Long-term outcomes of heavy silicone oil tamponade for complicated retinal detachment

PURPOSE: To assess the long-term success rates and complications of heavy silicone oil tamponade (Oxane HD) in the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR). METHODS: Twenty-one eyes of 21 patients with complicated retinal detachment and PVR were included in this study. Vitreoretinal surgery with heavy silicone oil (Oxane HD) tamponade was performed in all patients. Heavy silicone oil was injected by perfluorocarbon liquid-air-silicone oil exchange, and was removed after 3 months. The main outcomes of the surgery including the success and complication rates were evaluated during the mean follow-up period of 11.4+/-0.88 months. Wilcoxon signed ranks test was used for statistical analysis of visual acuity changes. The outcomes of our study were compared with those of the previous studies. RESULTS: All eyes had complicated retinal detachment with PVR Grade C3 or worse. Retinal detachment was rhegmatogenous in 6 eyes, secondary to previous detachment surgery in 11 eyes, secondary to proliferative diabetic retinopathy in 3 eyes, and secondary to perforating eye injury in 1 eye. The overall anatomic success rate was 80.9% at the end of the follow-up period. The overall visual success rate was 42.8%, with no statistically significant difference from baseline (p>0.05). Postoperative complications included severe reproliferation (4 eyes), intraocular pressure rise (3 eyes), anterior dislocation of silicone oil (2 eyes), posterior subcapsular cataract formation (4 eyes), vitreous hemorrhage (1 eye), rubeosis iridis (3 eyes), optic atrophy (1 eye), and ocular pain and photophobia (21 eyes). CONCLUSIONS: According to the results of this study, vitreoretinal surgery with temporary heavy silicone oil tamponade appears to increase the anatomic success rates with minimal complication rate in cases with complicated retinal detachment and PVR.     

The use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery

Background  

Conventional silicone oil provides suboptimal support of the inferior retina. In this study we evaluated the efficacy of Oxane HD in the management of complex retinal detachments involving lower quadrants of the retina.     

重硅油填充术治疗硅油眼复发性视网膜脱离9例临床观察

目的:观察重硅油作为眼内填充物治疗硅油眼复发性视网膜脱离的临床效果。方法:2008-01/2009-06期间我院收治的硅油眼复发性视网膜脱离患者9例9眼,均采用取油、剥膜、视网膜复位、重硅油填充术。其中男6例,女3例;年龄23～45(平均33.78±6.89)岁;原有眼球穿通伤6例、孔源性视网膜脱离3例;伴不同程度的视网膜前及下增殖。重硅油填充术前手术次数1～3次,接受1次手术1例、2次手术5例、3次手术3例。患者随访观察时间3～10mo。所有患者先行硅油取出然后依病情联合剥膜、重水应用、激光、冷凝、气液交换等,最后行重硅油填充。结果:术后1wk全部病例视网膜均获复位,复位率100%。随访期间总共4例发生视网膜再脱离,视网膜脱离最早出现为术后1.5mo,最迟出现为术后3mo,2例为重硅油存留时发生,2例为重硅油取出术后,复位率56%;最后一次随访时视力较术前改善者5例,改善率56%;7例术后眼压较术前有升高,药物均可控制;9例术后前房均有反应,且持续时间较长,2～3mo;本组病例重硅油填充术后均发生乳化现象,最短2wk即发现乳化小滴,最长3mo,平均2.08±0.58mo。结论:重硅油填充治疗复杂性视网膜脱离应严格掌握适应证、密切随访观察减少并发症的发生。     

重硅油眼内填充治疗复杂性视网膜脱离的近期效果

目的 观察重硅油作为眼内填充物治疗复杂性视网膜脱离的疗效和安全性.设计回顾性病例系列.研究对象复杂性视网膜脱离患者16例16眼.方法 采用玻璃体切割联合重硅油填充术治疗.术中依病情联合剥膜、视网膜切开、重水应用、眼内激光、超声乳化白内障吸出人工晶状体植入等.主要指标视网膜复位情况,视力、眼压等.结果 平均随访(15.1±8.48)周(3～28周).15例(93.8%)患者视网膜全部复位,裂孔封闭.13例患者于术后1～3个月行重硅油取出,3例在最后随访时重硅油仍未取出.1例在取硅油时发现上方裂孑L前缘稍浮,视网膜限局脱离,而行惰性气体填充术.所有患者术后均出现不同程度的晶状体混浊,主要表现为后囊膜混浊.4例出现暂时性高眼压.结论 重硅油眼内填充对治疗裂孔位于2～10点钟位之下方或两个以上裂孔位于视网膜同一侧的复杂性视网膜脱离疗效较好,并发性白内障是其主要副作用.(眼科,2008,17:254-257)     

Comment to: the use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery

Graefe's Archive for Clinical and Experimental Ophthalmology -     

Response to: the use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery

Graefe's Archive for Clinical and Experimental Ophthalmology -     

Inferior retinal detachment with silicone oil tamponade

Silicone oil is a valuable surgical tool to treat severe retinal detachment (RD). However, following surgery, remaining RD or the appearance of inferior RD with silicone tamponade is a delicate situation. Anamnesis and careful examination should provide a suitable treatment. Silicon oil removal will be considered after treatment of this residual RD. The endocular approach may be required: dissection of vitreoretinal proliferation, phakoexeresis, or retinectomy, whereas complementary indentation, subretinal fluid puncture, and scleral shortening are external therapeutic methods. One of the frequent causes of these persistent RDs is the presence or the progression of a more or less large and extended anterior vitreoretinal proliferation, which will sometimes require extended silicon oil tamponade. Indeed, after a certain time has elapsed, the existence of a genuine retinal adhesion disease makes a durable reapplication without internal tamponade impossible.     

Anatomical and functional outcomes after Densiron 68 heavy silicone oil tamponade for complicated retinal detachment in Chinese eyes

AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment (RD) in Chinese eyes.METHODS: Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study. All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO. Anatomical and functional results and complications were evaluated, including retinal status, visual acuity (VA), intraocular pressure (IOP), intraocular inflammation, lens opacity, and HSO emulsification.RESULTS:All the patients were followed up for 3mo to 1y (5.8±1.16mo). Retinal reattachment was achieved in 19 of 21 patients (90.5%). VA improved in 18 of 21 patients (85.7%), from 1.93 logMAR (±0.48) to 1.52 logMAR (±0.45) (P=0.001). Postoperative complications included early dispersion of HSO in 7 eyes (38.8%), cataract in 10 of 18 phakic eyes (55.5%), moderate postoperative inflammation reaction in 10 eyes (47.6%), and elevated IOP in 5 eyes (23.8%), all of which were controlled by medication or by surgery.CONCLUSION: High anatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO; however, it should not be ignored that Densiron 68 HSO can cause some complications in the eye.     

1000 cSt silicone oil vs heavy silicone oil as intraocular tamponade in retinal detachment associated to myopic macular hole

Background  

Several surgical techniques have been described for the treatment of retinal detachment (RD) associated to myopic macular hole (MMH). In this retrospective study, the anatomical and functional outcomes of pars plana vitrectomy (PPV) with long-term tamponade, using either 1000 cSt silicone oil (SO) or heavy silicone oil (HSO), are compared.     

视网膜脱离硅油充填术继发性青光眼临床观察

目的 探讨视网膜脱离硅油充填术继发性青光眼的相关因素及硅油取出对继发性青光眼的影响。方法 统计玻璃体切除硅油充填术视网膜复位后行硅油取出的病例，并对继发性青光眼的发生及其转归进行了随访观察。结果 120例121眼中25眼发生继发性青光眼(20．66％)，硅油取出后经1-3月随访23眼眼压降至正常，2眼药物控制。结论 随着硅油在眼内停留时间的延长继发性青光眼的发生率明显增加，玻璃体切除硅油充填术后以在视网膜复位后3-6月取出为宜。一旦发生继发性青光眼即是硅油取出的指征。     

Definitive internal tamponade with silicone oil in certain cases of retinal detachment

PURPOSE: The aim of this study was to analyze the effect of definitively maintaining silicone oil in the treatment of certain cases of retinal detachment. MATERIAL and METHODS: Sixteen cases of retinal detachment seen from July 1995 to April 1999 were retrospectively studied. For these eyes with residual visual acuity, we voluntarily maintained silicone oil. There were 11 men and 5 women, mean age 56 (range 24 - 82). Followup ranged from 18 to 45 months. RESULTS: We analyzed visual acuity outcome, complications, and main reasons for maintaining longterm silicone oil CONCLUSION: This study provided interesting insight concerning certain clinical situations where silicone oil has to be maintained definitively. In some cases, low, but useful, visual acuity can be achieved for long periods of time. This therapeutic approach would be particularly helpful for mono-ophthalmic patients.     

复杂性视网膜脱离术中应用硅油临床分析

目的:观察复杂性视网膜脱离术中应用硅油的疗效及并发症。方法:对我院收治的48例复杂性视网膜脱离术中应用硅油填充的患者进行回顾性分析。结果:48例手术患者术后视力或矫正视力光感～0.4。出院前复查眼B超,其中37例视网膜平复,11例可见视网膜脱离变形。主要并发症有并发性白内障21例,硅油乳化12例,继发性青光眼8例,角膜带状变性5例。11例2次手术未见眼球萎缩。结论:复杂性视网膜脱离手术中应用硅油填充可提高治愈率,但并发症较多,应引起临床医生重视。     

Surgical results of heavy silicone oil HWS-45 3000 as internal tamponade for inferior retinal detachment with PVR: a pilot study

Purpose  

To report the results of a prospective pilot study using a new heavy agent, HWS-45 3000, as endotamponade in complicated inferior retinal detachment.     

同期行硅油取出C3F8填充联合巩膜扣带术治疗硅油填充术后下方视网膜脱离患者的手术疗效

目的　探讨同期行硅油取出Ｃ３Ｆ８填充联合巩膜扣带术治疗硅油填充术后下方视网膜脱离患者的手术疗效。方法　选取１２例１２眼硅油填充伴下方视网膜脱离的患者,采用硅油取出并玻璃体内Ｃ３Ｆ８填充联合巩膜扣带术进行治疗,术中根据情况选择性联合实施冷冻、激光、剥膜、外放液等;术后观察随访视网膜复位情况、视力、眼压和并发症等。患者随访观察时间为１１～２３（１８．３５±４．２２）个月。结果　术后２ｄ所有患者视网膜完全复位,随访期间发现３眼复发视网膜脱离,远期复位率７５％。术后视力较术前改善,差异有统计学意义（Ｐ＝０．０４７）。术后６眼出现一过性眼压升高,最高至３５ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,给予药物降压后,眼压回归正常,并保持稳定,停药后未有再升高。术后患者末次随访时眼压为１８～２２（１４．５３±５．４２）ｍｍＨｇ。与术前比较,眼压增高（ｔ＝－５．３１１,Ｐ＜０．００１）。因术前存在视网膜脱离,故术前患者眼压均偏低,术后眼压恢复正常后眼球萎缩的可能性下降。术中未出现视网膜损伤、出血、重水残留等并发症,但所有患者眼睑肿胀、结膜水肿明显,尤以术中冷冻者（４例）更为显著,患者自觉磨涩疼痛症状较为明显,术后２ｄ症状逐渐减轻。结论　对于玻璃体切除硅油填充术后下方视网膜脱离患者,同期行硅油取出Ｃ３Ｆ８填充联合巩膜扣带术能有效地使视网膜再复位,缩短治疗周期。     

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的：探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。

方法：回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出; 巩膜扣带术中外加压块采用外加压复合体; 术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。

结果：术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。

结论：改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。