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.
ObjectiveTo evaluate the efficacy and safety of silicone oil removal combined with dexamethasone intravitreal implant (DEX) for the treatment of macular edema secondary to proliferative diabetic retinopathy (PDR). MethodsA retrospective case series study. From September 2023 to September 2024, 25 patients (25 eyes) with PDR complicated by macular edema who underwent silicone oil removal combined with DEX treatment at Eye Hospital of Shandong First Medical University were enrolled. There were 13 male patients (13 eyes) and 12 female patients (12 eyes). All eyes developed macular edema after pars plana vitrectomy (PPV) with silicone oil tamponade. All affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. BCVA was measured using the international standard logarithmic visual acuity chart, and the results were converted to logarithm of the minimum angle of resolution (logMAR) visual acuity records; OCT was used to measure the retinal thickness at the macular fovea (CMT). The surgical method was silicone oil removal combined with intravitreal injection of 0.7 mg DEX. At 1, 4, 8, and 12 weeks after the surgery, the above indicators were re-examined using the same methods and equipment as before the surgery. Paired t tests or Wilcoxon signed-rank tests were used to compare the changes in logMAR BCVA, CMT, and intraocular pressure before and after the surgery and between groups. ResultsThe logMAR BCVA values before surgery and at 4, 8, and 12 weeks after surgery were 1.12±0.11, 0.52 (0.30, 1.17), 0.30 (0.26, 0.50), 0.31 (0.30, 0.70). BCVA improved significantly after surgery, and the differences were statistically significant (t=3.492, 2.965, 4.739; P=0.003, 0.018, 0.001). The CMT values before surgery and at 1, 4, 8, and 12 weeks after surgery were (463.00±127.21), 245.66 (211.50, 305.23), (230.00±69.39), (240.59±48.75), and (251.56±69.86) μm. CMT decreased significantly after surgery, and the differences were statistically significant (t=?6.512, ?5.843, ?4.167, ?4.728; P＜0.05). One day after the surgery, two eyes developed transient elevation of intraocular pressure, which was controlled with topical hypotensive agents. During the follow-up period, no complications, such as migration of the implant into the anterior chamber, were observed. ConclusionsSilicone oil removal combined with DEX is effective and safe for the treatment of macular edema after PPV with silicone oil tamponade. It can significantly improve the patient's postoperative vision and effectively reduce macular edema.