Anatomical and functional results of endotamponade with heavy silicone oil - Densiron 68 - in complicated retinal detachment

BACKGROUND: High-density silicone oils are newly developed long-term tamponade agents for the treatment of complicated retinal detachment in the inferior retina. Previous studies describe satisfying anatomical and functional results. In this study we examined the largest cohort so far for a 9-month follow-up and performed a comparison to conventional silicone oil. METHODS: Our study documents results and adverse effects after vitreoretinal surgery and endotamponade with Densiron 68 in 99 cases of complicated retinal detachment. A 9-month follow-up was performed. Data of 21 patients with intraocular conventional silicone oil tamponade in complicated retinal detachment were retrospectively analyzed and served as control. RESULTS: Anatomical success was achieved in 78 of 89 eyes (87.6%) with completed follow-up; visual acuity did not change significantly (from mean preoperative logMAR 1.88 to postoperative logMAR 1.96 (p = 0.9). Compared to control a higher anatomical success but a similar number of adverse effects were observed with heavy silicone oil in vitreous. Nevertheless, patients who received Densiron 68 twice due to redetachment showed a significantly higher rate of intraocular inflammation with the tamponade agent in situ. CONCLUSION: Our results support the hypothesis of Densiron 68 as potent tamponade agent for complicated retinal detachment in the inferior retinal segments especially in eyes where a previous operation failed.     

Silicone oil-RMN3 mixture ("heavy silicone oil") as internal tamponade for complicated retinal detachment

PURPOSE: To evaluate the efficacy and safety of a silicone oil-RMN3 mixture ("heavy silicone oil") as heavier as water internal retinal tamponade after vitrectomy for complicated retinal detachment. The relative density of the heavier-than-water silicone oil was 1.03 g/cm3, and the viscosity was 3,800 cSt. Heavy silicone oil is designed to tamponade the inferior retina in complicated retinal detachment. METHODS: Patients with a complicated retinal detachment involving the inferior part of the retina requiring internal tamponade with silicone oil were recruited for this prospective study. Inclusion criteria were retinal detachment secondary to proliferative vitreoretinopathy (stage > or = C2), inferior or posterior tears, or penetrating trauma. The heavy silicone oil was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled at 1, 3, 6 months, and 1 year after the initial surgery. RESULTS: A total of 33 eyes of 33 patients aged from 20 to 84 years (mean, 56 +/- 18 years) were treated with heavy silicone oil. Follow-up ranged from 12 to 16 months. Rhegmatogenous retinal detachment with significant proliferative vitreoretinopathy accounted for 17 cases, inferior holes for three, and trauma with retinal detachment for three. Initial visual acuity ranged from 20/50 to hand motions. Initial retinal reattachment was achieved in all cases. Complications included increased intraocular pressure in six eyes (18%), intraocular inflammation and synechia formation in one eye (3%), a central retinal artery occlusion after heavy oil removal in one eye, and scattered retinal hemorrhages during follow-up in two eyes (6%). Significant emulsification was not observed during intraocular tamponade with heavy silicone oil. At the last follow-up, all eyes had macular attachment, and 24 eyes had a visual acuity better than or equal to 20/400. CONCLUSIONS: The results of this prospective study show the good intraocular tolerance of heavy silicone oil as tamponade in complicated retinal detachment. Its specific gravity allows for sufficient tamponade of inferior retinal tears for at least 3 months without significant side effects.     

重硅油Densiron 68眼内填充治疗外伤性视网膜脱离的疗效与并发症

【摘要】 目的 比较重硅油Densiron 68与普通硅油眼内填充治疗外伤性视网膜脱离的效果及并发症。设计 回顾性比较性病例系列。研究对象 北京同仁医院住院的外伤性视网膜脱离患者40例（40眼）。方法 患者均行标准睫状体平坦部玻璃体切除联合视网膜复位术。视网膜脱离及裂孔主要位于视网膜下方或后极部的20例患者应用Densiron 68填充,其他20例用普通硅油填充。术后随访12～68周。主要指标 视力、眼压、视网膜复位及并发症情况。结果 重硅油组和普通硅油组视网膜复位率分别为50%、55%（P=0.752）。上方视网膜脱离者未复位率,重硅油组60%（6/10）,普通硅油组11%（1/9）（P=0.057）;下方视网膜脱离未复位率,重硅油组10%（1/10）,普通硅油组67%（6/9）（P=0.020）。重硅油组logMAR视力术前（2.63±1.00）,术后（2.19±0.86）（P=0.037）;普通硅油组logMAR视力术前（2.27±1.06）,术后（1.74±1.04）（P=0.112）。重硅油组平均眼压术前（10.60±5.53） mmHg,术后（13.63±4.66）mmHg（P=0.040）;普通硅油组术前（12.76±7.81） mmHg,术后（13.69±6.18）mmHg（P=0.652）。普通硅油组术后高眼压发生率30%,重硅油组0%（P=0.020）。重硅油组均发生了不同程度的硅油乳化,普通硅油组75%发生乳化（P=0.047）。结论 重硅油眼Densiron68眼内填充对裂孔及脱离主要位于下方的外伤性视网膜脱离效果较好;但其术后乳化率高于普通硅油,不适于长期眼内填充。（眼科,2012,21：252-256）     

Efficacy and safety of heavy silicone oil Densiron 68® in the treatment of complicated retinal detachment with large inferior retinectomy

PURPOSE: To assess the efficacy and safety of a heavy silicone oil (Densiron 68(R)), a mixture of perfluorohexyloctane (F(6)H(8)) with silicone oil as temporary internal tamponade in selected retinal detachments treated with large inferior retinectomy. METHODS: Complicated retinal detachments with severe posterior and anterior proliferative vitreoretinopathy (PVR) were included in this study. In all cases, a large inferior retinectomy involving the inferior quadrants was performed. Densiron 68(R) was injected at the end of surgery after perfluorocarbon injection. A minimum follow-up of 6 months was required in order to be included in this retrospective study. RESULTS: Twenty-seven patients were operated on with a mean follow-up of 57.5 weeks. Twenty-three patients presented a posterior PVR > CP6 and 26 patients an anterior PVR > CA5. Heavy silicone oil was removed in 19 patients after a mean follow-up of 14 weeks. At the 4-week follow-up visit, only one retinectomy was reopened by a recurrent inferior retinal detachment with PVR CP3. Finally, anatomical success was achieved in 25 of the 27 patients (92.5%) after Densiron 68(R) removal at the last follow-up. The main adverse effect was inflammatory reaction with fibrin accumulation in the anterior chamber (40.7%). CONCLUSION: Densiron 68(R) appeared to be an efficient endotamponade agent in selected retinal detachments treated with large inferior retinectomy. It avoids fluid accumulation under the inferior retina and seems to limit the rate of inferior retinectomy reopening.     

Densiron intraocular tamponade: a case series

Purpose: To report on the use of Densiron (heavy silicone oil), a new endotamponade agent with proposed benefits in complex retinal detachments involving inferior proliferative vitreoretinopathy. Method: Retrospective case note review. Results: Ten cases (10 eyes) in which Densiron was used in eyes which had failed initial retinal detachment surgery. The overall success rate of long‐term total reattachment was 70%. Mean preoperative visual acuity was logMAR 2.03 (SD 0.406), which improved to a mean postoperative visual acuity of logMAR 1.00 (SD 0.571) (P = 0.001). Conclusion: Densiron was well tolerated with few side‐effects and appears to be a useful agent in patients with inferior proliferative vitreoretinopathy.     

重硅油应用眼内短期填充15例临床分析

目的 探讨重硅油(Densiron-68)用于眼内填充治疗复杂性视网膜脱离的临床效果、并发症及安全性.方法 采用玻璃体切割联合重硅油眼内填充治疗视网膜脱离患者15只眼,分别为糖尿病视网膜病变、急性视网膜坏死、黄斑裂孔性视网膜脱离、巨大裂孔性视网膜脱离、伴有严重PVR的复发性孔源视网膜脱离,填充时间最少为40d,最长为12个月.观察重硅油填充期间及取出后视网膜复位情况及并发症等.结果 12只眼取出重硅油后在随访期间(2～4月)观察到视网膜保持复位,复位率80%(12/15);3只眼视网膜脱离复发,其中2只眼再次手术并普通硅油填充,1只眼拒绝取出重硅油,14只眼矫正视力较术前提高,1只眼视力无改善.主要并发症有白内障、后发白内障、硅油乳化、瞳孔粘连、乳化滴粘附于人工晶状体、术后PVR、硅油充满前房、硅油进入视网膜下等.结论 重硅油眼内填充治疗复杂性视网膜脱离疗效肯定,并提高患者舒适度,但并发症发生率高,只适宜短期填充,且需要密切随访.     

玻璃体切除联合重硅油治疗下方视网膜脱离的临床研究

目的观察2种不同密度的硅油Densiron68与Oxane5700治疗下方视网膜脱离的临床效果。方法非随机前瞻性临床研究。玻璃体切除术联合硅油填充治疗视网膜脱离45例（46眼）。分析其临床疗效。结果随访至硅油取出术后6个月。Densiron68组和Oxane5700组在首次手术后视网膜复位率分别为78．3％和73．9％（P〉0．05）;进一步治疗后分别为91．3％和87．0％（P〉0．05）;随访结束时分别为91．3％和82．6％（P〉0．05）。但在曾行玻璃体手术或巩膜扣带术者的首次手术后复位率分别为71．4％和33,3％。术后炎症反应、硅油乳化、并发性或后发性白内障的发生率Densiron68组高于Oxane5700组（P〈0．05）。结论Densiron68和Oxane5700治疗复杂视网膜脱离的疗效无明显差异。术后炎症反应、硅油乳化、并发性或后发性白内障的发生率Densiron68组高于Oxane5700组。对曾使用普通硅油失败或无法坚持俯卧位者,Densiron68是一种较好的选择。     

松弛性视网膜切开术治疗视网膜脱离合并严重前增殖性玻璃体视网 …

目的 探讨松弛性周边视网膜切开术联合眼内激光治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变的效果。方法 对４４例视网膜脱离合并严重前增殖性玻璃体视网膜病变的患者行松弛性周边视网膜切开术,联合眼内激光和硅油填充治疗。观察术后视网膜解剖复位,视功能及术后眼压变化情况。其中２２例取出了硅油。结果 ４４例全部获得视网膜复位（其中８例合并皱褶）,３８例获得不同程度的视力改善。２２例取出硅油后,有２１例视网膜     

Schweres Silikonöl bei PVR

Purpose

To evaluate the safety and efficacy of Densiron-68 heavy silicone oil in the clinical management of complex retinal detachments with proliferative vitreoretinopathy (PVR).

Methods

We present a prospective, interventional noncomparative case series of 80 eyes of 79 consecutive patients. The primary end point was anatomical reattachment of the retina, defined as retinal reattachment in the absence of any tamponade agent. The secondary end point was to record the visual function and surgical complications. Inclusion criteria were PVR stages B–CA4, including posterior or inferior retinal breaks and the patient’s inability to posture.

Results

Patients were 59.1 (±18.1) years old, male:female =48:32, R:L=40:40. Fifty-six patients (70%) had previous unsuccessful retinal surgery, and 24 (30%) received heavy silicone oil at their first procedure. The extent of the detachments was 2.46 quadrants (±0.83) with macular involvement in 49 cases (61%). Fifty-six (67.5%) patients achieved retinal reattachment with one retinal operation and no tamponade, 64 (80%) achieved retinal reattachment with more than one operation and no tamponade, and 72 (90%) achieved a flat retina with tamponade in situ. Visual acuity rose from 1.48 LogMar (±0.91) to 1.12 (±0.82; p=0.009). Densiron was removed after 126 days (±55.1).

Conclusion

The treatment of PVR remains challenging. No tamponade agent can provide simultaneous support for the superior as well as the inferior retina; therefore, a tamponade agent that “sinks” is a welcome new tool for the surgeon. We regard the use of heavy as well as conventional silicone oil as complementary to each other.     

松弛性视网膜切开术治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变

目的探讨松弛性周边视网膜切开术联合眼内激光治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变的效果。方法对４４例视网膜脱离合并严重前增殖性玻璃体视网膜病变的患者行松弛性周边视网膜切开术，联合眼内激光和硅油填充治疗。观察术后视网膜解剖复位、视功能及术后眼压变化情况。其中２２例取出了硅油。结果４４例全部获得视网膜复位（其中８例合并皱褶），３８例获得不同程度的视力改善。２２例取出硅油后，有２１例视网膜保持复位。部分患者术后眼压偏低。１例患者黄斑移位。结论松弛性周边视网膜切开术是治疗严重前增殖性玻璃体视网膜病变的有效方法之一。视网膜下膜的清除有利于视网膜展平复位。部分患者出现术后眼压偏低和黄斑移位现象，因此应严格掌握手术适应证，术中尽可能避免黄斑移位，同时应在视网膜复位、眼压正常时再取出硅油。     

重硅油填充治疗下方裂孔源性视网膜脱离的临床研究

目的评价用重硅油填充治疗下方裂孔源性视网膜脱离伴严重增生性玻璃体视网膜病变（PVR）的手术效果及并发症。方法对下方视网膜裂孔和严重PVR的复杂性视网膜脱离12例（12只眼）行玻璃体切割联合玻璃体腔重硅油填充术。术后对视力、角膜、眼底及眼压等情况进行随访。结果术后随访2.5～27个月,平均7.7个月,83.3%的病例视网膜裂孔封闭、视网膜完全复位;术后视力6只眼（50%）提高,4只眼（33.3%）不变;2只眼（16.7%）下降;4只眼（33.3%）术后眼压异常,其中2只眼（16.7%）为一过性低眼压,2只眼（16.7%）为一过性高眼压;2只眼（16.7%）并发性白内障;2只眼（16.7%）重硅油乳化;1只眼（8.3%）重硅油进入前房;1只眼（8.3%）严重的前房炎症反应。结论对下方裂孔源性视网膜脱离伴严重PVR,行玻璃体切割联合玻璃体腔重硅油填充术,可获得满意的视网膜复位率,而且并发症的发生率低。     

重硅油眼内填充治疗外伤性视网膜脱离的临床观察

目的 观察重硅油(Densiron 68)眼内填充治疗复杂性外伤性视网膜脱离的临床效果及并发症.设计 回顾性病例系列.研究对象 外伤所致复杂性视网膜脱离患者20例(20眼),其视网膜脱离及裂孔位于下方为主.方法对患者均行标准玻璃体切除手术,应用重硅油填充;对未复位患者,将重硅油取出后采用普通硅油或者惰性气体再次填充.主要指标 视网膜复位率,患眼视力、眼压,眼前节,硅油乳化率.结果 一次填充重硅油后视网膜复位率50%(10/20);未复位的患者二次填充传统硅油或者惰性气体后视网膜复位率15%(3/20),未复位35%(7/20).平均随访(3.90±1.41)个月,随访结束时50%患者的眼内填充物已经取出.术后较术前视力(logMAR)显著提高(2.19±0.86,2.63±1.00,P=0.037).术后未发现难以控制的高眼压和感染;未发现与重硅油相关的角膜内皮损伤;保留晶状体患者的白内障均发展;硅油乳化率100%,平均乳化时间(2.18±0.87)个月.结论 应用重硅油眼内填充治疗外伤性视网膜脱离疗效较好,并发症较少.但重硅油乳化时间较短,适应证受限.     

重硅油在严重眼外伤玻璃体手术中的应用

目的探讨重硅油作为眼内填充物治疗严重眼外伤的临床应用。方法对严重眼外伤12例（12眼）进行了玻璃体切除联合重硅油填允。一类是因为眼内异物伤异物位于（损伤）下方视网膜或后极部者共8例。另一类是眼外伤引起下方视网膜脱离增生者共4例。均经闭合式玻璃体切除手术,术中根据病情需要进行异物摘出、剥膜、重水、激光、气-液交换等,最后,行重硅油填充。结果均于术后3个月行硅油取出。所有患眼视网膜全部平复,裂孔封闭、瘢痕稳定。结论重硅油对治疗下方复杂性异物伤和外伤性视网膜脱离有明显疗效。     

Silicone oil implantation in penetrating injuries complicated by PVR. Results from 1982 to 1986

Between 1982 and 1986, the authors implanted silicone oil in 34 eyes with retinal detachment and proliferative vitreoretinopathy (PVR) stages C-3 to D-3 caused by penetrating injuries. The retina had failed to reattach after initial vitrectomy, membrane peeling, and scleral buckling. Complete anatomic reattachment was achieved in 62%, partial reattachment in an additional 9%. Useful functional results were achieved in 68% of cases (visual acuity of 1/60 to 20/20). Postoperative complications included elevated intraocular pressure in 38% and progress of PVR with membrane formation under the silicone oil in 21% of the cases. Sixty-eight percent of the aphakic eyes developed band-shaped keratopathy. Because most of the eyes were aphakic, the authors do not report cataract incidence. In 15 eyes (44%) the silicone oil was removed. In 14 of these eyes the retina remains attached, in one eye silicone oil removal was followed by phthisis bulbi.     

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.     

玻璃体切除和硅油填充手术后视网膜再脱离及其治疗

目的：探讨玻璃体切除和硅油填充手术手视网膜再脱离的治疗。 方法：回顾总结增殖性玻璃体视网膜病变（proliferative vitreorinapthy PVR）5例5只眼和外伤性PVR3例3只眼的视网膜脱离手术后再脱离的治疗效果。治疗方法为经睫状体平坦部闭合式玻璃体切除、膜剥离、视网膜切开、内排溶剂化物、硅油填充，2只眼加视网膜下膜剥离取出。 结果：术后视网膜解剖复位6只眼，2只眼下方仍有浅脱离，术后视力提高6只眼，不变2只眼。 结论：视网膜再脱离的原因与增殖性视网膜前膜和下膜形成有关，治疗原则为玻璃体切除、解除增殖膜的牵引和充分地液/油交换. （中华眼底病杂志，1996，12：13-15）     

巩膜外环扎术治疗硅油填充眼早期视网膜脱离疗效观察

目的:观察巩膜外环扎术治疗硅油填充眼早期视网膜脱离的临床效果。方法:本研究为回顾性病例研究,对26例26眼行硅油填充术后早期(<15d)出现视网膜脱离的患者行巩膜外环扎及局部加压术。术后随访6～18mo,观察患者视网膜复位、视力及眼压情况。结果:患者26例26眼均存在下方视网膜脱离;22例22眼术后视网膜解剖复位,4例4眼再次行硅油注入术;术后视力提高者22例22眼,视力不变者3例3眼,视力下降者1例1眼;环扎术后早期存在眼压升高现象,观察至3mo眼压恢复正常。结论:巩膜外环扎术是治疗硅油填充眼早期视网膜脱离的有效手段。     

The combined use of perfluorohexyloctane (F6H8) and silicone oil as an intraocular tamponade in the treatment of severe retinal detachment

Background The purpose of this study was to investigate the combined use of perfluorohexyloctane (F6H8) and 1,000-centistoke silicone oil as a long-term intraocular tamponade in the treatment of complicated retinal detachment.Methods Sixty consecutive eyes affected by complicated retinal detachment with (1) retinal breaks of the lower two quadrants and severe proliferative vitreoretinopathy, (2) inferior giant retinal tear, (3) penetrating trauma or (4) choroidal detachment underwent pars plana vitrectomy using a combined internal tamponade of F6H8 and silicone oil. The double filling (DF) was removed after 40–50 days. The anatomical outcome and the complications due to the DF are reported.Results Retinal reattachment was achieved in all but one patient. Thirty-eight (63%) eyes needed further surgery with silicone oil tamponade. Silicone oil was successfully removed in 22 eyes. Sixteen (27%) eyes had retained silicone oil at the last follow-up examination. One eye showed persistent retinal detachment despite further surgery. Main complications of the DF were recurrent retinal detachment of the upper retina in six (10%) eyes and membrane formation in 25 (42%) eyes.Conclusions A combined internal tamponade of F6H8 and silicone oil may be a useful tool in the treatment of complicated retinal detachment involving the lower quadrants of the retina.     

硅油长期眼内填充的并发症及预后分析

目的:观察长期硅油填充眼的眼部改变,分析其长期填充的原因及预后。方法:回顾性分析我院硅油填充时间≥12mo的临床病例资料共44例,男31例,女13例,年龄27月龄～72岁。包括:外伤性视网膜脱离11例;眼球破裂伤11例;眼球穿通伤3例;球内异物5例;复发性视网膜脱离9例;增生性糖尿病视网膜病变5例。对硅油填充时间、视力、视网膜在位情况及眼部并发症等情况进行分析总结。结果:硅油填充时间为12mo～13a,平均34mo。视力提高者23例(52%),下降者8例,无改善者13例。37例(84%)视网膜完全复位,6例部分复位,1例未复位。并发症包括:并发性白内障10例;高眼压4例;低眼压2例;硅油乳化7例;带状角膜变性9例;角膜内皮失代偿3例;眼球萎缩3例;视神经萎缩2例;虹膜囊肿及结膜下囊肿各1例;无明显并发症者10例,占23%。结论:硅油长期眼内填充对于部分特殊病例具有一定的可行性及合理性,突出强调了术后定期随访复查的重要性。     

Comparison of Densiron 68 and 1 000 cSt silicone oil in the management of rhegmatogenous retinal detachment with inferior breaks

AIM:To compare success rates and complications of Densiron 68 and 1000cSt silicone oil (SO) in the management of rhegmatogenous retinal detachment (RRD) with inferior breaks (IBs).METHODS:Totally 61 eyes of 61 consecutive patients with RRD with IBs were assigned to pars plana vitrectomy (PPV) with Densiron (n=31) or PPV with SO (n=30) in order of presentation. SO and Densiron removal was performed 3 months after initial surgery. Follow up visits were terminated 6 months after SO removal.RESULTS:With a single operation, the Densiron group showed 84% and SO 74% reattachment. With further surgery, both groups showed 90% re-attachment. Complications such as cataract, raised intraocular pressure (IOP), inflammatory reaction, macular epiretinal membranes, and emulsification of SO were seen in both groups.CONCLUSION:Densiron and SO are found to have similar success rates and complications.