硅油填充术后继发高眼压的相关危险因素

硅油(silicone oil)作为一种暂时性玻璃体替代物,已被广泛应用于各种复杂的玻璃体视网膜疾病的治疗。然而,硅油的填充也引起了多种术后并发症,其中最常见的并发症是临时性或永久性的眼压升高。多项研究表明,硅油填充术后的眼内压受到多种因素的影响。本文就近年来硅油填充术后继发高眼压的相关危险因素及其发病机制进行综述,这可能为及时、有效地控制眼压提供参考。     

硅油填充术后继发高眼压的原因及处理

目的:探讨玻璃体切割联合硅油填充术后继发高眼压的发病原因及处理方法。方法:对在我院行硅油填充术的97例97眼患者进行术后眼压回顾性研究。结果:术后39眼(40%)发生高眼压,其中2wk内高眼压12眼(12%),2～8wk内高眼压8眼(8%),8wk以上高眼压19眼(20%);经过药物、手术等对症治疗后大多恢复正常。结论:继发性高眼压是玻璃体切割联合硅油填充术后常见并发症之一,术后炎症反应、硅油填充过量、硅油进入前房、硅油乳化等是高眼压发生的主要因素,人工晶状体眼或无晶状体眼高眼压发生率更高;药物和手术治疗可有效控制眼压。     

硅油填充术后早期高眼压的临床分析

目的：探讨玻璃体切割硅油填充术后早期高眼压的原因、临床表现及术后处理。 方法：对行玻璃体切割硅油填充术后的97例97眼患者的临床资料进行回顾性分析,高眼压的标准为术后眼压≥21mmHg（1mmHg=0.133kPa）。 结果：患者27例（27.84%）出现高眼压,以术后早期（术后1wk内）为多,所有患者经降眼压药物治疗及调整激素用量或停用激素处理后,眼压均控制在正常范围（10～21mmHg）。 结论：硅油填充术后早期高眼压是常见的并发症之一,术后眼内组织水肿、炎症反应、硅油填充过量等可能是引起术后早期高眼压的主要原因,但早期对症治疗均使眼压恢复正常,可早期预防视功能的损害。     

A microsurgical method for the injection of intraocular silicone oil

A microsurgical method for the injection of intraocular silicone oil is presented. This technique may give good chances for retinal reattachment, especially in severe cases of massive periretinal proliferation (MPP). Although there are a few reports of silicone toxicity we strongly feel that there is a place for intraocular silicone oil as long as vitrectomy techniques fail in getting good and predictable results in MPP. The use of the microscope, a contact lens and an endoilluminator permit a very good visibility of the whole surgical process and we favour this method over the older technique featuring the binocular indirect ophthalmoscope.     

Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery

AIM: To report anatomic and visual outcomes following silicone oil removal in a cohort of patients with complex retinal detachment, to determine association between duration of tamponade and outcomes and to compare patients with oil removed and those with oil in situ in terms of demographic, surgical and visual factors. METHODS: We reported a four years retrospective case series of 143 patients with complex retinal detachments who underwent intraocular silicone oil tamponade. Analysis between anatomic and visual outcomes, baseline demographics, duration of tamponade and number of surgical procedures were carried out using Fisher’s exact test and unpaired two-tailed t-test. RESULTS: One hundred and six patients (76.2%) had undergone silicone oil removal at the time of review with 96 patients (90.6%) showing retinal reattachment following oil removal. Duration of tamponade was not associated with final reattachment rate or with a deterioration in best corrected visual acuity (BCVA). Patients with oil removed had a significantly better baseline and final BCVA compared to those under oil tamponade (P=0.0001, <0.0001 respectively). CONCLUSION: Anatomic and visual outcomes in this cohort are in keeping with those reported in the literature. Favorable outcomes were seen with oil removal but duration of oil tamponade does not affect final attachment rate with modern surgical techniques and should be managed on a case by case basis.     

B型超声检查在硅油填充眼硅油取出术前的应用价值

目的结合临床探讨玻璃体内硅油填充眼B型超声检查的声像学特征,以及对硅油取出的时机、手术方式和术后预后评估的参考价值。方法对30例（30只眼）玻璃体内硅油填充眼行B型超声检查,测量眼轴,观察晶状体、玻璃体腔、硅油及眼底回声情况。结果 30例玻璃体内硅油填充眼可分为：（1）视网膜脱离;（2）视网膜增生机化;（3）视网膜正常。超声检查和术中所见诊断符合率可达86.66%（26/30）。结论 B型超声检查眼部操作简便,可做出直观性图像诊断,对手术方式的选择及预后有客观的参考价值。     

硅油填充术后前房硅油的原因探讨

目的 探讨硅油填充术后前房硅油的发生原因。方法 对55例(57只眼)行硅油填充术的病例的临床资料进行回顾性分析。结果 术后1—18个月随访发现13只眼前房硅油。其中8只眼为无晶状体眼，3只有晶状体眼者悬韧带断裂，2只眼为人工晶状体眼。结论 无晶状体眼和有晶状体眼晶状体悬韧带断裂为前房硅油的主要原因。     

早期玻璃体切除术治疗重症外伤性眼内炎的疗效

目的: 探讨玻璃体切割联合硅油填充手术的手术时机对治疗重症感染性眼内炎疗效的影响。方法: 回顾性分析59例重症外伤性眼内炎病例,按手术时机不同分为两组,≤24h患者为A组;>24h为B组,均接受玻璃体切割联合硅油填充手术,观察两组患者术中视网膜情况、术后疗效及术后最佳矫正视力(best corrected visual acuity,BCVA)的区别。结果: ≤24h手术患者术中可见视网膜受损情况较轻,手术有效率更高,术后BCVA更佳。结论: 玻璃体切割手术联合眼内硅油填充是治疗重症眼内炎的有效方法,及早发现并及时手术治疗是减少视力受损程度的重要因素。     

Ultrasound biomicroscopy following the intraocular use of silicone oil

We evaluated the ultrasound biomicroscopy findings and the amount and location of silicone oil residue in anterior structures of the eye before and after silicone oil removal. We examined the anterior structures in 40 silicone oil 1000 cs-filled eyes at the end of silicone oil tamponade time (mean silicone oil tamponade duration 5.1 months), and in the same eyes after silicone oil removal. High resolution ultrasound biomicroscopy, 50 MHz transducer, 50 m of resolution, was used. Silicone oil droplets - often not ophthalmoscopically visible - appeared as highly reflective images with after ringing effect. They were present in the anterior structures of the eye in up to 95% of eyes with silicone oil in the vitreous cavity, and in up to 87.5% after careful silicone oil removal. With ultrasound biomicroscopy it was possible to identify small silicone oil droplets with a typical morphological appearance. Once silicone oil is used in vitreoretinal surgery, its complete removal from the anterior structures of the eye is very difficult to achieve later on.Presented at the American Society of Ophthalmic Ultrasound Annual Meeting, S. Francisco, October 29, 1994     

不同手术方式对硅油充填术后早期并发症的影响

目的:探讨不同手术方式对无晶状体眼硅油充填术后早期并发症的影响。方法:回顾性分析在我院进行玻璃体视网膜手术的120例患者的临床资料,根据术中是否行巩膜扣带术及巩膜扣带术先后的不同,随机分为3组,每组40眼。A组:单纯硅油充填组;B组:术前预置环扎带+硅油充填组;C组:硅油充填后再进行外加压组,术后2wk内对各组硅油并发症进行观察。结果:术后A,B,C组高眼压的发病率分别为17.5%,12.5%,52.5%,硅油溢入前房的发病率分别7.5%,10.0%,30.0%。C组与其他两组比较差异有显著性意义(P<0.05)。D组与E组进行比较差异有显著统计学意义,χ2=7.505,P<0.01。结论:硅油充填术后早期并发症与手术方式密切相关,适当改进手术技巧,能降低硅油充填术后并发症的发生率。     

復雜視網膜脱離硅油填充后的高眼壓與低眼壓

目的探討復雜性視網膜脱離平坦部玻璃體切割硅油填充后高眼壓與低眼壓的發生和危險因素.方法對62例(66眼)平坦部玻切硅油填充的復雜網脱病例進行隨訪檢查.結果隨訪至1年,高眼壓和低眼壓發生率爲31.82%和15.15%,術后第一天高眼壓與其它隨訪期比較無差异,p＞0.05.增殖性糖尿病視網膜病變和增殖性玻璃體視網膜病變及有青光眼史和糖尿病史與無上述病史的高眼壓發生率有顯著差异,分别爲p＜0.01和p＜0.05.80%術后低眼壓患者術前就存在低眼壓和無晶狀體.結論高眼壓和低眼壓是復雜網脱硅油填充術后的常見許發症,其發生率分别爲31.82%(21眼)和15.15%(10眼),前者的危險因素包括青年眼和糖尿病史及術后第一天高眼壓的發生;術前低眼壓和無晶狀體是后者的危險因素.     

硅油填充术后的角膜内皮改变

目的评价硅油对有晶状体及无晶状体眼角膜内皮的影响。方法对45例(45眼)视网膜脱离患者行玻璃体切割联合硅油填充术,其中有晶状体组(22眼)及无晶状体组(23眼),比较其术前,术后1、3、6、9个月的改变。了解前房硅油对角膜内皮的影响。结果两组患者手术前后角膜内皮细胞的密度及角膜厚度的改变均无统计学差异,但两组同期角膜内皮细胞密度比较在术后1个月、6个月呈现显著差异(P=0.002,P=0.034)。硅油接触角膜内皮时,呈现“亮度颠倒”现象。末次随访时(术后9个月)的内皮细胞密度与无前房硅油组相比有极显著差异(P=0.000)。结论无论晶状体是否存在,玻璃体腔内的硅油对角膜内皮无明显的损害。而当硅油进入前房则将对角膜内皮造成严重的损害。     

High-density silicone oil (Densiron) as a primary intraocular tamponade: 12-month follow up

Background The high-density silicone oil (Densiron 68), a mixture of F₆H₈ with silicone oil, seems to be a therapeutic option, at least in selected patients with complex inferior retinal re-detachment, where standard procedures have already failed. In an interventional case series we used Densiron as a primary endotamponade. Methods Twelve eyes of 12 patients aged 31 years to 85 years with inferior complex rhegmatogenous retinal detachment with secondary proliferative vitreoretinopathy (PVR) grades CP2 to CA8 were included. Surgical techniques (pars plana vitrectomy, membrane peeling, retinotomy, retinectomy, endophotocoagulation, cryocoagulation, endotamponade) did not include a scleral buckling procedure (except one eye). Mean duration of the Densiron endotamponade was 78.3  ±  29.74 days, with a mean follow up after removal of 400.6 ± 85.4 days. Results After Densiron removal, four patients (33.3%) showed a stable reattached retina without further interventions, while, in six patients (50%), recurrent retinal re-detachment appeared during endotamponade, generally within 2 months. One patient (8.3%) developed re-detachment 5 months after Densiron removal. One eye (8.3%) lost light perception due to severe intraretinal fibrosis with chronic hypotonia, despite complete retinal re-attachment. Visual acuity improved from mean logarithm of the minimum angle of resolution (logMAR) of 2.95 ± 1.21 to 1.87 ± 1.32 (statistically significant, P = 0.022). Side effects included temporary inflammatory reaction/fibrin accumulation (n = 2/2), moderate-to-severe intraretinal fibrosis (n = 3), elevated intraocular pressure (IOP) (n = 3), emulsification (n = 2), sterile hypopyon (n = 1), vitreous haemorrhage (n = 1) and chronic hypotony (n = 1). Conclusion Primary anatomical success rate of 33.3% was less encouraging than as expected. Especially, re-detachments within the posterior staphyloma in highly myopic patients were common during Densiron endotamponade. However, the surgical success increased to 75% after re-intervention, even without the use of an additional encircling band. The observed adverse effects and the functional outcomes do not contraindicate the use of Densiron as an internal tamponade for a period of 3 months.     

Surgical management of silicone oil migrated into suprachoroidal space after vitrectomy

AIM: To report a successful surgical management of silicone oil migrated into suprachoroidal space after the repair of the retinal detachment with hemorrhagic choroidal detachment. METHODS: Retrospective observational case report. A 30-year-old man with retinal detachment and hemorrhagic choroidal detachment due to severe corneal penetrating injury, underwent a pars plana lensectomy and vitrectomy, endolaser, and silicone oil tamponade followed by transscleral suprachoroidal hemorrhage drainage in the right eye. One week later, a localised temporal choroid elevation was noted. This persistent elevation was confirmed by operation research to be silicone oil migration into suprachoroidal space. RESULTS: The migrated silicone oil was drained via trans-scleral cut down, and the intravitreal silicone oil was removed and replaced by 16% C2F6. Over the next 2 weeks, the elevation vanished and the choroid became completely flat. CONCLUSION: The migration of silicone oil into suprachoroidal space is a rare complication of vitrectomy. The pathway of the migration is most likely through internal orifice of sclerotomy sites. Trans-scleral drainage surgery is an effective method to remove the migrated silicone oil from suprachoroidal space.     

有晶体眼硅油入前房继发青光眼的手术处理

目的：总结前房硅油排出术治疗有晶体眼硅油入前房继发青光眼的临床效果。方法：对６例玻璃体切除,硅油填充术后有晶体眼硅油入前房者,行１２点位角膜缘穿刺注入Ｈｅａｌｏｎ,６点位角膜缘切开排除硅油,悬韧带断裂超过２点钟同时行６点位虹膜周边切除术。结果６眼术后眼压控制正常、硅油在位、视网膜在位、除１例角膜轻度混浊外无其他并发症。结论：采用Ｈｅａｌｏｎ注入硅油排出虹膜周边切除术治疗有晶体眼硅油入前房继发青光眼     

有晶状体眼前房硅油的原因分析和处理

目的:探讨有晶状体眼在玻璃体切割术后硅油进入前房的原因及处理方法.方法:对19例视网膜脱离的患者行常规玻璃体切割联合硅油填充手术,对术后发生的硅油进入有晶状体眼前房的原因进行回顾性分析,并根据不同原因及发生程度采取不同处理.结果:有2例(2眼)硅油进入前房发生于二次环扎术中,17例(19眼)发生于术后2～11 d之内(其中1例取出前房硅油3d后硅油再度进入前房并形成瞳孔阻滞继发青光眼,二次取出前房硅油并行虹膜6点位周边切除后再未发生硅油进入前房).所有病例均在硅油进入前房1wk内取出前房硅油,并对其中13例出现继发性青光眼患者行6点位虹膜周边切除;全部病例眼压控制于20mmHg以下,视力均恢复至硅油进入前房之前的矫正视力,取出前房硅油后未出现严重角膜并发症,无1例出现视网膜脱离.结论:有晶状体眼在玻璃体切割术后硅油进入前房原因主要为眼外伤、高度近视、术中医源性损伤等造成悬韧带损伤.对于玻璃体切割术后有晶状体眼前房进入硅油应注意体位及观察角膜、眼压,尽早取出前房硅油,有瞳孔阻滞继发性青光眼的患者必要时行虹膜6点位周边切除.可保护角膜、视网膜及有效的视力.     

The effects of intraocular silicone oil placement prior to iodine 125 brachytherapy for uveal melanoma: a clinical case series

Purpose

To investigate the role of silicone oil as an adjunct to iodine 125 (¹²⁵I) brachytherapy in attenuating radiation dose and reducing radiation retinopathy.

Methods

A 16-mm COMS plaque loaded with ¹²⁵I seeds was simulated in vitro on an eye model containing silicone oil as a vitreous substitute using BrachyDose. The radiation dose ratio of silicone oil vs water to ocular structures was calculated at angles subtended from the centre of the eye. Silicone oil was then used in three choroidal melanoma patients who underwent 23-gauge vitrectomy, silicone oil placement, and ¹²⁵I brachytherapy.

Results

Silicone oil reduced the ocular radiation dose in vitro to 65%. Radiation dose ratios on the retina increased from 0.45 to 0.99 when moving from points diametrically opposed to the plaque''s central axis. In 10–24 months'' follow-up, no patients have developed radiation retinopathy. Each patient required silicone oil removal and experienced cataract progression, and one also developed a retinal detachment.

Conclusions

This study confirms that silicone oil attenuates radiation dose in vitro, and may protect against radiation retinopathy clinically in patients, however it requires extensive surgical interventions. Further studies in only very selected populations using silicone oil as an adjunct to ¹²⁵I brachytherapy will best elucidate its role in shielding radiation retinopathy.     

玻璃体切除联合硅油填充术后高眼压的病因

继发性高眼压是硅油填充术后较常见的并发症,其主要原因有:(1)硅油填充过多;(2)硅油乳化;(3)硅油进入前房;(4)硅油的慢性毒性作用;(5)联合其他手术;(6)眼外伤;(7)患者术前眼基础状况;(8)术后用药及术后体位等.本综述对玻璃体切除联合硅油填充术后继发高眼压的病因、治疗、预后等进行回顾性分析.     

人工晶状体眼硅油入前房继发青光眼的预防与处理

目的探讨人工晶状体眼硅油入前房继发青光眼的预防与处理方法。方法对人工晶状体眼视网膜脱离患者12例，在行玻璃体切割硅油填充术后，有硅油入前房继发青光眼者，行Healon注入前房、硅油排出，常规作6点位虹膜周边切除术。结果12眼眼压恢复正常，人工晶状体位正，硅油及视网膜在位，未见不良并发症。结论采用Healon注入、硅油排出联合6点位虹膜周边切除术是治疗人工晶状体眼硅油入前房继发青光眼的有效方法，应采取积极措施预防该并发症的发生。     

First experiences with high-density silicone oil (Densiron) as an intraocular tamponade in complex retinal detachment

Background In this study, we evaluated the anatomic and functional outcome and intraocular adverse effects after a 3-month endotamponade with Densiron 68, a mixture of F₆H₈ with silicone oil, in complex inferior re-detachments.Methods Forty-eight eyes of 48 patients aged 27–82 years with retinal re-detachment due to proliferative vitreoretinopathy (PVR) grades CP1 to CA7 were included. Mean duration of the Densiron endotamponade was 108.7±66.9 days, with a mean follow-up after removal of 102.8±31.9 days.Results Twenty-two patients (45.8%) showed stable retinal reattachment after Densiron removal. Fourteen patients (29.2%) developed retinal re-detachment after removal, generally within 1 month and in the upper circumference (n=8). In 11 patients (22.9%) recurrent re-detachment (inferior n=8) appeared during Densiron endotamponade. In one eye (2.1%) treatment was primarily unsuccessful. Visual acuity improved from mean logMAR 1.66±1.03 to 1.47±0.97 (not statistically significant, P=0.257). Side effects included temporary inflammatory reaction (n=10), fibrin accumulation (n=6), sterile hypopyon (n=2), vitreous hemorrhage (n=6), elevated IOP (n=5), emulsification (n=4) and chronic hypotony (n=4).Conclusion The anatomical success rate without further interventions of 45.8% (22 of 48 patients) seems unsatisfactory. However, in evaluating the potential of Densiron, it should be considered that all patients in this study had previous surgery with standard procedures, including silicone oil, which had already failed. Intraoperative laser photocoagulation of the periphery of the upper quadrants might reduce the risk of retinal re-detachments.