ObjectiveTo evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil. MethodsThe clinical data of 821 patients (858 eyes) who underwent removal of silicone oil in General Hospital of PLA during 2008-2012 were retrospectively analyzed. The patients included 518 males and 303 females. The age was ranged from 1 to 79 years old, with an average of 44.03 years. All patients underwent removal of silicone oil after vitrectomy combined with silicone oil tamponade (the tamponade period was ranged from 40 days to 13 years, with an average of 6.82 months). The incidence, time and causes of retinal re-detachment were analyzed. ResultsRetinal re-detachment occurred in 43 patients (44 eyes, 5.13%). Among these retinal re-detachment in 44 eyes, 23 eyes (52.27%) occurred in 1 week, 13 eyes (29.55%) in 1-4 weeks, 4 eyes (9.08%) in 4-8 weeks, 2 eyes (4.55%) in 8-12 weeks, and 2 eyes (4.55%) more than 12 weeks after silicone oil removal. Possible reasons of retinal re-detachment included activated original retinal holes (7 eyes), residual peripheral vitreous (3 eyes), traction of epiretinal proliferative membrane (18 eyes), new retinal hole (9 eyes), non-closure of original retinal holes (5 eyes) and traction of retinal incarceration in the scleral incision (2 eyes). ConclusionsThe incidence of retinal re-detachment after silicone oil removal is 5.13%. The incidence reduced gradually with the extension of time after removal silicone oil.
PURPOSE:To assess the effects of silicone oil removal on the complications associated with its use. METHODS:Retrospective analysis of the results of silicone oil removal after vitreous surgery for retinal detachment in 913 eyes in National Ophthalmology Centre of French. The follow-up period was at least six months and the mean duration of oil tamon- ade was 6.4 months. RESULTS :Retinal detachment recurred in 7.3%. The development of cataract continued after silicone oil removal. No patient retained a clear lens in the eye with oil remained in situ for more than 3 months. TWO of 5 eyes with keratopathy at the time of oil removal recovered after the oil removal ;but the corneas of another 4 eyes became dystrophic after the oil removal. Twelve of 15 eyes with secondary ocular hypertension incontrollable through medicinal treatment relieved after oil removal ,but another 11 eyes became hypertensive after oil removal. Persistent emulsive droplets wre found in anterior chamber angles of the above 11 hypertensive eyes and the 7 eyes with keratopathy. CONCLUSINOS:Early removal of silicone oil after retinal detachment operation might delay the development of cataract but can not avoid its occurence ,and ocular hypeitension and keratopathy can be prevented by early and complete removal of silicone oil. Chin J Ocul Fundus Dis,1997,13: 22-23）
Objective To investigate the feasibility of using magnetic resonance imaging (MRI) to measure the visual axis length in silicone oil filled eyeballs. Methods Thirty-two silicone oil-filled eyes of 32 patients were studied. The antesilicone oil spaces (ASS) and retro-silicone oil spaces (RSS) on the visual axis was measured on the cross-sectional T1 weighted images (T1 WI) and T2WI, the length of the visual axis was measured on the fatsuppressed T2WI. The length of the visual axis was the distance from the corneal vertex to the macular fovea, and it was also measured by A-mode ultrasound in sitting position with different ultrasonic velocity. The postoil gap was also measured by A-mode ultrasound in supine position. Results Compared with the signal of the contralateral vitreous body, the silicone oil signal was higher on T1WI images, lower on T2WI images. After fat suppression, the silicone oil signal and chemical shift artifact were reduced. There were different levels of ASS and RSS in the vitreous cavity of all 32 cases, the RSS depth was (2.47plusmn;1.31) mm on average by MRI. However, RSS was detected in only 56.25% (18 cases)eyeballs by A-mode ultrasound. The visual axis length of silicone oil-filled eyes was (23.52plusmn;4.67) mm by MRI, and (20.57plusmn;5.32) mm by A-mode ultrasound in sitting position. The differences between two measurements was statistically significant (t=30.17, P＜0.05). Conclusions In addition to A-mode ultrasound, MRI might be another effective method to detect RSS and ASS, and to measure the axial length of silicone oil-filled eyes.
Objective To evaluate the efficacy and its affecting factors of silicone oil as an introocular tamponade for copmlicated retinal detachments in children(le;14 years). Methods We analysed retrospectively 34 cases(36 eyes) of complicated retinal detachments in children, who were performed with pars plana vitrectomy combined with silicone oil tamponade from June 1993 to November 1997. Results After 3-21 months of follow-up, the detached retinas in 19 eyes(52.7%) were reattached, in 10 eyes(27.8%) partially reattached and in 6 eyes (16.7%) redetached, 1 eye(2.8) had a media opacity that precluded evaluation of the retina. Postoperative visual acuity was less than 0.05 in 12 eyes(33.3%), and 0.05-0.2 in 20 eyes(55.6%), 2 cases(4 eyes) could not tell their visions(11.1%). Conclusion Silicone oil tamponade is an effctive therapy for complicated retinal detachments in children. The major cause of surgical fai;ure was development of recurrent proliferative vetrioretinopathy. (Chin J Ocul Fundus Dis,1999,15:7-8)
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) in the treatment of different types of chorioretinal coloboma with retinal detachment (RD). MethodsA single-center, retrospective clinical study. From April 2021 to March 2023, 24 eyes of 23 patients who were diagnosed as chorioretinal coloboma with RD in Henan Provincial Eye Hospital were included in this study. There were 11 males with 12 eyes and 12 females with 12 eyes. The mean age was (33.3±13.7) years old. Best corrected visual acuity (BCVA), spectral domain optical coherence tomography were performed. The BCVA examination was performed using a international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the types of chorioretinal coloboma, the affected eyes were divided into the coloboma involved the optic disc group and the coloboma not involved the optic disc group, with 15 eyes and 9 eyes. According to whether the RD containing the coloboma area, the affected eyes were divided into RD containing the coloboma area group and the RD not containing the coloboma area group, with 15 eyes and 9 eyes. All eyes underwent standard pars plana three-channel 25G PPV, retinal laser photocoagulation combined with silicone oil tamponade. The follow-up time after surgery was (19.5±16.3) months. The last follow-up was the time point for efficacy determination. The retinal reattachment, BCVA recovery and postoperative complications were observed. Paired t-test or t test was performed for comparison of quantitative data. Fisher's exact test was performed for comparison of qualitative data. ResultsAt the last follow-up, retinal reattachment was achieved in 20 eyes (83.3%, 20/24). The logMAR BCVA of the coloboma involved the optic disc group before and after surgery were 1.85±0.62 and 1.71±0.71, the difference was no significant (t=0.845, P=0.412). The logMAR BCVA of the coloboma not involved the optic disc group before and after surgery were 1.75±0.45 and 0.84±0.26, the difference was statistically significant (t=6.153, P＜0.001). The improvement of BCVA in the coloboma not involved the optic disc group was significantly higher than that in the coloboma involved the optic disc group after surgery, with statistically significant differences (t=3.024, P=0.006). There was no significant difference in the retinal reattachment rate between the two groups (P=0.615). There was no significant difference in the retinal reattachment rate between the RD containing the coloboma area group and the RD not containing the coloboma area group (P=0.259). Postoperative complications included elevated intraocular pressure in five eyes, cataract progression in ten eyes, recurrent RD in two eyes, bullous keratopathy in one eye and band-shaped keratopathy in one eye. ConclusionPPV combined with silicone oil tamponade is safe and effective in the treatment of chorioretinal coloboma with RD, the improvement of visual acuity in the coloboma not involved the optic disc group is better than that in the coloboma involved the optic disc group after surgery.
Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.
ObjectiveTo investigate and evaluate the clinical efficacy and safety of a modified anterior approach for transpupillary silicone oil removal combined with phacoemulsification and intraocular lens (IOL) implantation. MethodsA retrospective case-control study. A total of 148 patients (148 eyes) who underwent silicone oil removal combined with cataract surgery at the Department of Ophthalmology, Guangdong Provincial People's Hospital between January 2020 and November 2024 were included in the study. All affected eyes underwent preoperative examinations including best-corrected visual acuity (BCVA), intraocular pressure, corneal topography, and optical coherence tomography (OCT). Based on the method of silicone oil removal, the eyes were divided into two groups: group A (modified anterior approach transpupillary silicone oil removal combined with phacoemulsification and IOL implantation, 99 eyes) and group B (standard pars plana vitrectomy for silicone oil removal combined with phacoemulsification and IOL implantation, 49 eyes). The surgical duration, changes in BCVA and intraocular pressure at 1 day, 7 days, and 1 month postoperatively, as well as the incidence of complications such as corneal edema and its resolution, conjunctival congestion, iris prolapse, posterior capsule rupture, nucleus drop, IOL position, residual silicone oil in the vitreous cavity or anterior chamber, vitreous hemorrhage, recurrent retinal detachment (RD), and choroidal detachment or hemorrhage, were compared between the two groups. The independent sample t-test was used for the comparison of measurement data between the two groups, and the χ2 test was used for the comparison of count data. Results The operation time of group A and group B was (17.01±1.28) min and (31.62±2.32) min, respectively. The operation time of group A was significantly shorter than that of group B, and the difference was statistically significant (t=?41.002, P＜0.001). The comparison of BCVA (t =?0.561, ?0.833, ?1.386) and IOP (t =?0.055, 1.375, ?0.507) between the two groups of affected eyes before surgery and at 1 day and 7 days after surgery showed no statistically significant differences (P＞0.05). There was no silicone oil residual in group A, while 3 eyes in group B were observed with silicone oil residual (6.1%, 3/49). Neovascular glaucoma was observed in one eye. Compared to group A, group B exhibited a statistically significant increase in the incidence of postoperative conjunctival congestion, silicone oil retention, and posterior capsular opacification (χ2=10.600, 6.187, 92.617; P＜0.05). In contrast, no statistically significant differences were observed between the groups in the incidence of corneal edema or recurrent retinal detachment (RD) (χ2=0.272, 1.557; P＞0.05). No intraoperative complications, such as iris prolapse, posterior capsular rupture, nucleus drop, zonular dehiscence, choroidal detachment, or hemorrhage, occurred in any of the operated eyes. Furthermore, no postoperative complications, including corneal endothelial decompensation, IOL displacement, or endophthalmitis, were observed during the follow-up period. ConclusionCompared to the conventional pars plana approach for silicone oil removal combined with cataract surgery, the modified anterior perfusion transpupillary approach demonstrated significantly shorter surgical duration and a reduced incidence of postoperative complications.
Objective To investigate the main causes and risk factors of recurrent retinal detachment (RRD) after silicone oil removal (SOR) in eyes with complex retinal detachment. Methods It was a retrospective case series study. A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study. All patients underwent vitrectomy operation. Additionally, they were given heavy water, membrane peeling, retinotomy or partial cutting, intraocular laser photocoagulation or frozen, gas-liquid exchange or direct oil exchange operation accordingly. Ninety-eight eyes with multiple holes, old retinal detachment, hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously. Intravitreal silicone oil was padded at the end of operation. Cutting, stripping or resection and 360° preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR. Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation. One week after SOR and during follow-up, the visual acuity, intraocular pressure (IOP), slit lamp microscope, and ophthalmoscope examination were examined with the same technique and methods as preoperation. The eyes were divide into two groups based on the attachment status of retina after SOR, which were reattached group (419 eyes) and redetached group (39 eyes) respectively. The following data were recorded: the age of patients, ocular axial length, logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and IOP before vitrectomy operation and before and after SOR, the number of retinal breaks, the duration of silicone oil filling, the duration of followup, and the related factors during vitrectomy operation and SOR. The relation of age, sex, high myopia, the size and location of holes, aphakic eye, proliferative vitreoretinopathy (PVR) C3 level and above, previous history of failed retinal detachment operation, 360° preventive laser photocoagulation, assistant scleral buckling surgery, SOR via corneal puncture to RRD after SOR were analyzed. Odds ratio (OR) and its 95% confidence interval (CI) were calculated for the age ＜40 years old and gender. High myopia, assistant scleral buckling surgery and SOR via corneal puncture were further analyzed by multiple regression equation. Results After SOR operation, the total average logMAR BCVA was 0.86±0.63. The average logMAR BCVA was 0.82±0.59 and 0.99±0.70 respectively for the reattached and redetached groups, which was not statistically different (F=1.559,P＞0.05). The number of high myopia eyes in the reattached and redetached groups were 116 and 22 eyes, respectively, accounted for 27.7% and 56.4%, and the difference was statistically significant (χ2=13.984,P＜0.01). Three eyes underwent vitrectomy with scleral buckling occured RRD, accounting for 3.1%; while 36 eyes underwent vitrectomy without scleral buckling occured RRD, accounting for 10.0%. The incidence of RRD between them was statistically significant (χ2=4.761,P＜0.05). The incidence of RRD was not retated to the PVR levels before the operation, previous history of failed retinal detachment operation, aphakic eye and preventive laser photocoagulation (OR=1.626, 1.699, 1.986, 0.709; 95%CI:0.836-3.162, 0.832-3.658, 0.921-4.279, 0.268-1.875; P＞0.05) . RRD had a close relation with high myopia and assistant scleral buckling surgery (OR=3.380, 0.284; 95%CI:1.733 -6.595, 0.086-0.944; P＜0.05). The raise of risk derived from SOR via corneal puncture had no statistical significance (OR=2.119; 95%CI: 1.043-4.306; P＞0.05). The incidence of RRD after SOR was 8.5%; of which, 35.9% originated from new breaks and 69.2% were related to new breaks, in contrast, only 5.1% originated from PVR but 51.3% were related to PVR. ConclusionsHigh myopia is an independent prognostic risk factor of RRD after SOR. Combined scleral buckling surgery is a protective factor of RRD after SOR. To the well reattached eyes before SOR, the new breaks seems to be the main cause of RRD, wheras PVR was probably a secondary phenomenon.
Objective To compare the outcome of C3F8 versus silicone oil intraocular tamponade after pars plana vitrectomy (PPV) for the treatment of severe highly myopic macular hole retinal detachment (MHRD). Methods Thirty-two highly myopic MHRD patients (32 eyes) with extreme long axial lengths (ge;29.0 mm), quot;severequot; retina pigment epithelium (RPE) and chorioretinal atrophy, and posterior staphyloma who underwent PPV, were enrolled in this study. The patients were divided into two groups according to different intraocular tamponade agents: C3F8 (group A, 15 eyes) and silicone oil (group B, 17 eyes). The patients with retinal re-detachment after surgery received PPV again. The differences of sex (P=1.000), age (t=0.444, P=0.660), best-corrected visual acuity (t=0.084, P=0.934), diopter (t=0.449, P=0.978), lens state (P=1.000), time of the symptoms (t=0.375, P=0.710) and degree of retinal detachment (chi;2=0.014, P=0.907) between group A and B were not statistically significant. The anatomic reattachment of the retina, macular hole closure, and vision acuity were observed at one week, one, three, six and 12 months after surgery. Results The rates of retinal reattachment and macular hole closure were 60.00% and 13.33 % in group A, 82.35% and 29.41% in group B in the first time of surgery. There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.243, 0.402). The rates of retinal reattachment and macular hole closure were 86.67% and 20.00% in group A, 94.12% and 29.41% in group B in the second time of surgery. There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.589, 0.691). Twelve months after surgery, the vision acuity improved in five eyes, unchanged in seven eyes , and decreased in three eyes in group A; the vision acuity improved in seven eyes , unchanged in eight eyes , and decreased in two eyes in group B. The differences of vision result was not statistically significant between two groups (chi;2=0.209, P=0.647). Conclusion The rates of retinal reattachment and macular hole closure with silicone oil tamponade was higher than that with C3F8 tamponade in eyes with severe highly myopic MHRD, but the differences are not statistically significant.
Silicone oil is a stable intraocular tamponade widely used in various vitreoretinal surgeries. However, it can migrate into the anterior chamber for various reasons, leading to complications such as pupillary block glaucoma, corneal endothelial decompensation, and keratopathy. The inferior peripheral iridectomy (later referred to as the Ando iridectomy) can allow the aqueous humor from the posterior segment to drain into the anterior chamber, and this drainage exerts pressure on the silicone oil, pushing it back into the vitreous cavity, thereby effectively addressing the complications. The application of the Ando iridectomy has expanded from aphakic eyes to phakic eyes and pseudophakic eyes in recent years, each with specific indications. The diameter of the Ando iridectomy should be ≥ 2 mm. The incision for the Ando iridectomy should be made at the 6 o'clock position at the iris root, at the lower edge of the silicone oil droplet in the anterior chamber, or in the inferior aqueous humor zone. Postoperatively, the Ando iridectomy may close due to inflammation or blood cell blockage. In such cases, it can be reopened using laser photocoagulation, surgical peripheral iridectomy, or needle puncture to restore its functionality. Currently, there is no standardized protocol for the application of the Ando iridectomy in vitreoretinal surgeries, and this warrants further research.