ObjectiveTo compare the safety and efficacy of a modified 23G with suturing incision and traditional 23G vitrectomy for silicone oil removal. MethodsA total of 177 patients (180 eyes) who underwent silicon oil removal (the average tamponade period was 4.5 months) were enrolled in this prospective study. The patients included 112 males (113) and 65 female (67). The mean age was (43.8±10.3) years. The corrected vision, indirect ophthalmoscopy, intraocular pressure, B-ultrasound and optical coherence tomography were measured for all patients. All patients had no complete retinal detachment. The patients were randomly divided into modified 23G with suturing incision group (group A, 88 eyes) and traditional 23G vitrectomy (group B, 92 eyes). The differences of sex (χ2=1.596), age, corrected vision (t=0.785), intraocular pressure (t=0.352), primary disease (χ2=1.982) and lens condition (χ2=2.605) were not significant (P>0.05). The operation time, intraocular pressure, silicon oil retention, choroidal detachment, retinal redetachment and endoophthalmitis were recorded at the end of the operation. ResultsThe difference of mean operation time was not significant between group A and B (t=1.950,P>0.05). The differences of mean visual acuity 1 day, 1 week and 3 months after operation were not significant between group A and B (t=0.873, 1.115, 0.141; P>0.05). There was difference of mean intraocular pressure at 1 day after operation (t=2.550,P<0.05), but not at 1 week and 3 months after operation (t=1.451,1.062; P>0.05) between group A and B. There were 25 eyes (28.4%) with intraocular hypotension, 8 eyes (9.1%) with choroidal detachment, 5 eyes (5.7%) with vitreous hemorrhage, 9 eyes (10.2%) with retinal redetachment, and 7 eyes (8.0%) with silicon oil retention in group A. There were 5 eyes (5.4%) with intraocular hypotension, 2 eyes (2.2%) with choroidal detachment, 2 eyes (2.2%) with vitreous hemorrhage, 8 eyes (8.7%) with retinal redetachment, and 1 eye (1.1%) with silicon oil retention in group B. The differences of incidence of intraocular hypotension, choroidal detachment and silicon oil retention were significant (P<0.05). No endoophthalmitis occurred. ConclusionThe safety of modified 23G with suturing incision is better than traditional 23G vitrectomy for silicone oil removal, with decreased incidence of intraocular hypotension, choroidal detachment and silicon oil retention.
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 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 relative factors of effect of vitrectomy on corneal endothelial cells. Methods Retrospective analysis of the results of corneal endothelium microscopy performed on 213 eyes of 213 patients undergone vetrectomy operations including single vitrectomy (78 eyes), vitrectomy combined with cataract extraction (135 eyes), silicone oil injection (34 eyes), and C3F8 injection (53 eyes) before and after 1 week, 1 and 3 moths of these surgical procedures. Results There was no significant difference between pre- and postoperative corneal endothelium density in single vitrectomy group and vitrectomy combined with cataract extraction with posterior capsule integrity group (Pgt;0.05). The corneal endothelium density significantly decreased postoperatively in C3F8or silicone oil injection group with broken posterior capsule (Plt;0.05). Conclusion C3F8 and silicone oil may damnify corneal endothelium in patients undergo vitrectom y combined with cataract extraction with broken posterior capsule. (Chin J Ocul Fundus Dis，2004，20：101-103)
ObjectiveTo investigate the potential effect of hyperopia status on subfoveal choroidal thickness (SFCT) in silicone oil (SO)-filled eyes.MethodsThis self-comparative study was conducted in Department of Ophthalmology, Central Theater Command General Hospital. The 50 patients (100 eyes) were collected with unilateral macula-on rhegmatogenous retinal detachment from January 2019 to July 2019, who successfully underwent pars plana vitrectomy (PPV) and SO tamponade. Retinal reattachment was observed after surgery in all patients. One month after PPV, the affected eye was wore soft, contact lenses for 24 hours to correct refractive error (RE), depending on its optometry value. The SFCT of the affected eyes was measured using OCT before and after lenses wear. The fellow eyes also received OCT examination at the same time. T test was used to compare SFCT between SO-filled eyes and fellow eyes.ResultsThe mean RE of the SO-filled eyes was +6.38±1.12 D. The mean SFCT of SO-filled eyes (247.12±17.63 μm) was significantly thinner than that of the fellow eyes (276.32.55±17.63 μm) (P＜0.001). The SFCT of the SO-filled eyes was significantly thinner than fellow eyes, and the difference was statistically significant (t=－3.95, P＜0.001). After lenses wear, the mean SFCT of the SO-filled eyes increased to 276.32±24.86 μm. Compared with before lenses wear, the difference was statistically significant (t=－4.30, P＜0.001). Compared with the fellow eye, the difference was not statistically significant (t=0.05, P＞0.05).ConclusionSFCT reduction in the SO-filled eyes may be due to the hyperopia status caused by SO, which can be reserved by RE correction.
Objective To observe the effect of emergent vitrectomy combined with lensectomy, silicone oil temponade for endogenous endophthalmitis. Methods The clinical data of 28 patients (30 eyes) with endogenous endophthalmitis were analyzed retrospectively. All patients had no history of ocular trauma and intraocular surgery history. There were 21 patients without systemic symptoms, three patients with fever, two patients with eye pain and headache, and two patients with abdominal pain when presentation. All patients diagnosed by best corrected visual acuity, intraocular pressure, slit-lamp microscopy, direct and indirect ophthalmoscope examination and intraocular B-ultrasound examination. Emergent surgery (vitrectomy, lensectomy, silicone oil temponade) was performed in all 30 patients, those with fever or abdominal pain was also treated by relevant clinical departments. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. The follow-up was 18 to 30 months. The preoperative and postoperative visual acuity, intraocular pressure and eye retention situation were observed.Results Endophthalmitis was controlled in 28/30 eyes (93.3%) after surgery, recurrent vitreous empyema occurred in 2/30 eyes (6.7%). Evisceration was performed on those two eyes as uncontrolled intraocular pressure. The visual acuity improved significantly at one month and 18 months after surgery (chi;2=19.87, 32.44; P＜0.01). Postoperative intraocular pressure was normal in 24 eyes (80.0%), transient elevated and controlled in six eyes (chi;2=7.43；P＜0.05). 12/28 (42.9%) vitreous samples were positive for pathogen culture, including 7/12 (58.3%) positive for bacteria, 5/12 (41.7%) positive for fungi. There are 18/28 patients (64.3%) also had hepatobiliary system infections. Conclusion Emergent vitrectomy combined with lensectomy, silicone oil temponade is effective for endogenous endophthalmitis.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Objective To investigate the characteristics and risk factors of optic nerve atrophy in eyes with complicated retinal detachment after silicone oil tamponade during the procedure of vitreoretinal operation. Methods The clinical data of 97 patients with complicated retinal detachment who had optic nerve atrophy after silicone oil tamponade during the procedure of vitreoretinal operation were an alyzed retrospectively. Logistic regression analysis by SPSS statistical software was used to analyze the factors like age, disease history, primary diseases, preoperative ocular condition, complications in and after the operation, the time taking out the silicone oil, and emulsification of the silicone oil, and Ple;0.05 was considered to be the symbol of significant difference. Results All of the affected eyes had optic discs with clear border, including paler optic disc in 65 eyes, pale one in 21 eyes, and paler optic disc with enlargement of the cup/disc (ge; 0.6) in 11 eyes. The result of logistic regression analysis showed that the intraocular pressure (P=0.022) and the visual acuity (P=0.001) during the silicone oil removal were in the equation. Conclusion The risk factor of optic nerve atrophy is the chronic increase of intraocular pressure after silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22: 305-307)
Objective To invesligate the treatment of retinal de tachment(RD) after silicone oil tamponades(SOT)． Methods The records of a consecutive series of 32 eyes with redetachment of retina after SOT surgery between 1998 to 2000 were reviewed retrospectively． The surgical techniques used for these cases included remove of silicon oil,peeling of preretinal membrane, retinotomy, endolaser photocoagutation, secondary vitrectomy and C3 F8 tamponades． Results In 28 of 32 eyes the retina was reattached (87．6%)． The postoperative visual acuity was improved in 12 eyes, redused in 4 eyes and remained no change in 16 eyes． The postop erative complications in 6 eyes included secondary glaucoma(3 eyes), hypotony (1 eye) and hyphema (2 eyes)． Conclusion The techniques of preretinal membrane peeling, retinotomy, endophotocoagulation and C3 F8 tamponades can be effectively used in combination to treat the redetachment of retina after the silicone oil tamponades surgery． (Chin J Ocul Fundus Dis,2001,17:214-215)
Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma. Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study. All the patients were examined for corrected visual acuity (CVA), slit lamp microscope and preset lens, indirect ophthalmoscope, A/B ultrasound, optical coherence tomography (OCT) and intraocular pressure examination. The average axial length was (29.1plusmn;1.8) mm. There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy. The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The average logMAR CVA was 1.93plusmn;0.37. All the patients were treated with PPV and triamcinolone acetonide or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade. TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes. The duration of silicone oil tamponade was (6.2plusmn;1.6) months. CVA, retina and macular hole status and complications were observed postoperatively. Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis. Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success. Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi-square. Results The mean logMAR CVA was 1.34plusmn;0.48 after surgery, which significantly improved compared to that before surgery (t=39.38, P＜0.01). The CVA after surgery was independent of axial length (r=0.142, P＞0.05), choroid atrophy (t=0.23, -0.165,P＞0.05) and macular hole closure (t=0.12, -0.005, P＞0.05). The retina reattached in 79 eyes (92.9%) and recurrence of retinal detachment occurred in six eyes (7.1%). Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment, proliferative vitroretinopathy, axial length, choroid atrophy and ILMP (OR=1.428, 5.039, 0.815, 2.578, 0.432; P＞0.05). Of these 85 eyes, macular hole closed in ten eyes (11.8%), macular hole did not close in 75 eyes (88.2%). There were 24 eyes (28.2%) experienced high intraocular pressure during the first 2 weeks after surgery, all of them were under control with drugs. There were 12 eyes (14.1%) presented with high intraocular pressure before the silicone oil removal, all of them were under control only by silicone oil removal. Conclusion For the treatment of MHRD with posterior staphyloma, PPV combined with ERMP and (or) ILMP and silicone oil tamponade show a high retinal reattachment rate.