Functional results after vitrectomy with silicone oil injection.

In a prospective study we investigated the visual acuity and differential light sensitivity in 39 patients (40 eyes) with reattached macula. One group, treated with an encircling band (21 eyes), was compared to another, where vitrectomy and silicone oil injection had been necessary (19 eyes). Intraoperatively 9 of the vitrectomized eyes received an infusion of daunomycin (7.5 mg/l for 10 min). On average the vitrectomized eyes had a greater loss of visual acuity and differential light sensitivity. In all groups we found a positive correlation between visual acuity and the differential light sensitivity. At the same visual acuity we did not find any obvious difference in sensitivity between the groups. Correlation and regression line were similar for both groups. The mean relative sensitivity was lower in the fovea than in the rest of the tested field. A selective effect of silicone oil on either spatial resolution or differential light sensitivity could not be verified. The intraoperative application of daunomycin had no influence on the functional results.     

Acute glaucoma following vitrectomy and silicone oil injection.

Three cases are described of acute glaucoma following vitrectomy and silicone oil injection in proliferative vitreous retinopathy. The first case developed silicone-induced pupillary block in a phakic eye. Cases 2 and 3 developed elevated pressure in aphakic eyes with deep anterior chambers. Cases 1 and 3 were treated by laser iridectomy. Case 2 was treated by removal of silicone. The pathogenesis and treatment of these problems are discussed.     

Keratopathy and pachymetric changes after photorefractive keratectomy and vitrectomy with silicone oil injection

We present a man who, after bilateral excimer laser photorefractive keratectomy (PRK) for high myopia in the right eye, had repeated retinal detachment surgery with lensectomy and injection of silicone oil. Visual acuity fluctuated in accordance with significant central corneal thickness diurnal variation. The case illustrates the possibility of PRK as a predisposing factor for keratopathy after retinal detachment surgery with silicone injection in an aphakic eye.     

Ultrastructure of the anterior lens capsule after vitrectomy with silicone oil injection

To clarify the mechanical difficulties experienced when performing anterior capsulorhexis in vitrectomized eyes filled with silicone oil. Five anterior lens capsules removed from eyes with a silicone oil history were submitted to light and electron microscopic analysis and then compared to two capsules from eyes with trauma history and seven capsules from eyes without silicone oil or trauma history. Comparable abnormalities of the inner and outer surface of the anterior lens capsule were consistently observed after silicone oil fill of the vitreous cavity or after traumatic impact to the lens: patches of multilayer epithelial cells with interspersed capsule material and connective tissue were observed on the posterior surface of the anterior lens capsule. The development of this anterior subcapsular tissue plaque is obviously influenced not only by the PVR process or by side effects of the surgical procedure but also by the silicone oil tamponade or a trauma history. The plaque can be considered primarily responsible for the increased mechanical resistance of the lens capsule in all eyes with silicone oil/trauma history examined in this study.This study was supported by Aktion Kampf der Erblindung (AKDE).     

Toxic anterior segment syndrome outbreak after vitrectomy and silicone oil injection

Purpose. To report a rare outbreak of toxic anterior segment syndrome (TASS) in 4 patients who underwent vitrectomy with silicone oil injection. Methods. Review of the medical charts of all patients who underwent surgery in the operating theater of our department during a 10-day period in May 2011. Results. We report on 4 patients who developed TASS after vitrectomy with silicone oil injection. The clinical presentation was typical of TASS, and different from the anterior chamber reaction that may occur after silicone oil injection. All cases were treated effectively with topical steroids, and the outbreak stopped after the silicone oil batch was exchanged. Conclusions. We discuss the possible mechanisms for this unusual TASS outbreak, and suggest the silicone oil as its cause.     

玻璃体切除硅油填充术后高眼压的临床治疗

目的探讨玻璃体切除硅油填充术后高眼压的治疗方法。方法对视网膜脱离患者行玻璃体切除硅油填充术,术后眼压大于25 mm Hg的86例（86只眼）进行药物或手术治疗。结果 61只眼（70.9%）经药物治疗眼压控制。14只眼（16.2%）经前房穿刺术后眼压控制。8只眼（9.3%）出现虹膜周切口阻塞,其中6只眼经激光打孔再通,2只眼只行手术切除周边虹膜。3只眼（3.4%）出现新生血管性青光眼,其中1只眼行睫状体冷凝,2只眼行睫状体光凝联合硅油取出后眼压控制。眼压控制后8,4只眼（97.6%）视力有不同程度提高。结论及时发现并针对病因进行药物或手术治疗可有效控制玻璃体切除硅油填充术后高眼压。     

Electroretinographic studies following vitrectomy and intraocular silicone oil injection.

Vitrectomy was performed bilaterally in pigmented rabbits and followed by silicone oil injection in one eye only. Electroretinographic studies were performed preoperatively and at selected postoperative intervals. In the early postoperative period both eyes showed an initial reduction in a and b wave amplitudes, followed by a return to baseline values. The amplitudes were symmetrically and equally affected. Sequential studies over a 20-month period showed no deterioration in electroretinographic response in eyes with and without silicone oil injection.     

Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade

AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation(PRP) or extra-PRP were conducted within 2 d. The follow-up time was 6 mo. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), neovascularization of iris(NVI) were recorded before and after treatment.RESULTS: Within 2 d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2 d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.     

Pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection

PURPOSE: To describe pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection. DESIGN: Interventional case series. METHODS: Cases were collected from January 1997 to July 2000 from three tertiary referral centers. RESULTS: Seven phakic patients (seven eyes) and one pseudophakic patient (one eye) presented 1 to 90 days after vitrectomy and silicone oil injection with intraocular pressures of 36 to 70 mm Hg. Five patients had an observed or potential weakness of the iris-lens diaphragm. Treatment with Nd:YAG-laser peripheral iridotomy or inferior iridectomy provided a temporary reduction in intraocular pressure for some patients, but all eventually required removal of silicone oil. CONCLUSION: Pupil block glaucoma after silicone oil injection is well recognized in aphakic patients, but ophthalmologists should be aware that it can occur in phakic and pseudophakic patients, particularly in complicated cases and patients with a weakness of the iris-lens diaphragm.     

Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments

ObjectiveTo determine the incidence and associations of glaucoma after pars plana vitrectomy (PPV) and silicone oil injection (SOI) for complicated retinal detachments and the response to treatment.DesignRetrospective noncomparative case series.ParticipantsA total of 150 eyes of 150 patients who had completed a minimum of 6 months of follow-up were included in this study. Analysis included clinical records of all consecutive cases of complicated retinal detachment that underwent PPV with SOI between July 1991 and February 1996.InterventionSurgical intervention for vitreoretinal pathology included standard three-port PPV and additional procedures as appropriate for the retinal pathology, and SOI. Procedures for the control of glaucoma were silicone oil removal (SOR), trabeculectomy with mitomycin C, cyclocryotherapy, semiconductor diode laser contact transscleral cyclophotocoagulation (TSCPC) and anterior chamber tube shunt to encircling band (ACTSEB).Main outcome measuresPresence of glaucoma (predefined as intraocular pressure [IOP] ≥ 24 mmHg, which also was ≥10 mmHg over the preoperative level, sustained for ≥6 weeks) and the result of medical and surgical management were the main outcome measures. Demographic, preoperative, intraoperative, and postoperative parameters including the age of the patient, etiology of retinal detachment, refractive status, pre-existing glaucoma, aphakia, diabetes mellitus, presence of silicone oil (SO) in the anterior chamber, emulsification of SO, rubeosis iridis, and anatomic success were evaluated by univariate and multivariate logistic regression analyses to assess their predictive value in the causation of glaucoma and to determine factors prognosticating response to treatment.ResultsThe main indications for PPV+SOI were proliferative vitreoretinopathy (57%; 85 of 150), proliferative diabetic retinopathy (15%; 23 of 150), and trauma (14%; 21 of 150). Glaucoma occurred in 60 eyes (40%) at 14 days median (range, 1 day–18 months). Elevation of IOP could be attributed directly to SO in 42 (70%) eyes. Glaucoma was controlled in 43 (72%) of 60 eyes on treatment (with medicines alone in 30%; SOR and medicines in 25%; trabeculectomy with mitomycin C/ACTSEB/cyclocryotherapy or TSCPC in 17%); 28% (17 of 60) remained refractory. Independent predictive factors for glaucoma on multivariate analysis were rubeosis iridis (odds ratio, 10.76), aphakia (odds ratio, 9.83), diabetes (odds ratio, 6.03), SO in anterior chamber (odds ratio, 4.74), and anatomic failure (negative risk factor; odds ratio, 0.11). Poor prognostic factors for the control of glaucoma were SO emulsification (odds ratio, 15.34) and diabetes (odds ratio, 6.03).ConclusionGlaucoma is a frequent and often a refractory complication of PPV with SOI and has a multifactorial etiology. Aggressive medical and surgical management with SOR, trabeculectomy with mitomycin C, glaucoma shunts, and cyclodestructive procedures shows modest success in controlling IOP.     

The role of nystagmus in silicone oil emulsification after pars plana vitrectomy and silicone oil injection for complex retinal detachment

PURPOSE: The purpose of this study was to determine whether nystagmus has a role in silicone oil emulsification after pars plana vitrectomy and silicone oil injection for complex retinal detachment. METHODS: A retrospective review was conducted of the clinical and operative records of eight eyes with nystagmus that underwent pars plana vitrectomy and silicone oil injection for repair of retinal detachment associated with proliferative vitreoretinopathy. Three male (37.5%) and 5 female (62.5%) patients were included in this study. The mean age was 36.4 years (range, 19 to 54 years) and the mean follow-up time was 18.3 months (range, 5 to 49 months). RESULTS: Three eyes underwent combined lensectomy and vitrectomy. During the initial postoperative period, retinal attachment was obtained in 6 (75%) patients. Two of eight eyes required further surgery. Silicone oil emulsification occurred in all eyes to different degrees in the 1- to 3-month postoperative period. No inverse hypopyon was observed in any of patients. Three of eight eyes developed open angle glaucoma due to silicone oil emulsification before the silicone oil removal. In these patients, intraocular pressure was controlled successfully by medical therapy. Silicone oil removal was performed before the planned time because of early emulsification. After the removal of silicone oil, two of three eyes had established open angle glaucoma and medical therapy was maintained. After the removal of silicone oil, recurrent retinal detachment developed in two eyes and one of them developed phthisis bulbi. CONCLUSIONS: Silicone oil emulsification may develop earlier than expected in patients with nystagmus who underwent pars plana vitrectomy combined with silicone oil injection.     

微切口超声乳化术联合硅油取出术治疗玻切术后硅油填充眼合并白内障

目的：观察玻璃体切割术后硅油填充眼行微切口白内障超声乳化联合睫状体平坦部硅油取出术的临床疗效。 方法：2013-02/11对43例43眼玻璃体切割术后硅油填充眼合并白内障患者行微切口白内障超声乳化联合睫状体平坦部硅油取出术,术中均Ⅰ期植入人工晶状体,观察患者术后3 mo最佳矫正视力和手术并发症发生情况等。结果：术后3mo,最佳矫正视力较术前提高者共39例（91%）,最高矫正视力达0.6,视力无提高者4例（9%）。所有患者均未发生后囊膜破裂、硅油残留、角膜内皮失代偿、前房积血、玻璃体积血、人工晶状体移位、继发性青光眼、锯齿缘离断等并发症。 结论：微切口超声乳化人工晶状体植入术联合睫状体平坦部硅油取出术是一种有效、安全的手术方式。     

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 intravitreal silicone oil injection in eyes with rubeosis iridis

We postoperatively evaluated the data from 10 patients who underwent pars plana vitrectomy and intravitreal silicone oil injection for complications of proliferative diabetic retinopathy and rubeosis, or for proliferative vitreoretinopathy and rubeosis. There was no change in the zone of iris affected by the rubeosis or in the calibre of rubeotic vessels. Visual acuity improved in two patients and stayed the same in eight. Retinas were completely attached in 50% and partially attached in 30% of the patients on the last follow-up visit. The use of silicone oil in these patients caused no untoward effects in these severely diseased eyes.     

Early vitrectomy with primary silicone oil injection in very severely injured eyes

Performing early vitrectomy with primary silicone oil filling in 11 severely injured eyes (large or multiple intraocular foreign bodies, double perforations, ruptures - all with vitreous hemorrhage and retinal detachment), the authors succeeded in treating the posterior segment trauma with adequate hemostasis in ten cases. During postoperative follow-up of between 12 and 39 months there were no recurrences of hemorrhage. Primary retinal reattachment was achieved in seven eyes. A traction detachment due to proliferative vitreoretinopathy developed in three eyes at a relatively late stage (6-19 months postoperatively): reoperation was successful in two cases. With regard to functional results, six eyes had a visual acuity of between 1/25 and 0.6, and in four it was in the range between perception of light projection and hand movements. There were three cases with keratopathy encouraged by aniridia or hypotonia. One eye with emulsification of the silicone oil developed a secondary glaucoma which responded to topical treatment. In three cases the silicone oil was removed without complications. In one eye there was an expulsive choroidal hemorrhage which could not be managed intraoperatively and which led to phthisis and amaurosis postoperatively.     

Management of complicated retinal detachment by vitrectomy and silicone oil injection

One hundred eyes of 95 patients were operated with vitrectomy and silicone oil injection. The patients were divided into 3 groups: Penetrating trauma (PT)-22 eyes, proliferative diabetic retinopathy (PDR)-14 eyes, and proliferative vitreoretinopathy (PVR)-64 eyes. All of the eyes had retinal detachment including the macula. Final attachment of the retina was achieved in 40% of PT, 50% of PDR, and 60% of PVR. Improvement of visual acuity following the operation was noted in 54% of PT, 43% of PDR, and 67% of PDR. Postoperative complications included band keratopathy, elevation of IOP, hypotony, and cataract. Neovascularization of the iris, either preoperative or postoperative, is associated with very poor prognosis.     

Pars plana vitrectomy and silicone oil injection in proliferative diabetic retinopathy

A retrospective study is reported on 106 eyes with proliferative diabetic retinopathy, treated by vitrectomy and silicone oil injection. Indications were traction detachment in 91 eyes and nonclearing rebleeding in 15 eyes; 31 eyes had previously had vitrectomy. Anatomical success was obtained at the end surgery in 91 eyes, and after a minimum follow-up of 6 months in 68 eyes (64%). Functional results were as follows: satisfactory visual acuity (0.5–0.05) in 23 eyes (22%), ambulatory vision (0.03-CF) in 14 eyes (13%), HM-LP in 54 eyes (51%), and NLP in 15 eyes (14%). The functional results are limited by recurrent detachments due to characteristic reproliferations under the silicone bubble or by ischemic diabetic angiopathy in the attached retina. A positive effect of silicone oil is demonstrated in the reduction of preexisting or postoperatively new iris neovascularization and in preventing postoperative rebleeding.This study was supported by the Retinovit Foundation. Presented in part at the 1986 meeting of the Club Jules Gonin in Copenhagen, Denmark     

细胞因子在玻璃体切除联合硅油填充术后并发性白内障患者房水中的表达

目的 比较玻璃体切除联合硅油填充术后并发性白内障患者与年龄相关性白内障患者房水中细胞因子的表达差异情况,探讨细胞因子与并发性白内障的相关性。设计 实验研究。研究对象 北京同仁医院因玻璃体切除联合硅油填充术后3个月~6年需手术治疗的并发性白内障患者（实验组）19例（19眼）及需手术治疗的年龄相关性白内障患者（对照组）11例（11眼）。方法 每例受试者白内障手术中收集房水0.1～0.2 ml,通过流式细胞仪检测房水中细胞因子IL-1β、IL-2、IL-4、IL-5、IL-6、IL-10、TNF-α、IFN-γ的表达。主要指标 上述8种细胞因子的表达量。结果 实验组中IL-6的表达量（199635.64±28156.5 fg/ml）及IL-10的表达量（273.57±206.7 fg/ml）均明显高于正常对照组 （3340.96±1970.36 fg/ml）及（117.45±64.77 fg/ml）（P均＜0.05）。其余6种细胞因子表达两组间差异则无统计学意义。结论 玻璃体切除联合硅油填充术后并发性白内障患者房水中细胞因子IL-6、IL-10含量较高,可能与并发性白内障的形成或加速有关。（眼科,2013,22：269-272）