontoxic, it can cause chronic inflammation when spilled into the subconjunctival space.

Técnica de inyección de aceite de silicón en cirugía vitreorretiniana / Silicon-oil injection technique in vetreoretinal surgery

Los autores proponen una técnica para la inyección intraocular de aceite de silicón en cirugía vitreorretiniana basándose en el principio de Pascal de la prensa hidráulica. En la técnica se utiliza una jeringa de 3 ml y un catéter intravenoso de teflón calibre 18. La inyección intraocular del aceite de silicón se realiza vía pars plana durante la cirugía vitreorretiniana. Los autores han realizado esta técnica en 107 casos operados de 1992 a 1997 sin haber tenido complicaciones durante el procedimiento. Se considera una técnica segura en su aplicación, fácil de realizar y de bajo costo

Fluid vitreous substitutes in vitreo retinal surgery.

Advances in the surgical instrumentation and vitreoretinal techniques have allowed intraoperative reapproximation of retina to a more normal position. The use of intravitreally injected liquid materials (viscoelastic liquids, liquid perfluorocarbons and silicone oil), as adjunctive agents to vitreo-retinal surgery play an important role in facilitating retinal reattachment. These materials are used as intraoperative instruments to re-establish intraocular volume, assist in separating membranes adherent to the retina, manipulate retinal detachments and mechanically flatten detached retina. Over the longer term, silicone oil maintains intraocular tamponade. One should be cognizant of the potential uses, benefits and risks of each of these vitreous substitutes.

Selection of surgical technique for retinal detachment with coloboma of the choroid.

Four eyes with rhegmatogenous retinal detachment and coloboma of the choroid were managed by conventional scleral buckling (one eye); scleral buckling combined with lensectomy, vitrectomy, and fluid-air exchange (two eyes); and vitrectomy, silicone oil injection without scleral buckling (one eye). Retinal break was seen within the coloboma in two eyes, at the periphery in one eye, and, both in the coloboma and periphery in one eye. At a follow-up of 15 months, the retina was found attached in all the patients. The success of these surgical procedures could be attributed to careful preoperative/intraoperative fundus examination and individualised surgical planning.