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.     

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.     

重硅油在复杂性视网膜脱离手术中的应用

微创玻璃体手术的快速发展,为视网膜脱离的患者带来福音.许多以前无法治疗的复杂性视网膜脱离得到解剖复位,术后视力得以提高.良好的玻璃体替代物对玻璃体手术的疗效及技术的改进具有非常重要的意义.目前临床上常用的硅油和长效气体( C3F8)比重都比水小,对下方视网膜脱离顶压不足,而且术后患者要保持俯卧体位.重硅油比重比水大,可以对下方视网膜产生有效顶压.本文就重硅油的理化性质、临床应用、治疗效果及并发症等作一简要综述.     

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。     

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.     

重硅油玻璃体腔充填治疗复杂性视网膜脱离的临床研究

目的 评价重硅油作为眼内填充剂治疗复杂性视网膜脱离的有效性和安全性.方法 采用标准的玻璃体切割联合重硅油Oxane HD充填术治疗复杂性视网膜脱离患者13例13只眼,术中根据病情联合白内障摘除、巩膜环扎、增殖膜剥除、视网膜切开、重水压平视网膜行眼内激光光凝等.观察重硅油充填期及取出后术眼的最佳矫正视力、视网膜解剖复位情况、手术后并发症等.结果 重硅油充填期平均为93d,取出后平均随访170d.13只眼中有12只眼最佳矫正视力提高,1只眼视力无改善.有10只眼在眼内充填重硅油至取出后保持稳定的视网膜复位至随访结束.术后主要并发症包括轻至中度的眼压升高、眼前段炎症反应、晶状体混浊、增殖膜形成和硅油乳化等.结论 重硅油Oxane HD作为眼内填充物可以有效安全地治疗复杂性视网膜脱离,尤其是伴下方或后极部裂孔的视网膜脱离.     

重硅油在外伤性视网膜脱离复位手术中的应用

目的 观察重硅油作为眼内填充物在外伤性视网膜脱离复位手术中的临床效果、并发症及安全性.方法 对15例(16眼)伴有全身外伤的外伤性视网膜脱离进行玻璃体切除术,术后应用重硅油填充,随诊2～5个月取出重硅油,取油后随访3～6个月,观察手术前后视力、眼压、晶状体情况,视网膜复位情况及硅油乳化情况.结果 硅油取出后13例(14眼,87.50％)视网膜平复,11例(12眼,75.00％)矫正视力较术前不同程度提高;1例(1眼,6.25％)因前增生性玻璃体视网膜病变而视网膜未复位,再次手术行标准硅油填充,视网膜复位好,另1例(1眼,6.25％)因合并严重的外伤性脉络膜脱离而视网膜无法复位,行眼内容摘除术.患眼重硅油填充术后主要的眼部并发症为硅油乳化,为术后2周至2月,平均乳化时间为(1.28±0.12)月,未引起明显的眼压升高或角膜内皮细胞损伤.结论 外伤性视网膜脱离行玻璃体切除手术后用重硅油填充效果良好,无明显并发症,明显提高了患者舒适度,但乳化较快.     

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.     

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。     

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。     

硅油取出前视网膜脱离病因分析

目的；报告硅油取出前视网膜脱离发生率，并分析发生此视网膜脱离的有关病因。方法：选择增生性玻璃体视网膜病变（PVR）和增生型糖尿病视网膜病变患者行玻璃体切割联合硅油填充手术。结果：16眼中，有10眼在硅油取出前视网膜复位，6眼视网膜脱离，视网膜脱离发生率为37．5％，视力增进4眼（25％），不变8眼（50％），下降4眼（25％）。术后并发症为晶状体混浊加重（5眼，31％），继发性青光眼（2眼，13％），虹膜新生血管（1眼，6％），低眼压（2眼，13％），PVR加重（2眼，13％）。结论：硅油取出前视网膜脱离发生主要原因为原裂孔未封闭，新裂孔形成，视网膜表面增殖膜形成等。     

玻璃体切除联合重硅油填充治疗下方PVR视网膜脱离

目的探讨玻璃体切除联合重硅油眼内填充治疗下方严重PVR视网膜脱离的效果。方法对26例（26眼）诊断为合并下方PVR视网膜脱离者行玻璃体切除联合眼内重硅油填充,并同时随机抽取26眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内硅油填充作为对照治疗。术后随访7～12月,观察其视网膜复位、视力、眼压及硅油乳化等情况。结果重硅油组视网膜一次性完全复位者24眼,占92．30％,硅油组一次性视网膜完全复位者18眼,占69．23％,（P〈0．05）。视网膜完全复位者绝大部分视力有不同程度提高。所有患者均未见明显炎症反应。结论玻璃体切除联合重硅油眼内填充是治疗下方PVR视网膜脱离的有效方法,可以降低术后视网膜脱离的复发率。     

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.     

Oxane HD vs silicone oil and scleral buckle in retinal detachment with proliferative vitreoretinopathy and inferior retinal breaks

BACKGROUND: To compare pars plana vitrectomy (PPV) with 1300 cs silicone oil and scleral buckle (SB) vs PPV with Oxane HD tamponade for rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRB). METHODS: Twenty eyes of 20 consecutive patients with primary inferior RRD and PVR >/=CP2 were alternatively assigned to PPV and 1300 cs silicone oil and segmental SB in the inferior periphery (group 1, n = 10) or PPV with Oxane HD (group 2, n = 10) in order of presentation. Silicone oil/Oxane HD removal was performed 12 weeks after surgery. Subjects were followed up for 6 months from oil removal. RESULTS: Operative time was lower in Oxane HD group (P = 0.012). In both groups, the retina was primary reattached at the third month after oil removal in nine eyes (90%). At the end of follow-up, retina was reattached in nine eyes (90%) in group 1 (including one eye with oil in situ), and in eight eyes (80%) in group 2 (P > 0.05). CONCLUSIONS: Silicone oil+SB and Oxane HD appear equal for primary RRD with IRB, but a large multi-centre study is required. Oxane HD permitted a reduced operative time.     

Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

AIM:To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD).METHODS:A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three-port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow-up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure(IOP) were recorded and analyzed.RESULTS:Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow-up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.CONCLUSION:Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.     

Predictive factors of epiretinal membrane in complicated rhegmatogenous retinal detachment tamponaded with silicone oil

AIM: To determine the incidence and predictive factors for epiretinal membrane (ERM) formation in eyes with complicated primary rhegmatogenous retinal detachment (RRD) tamponaded with silicone oil (SO).METHODS: This retrospective case-control study included 141 consecutive patients with (51 eyes) and without (90 eyes) ERM formation after primary pars plana vitrectomy (PPV) and SO tamponade for complicated RRD. The risk factors for ERM were assessed using logistic regression analysis.RESULTS: The prevalence of postoperative ERM was 36.2% (51/141). Multivariate logistic regression analysis showed that the risk factors for ERM in SO-tamponaded eyes included preoperative proliferative vitreoretinopathy [PVR; odds ratio (OR), 2.578; 95% confidence interval (CI) 1.580–4.205, P<0.001], preoperative choroidal detachment (OR, 4.454; 95%CI 1.369–14.498, P=0.013), and photocoagulation energy (OR, 2.700; 95%CI 1.047–6.962, P=0.040). The duration of the preoperative symptoms, intraocular SO tamponade time, giant retinal tear, preoperative vitreous hemorrhage, preoperative best-corrected visual acuity, number of breaks, quadrants of RRD, axial length, and photocoagulation points were not predictive factors for ERM formation.CONCLUSION: Preoperative PVR, choroidal detachment, and photocoagulation energy are risk factors of ERM formation after complicated RRD repair. Better ophthalmic care as well as patient education are necessary for such patients with risk factors.     

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.     

Regular silicone and fluorosilicone oil in the prevention of retinal detachment caused by experimental proliferative vitreoretinopathy

The effect of both regular silicone and fluorosilicone in preventing retinal detachment caused by experimental proliferative vitreoretinopathy was studied in rabbit eyes which received 250,000 fibroblasts after vitrectomy and lensectomy. In the control group, 14 out of 20 eyes which received fibroblasts had retinal detachments with disorganization of internal structures. In eyes receiving fibroblast and regular silicone, 4 out of 20 eyes had shallow retinal detachment. In the eyes receiving fibroblasts and fluorosilicone, 5 of 28 eyes had shallow retinal detachment. Our findings indicate that both regular silicone and fluorosilicone were effective in preventing retinal detachments caused by experimental proliferative vitreoretinopathy. There was no statistical difference between the two silicone oils.Supported in part by Public Health Service Grant EYO 2377, from the National Eye Institute, National Institutes of Health, Bethesda, MD.     

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。     

玻璃体切割注硅油术治疗复杂性视网膜脱离的远期疗效和并发症

目的探讨玻璃体切割注硅油术治疗复杂性视网膜脱离的远期疗效和并发症,并对如何改进硅油应用方法进行讨论。方法回顾性分析了５０例硅油注入病例。结果手术后视网膜复位率为９４％,随访１２～４１个月,复位率降为７０％,并发症总发生率９０％,其中白内障发生率为７８％（有晶体眼白内障为９７．５％）,硅油进入前房、继发性青光眼、角膜病变各为２４％,１０例行硅油取出,其中５例视网膜再脱离,另有２例先发生前房出血后视网膜脱离。结论硅油长期在眼内导致严重并发症,硅油取出后又有视网膜再脱离及其它新并发症的危险,临床上应用硅油要严格掌握适应症和方法。