Complicated Retinal Detachment Research Articles

Post-operative face-up or face-down positioning after silicone oil tamponade in retinal surgery: Results of a retrospective study.

To compare the complications related to silicone oil, and anatomical and functional outcomes in patients nursed in different postoperative positionings after pars plana vitrectomy with silicone oil injection in retinal surgery. The retrospective cohort study was conducted at the Department of Ophthalmology, King AbdulAziz Medical City, Riyadh, Saudi Arabia, and comprised data of patients who underwent pars plana vitrectomy with silicone oil tamponade from January 2016 to October 2022. The patients were divided into two groups depending on how they were nursed in the postoperative period. Group A patients were nursed in postoperative face-down positioning and group B patients were nursed in the face-up position. Complications related to silicone oil tamponade, visual outcomes and anatomical results were compared between the groups. Data was analyzed using SPSS 26. Of the 157, 97(62%) were males and 60(38%) were females. The overall mean age was 5320 years. Group A had 87(55.4%) patients, while group B had 70(44.6%). There were 185 eyes involved; 104(56.2%) in group A and 81(43.8%) in group B. Overall, mean postoperative follow-up duration was 2519 months. Migration of silicone oil in the anterior chamber was more common in group A (p=0.470). Pupil block glaucoma was seen in 2(1.9%) eyes in group A only.Silicone oil-related complications, functional outcomes and anatomical outcomes were non-significantly different between the grpups (p>0.05) except a weak significant difference with respect to redetachments after removal of silicone oil (p=0.047). There was no difference seen in terms of complications as well as anatomical and physiological outcomes related to silicone oil tamponade in face-down or face-up postoperative positioning after pars plana vitrectomy with silicone oil tamponade for complicated retinal detachment surgery.

Comparison between Goldmann Applanation Tonometry and Air Puff Tonometry for Measurement of Intraocular Pressure in Siliconized Eyes

Abstract Background Silicone oil (SO) has been a part of vitreoretinal surgery since the 1960s. The use of silicone oil in conjunction with advanced vitreous surgical techniques can successfully treat complicated retinal detachment (RD). Aim of the Work to compare the intraocular pressure (IOP) measurements following Pars Plana Vitrectomy (PPV) with injection of Silicone Oil (SO) by Goldmann applanation tonometry (GAT) and noncontact Air Puff Tonometer (APT). Patients and Methods This study included a total of 165 eyes of 165 patients. Of these 165 patients, 110 have undergone PPV and silicone oil injection, while the remaining 55 participants served as the control group. Results The participants in our study were divided into a control group, and a siliconized group which was subdivided into SO 1000 cSt (Group A) and SO 5000 cSt (Group B). The control group had an average age of 50.65±12.26 years, Group A had an average age of 53.53±12.04 years, and Group B had an average age of 55.45±12.02 years. The control group in our study consisted of 28 males (50.9%) and 27 females (49.1%), while Group A had 37 males (67.3%) and 18 females (32.7%), and Group B had 38 males (69.1%) and 17 females (30.9%). Central corneal thickness (CCT) was measured for all participants. The average CCT was 536.53±28.66µm for the control group, 531.67±29.19µm for Group A, and 527.13±28.79µm for Group B. There was no statistically significant difference in the CCT measurements between the study groups (P = 0.410). The average IOP values were obtained using both the airpuff tonometer (APT) and Goldmann applanation tonometry (GAT) methods. In the control group, the average IOP was 16.56±2.98 mmHg using APT and 15.27±2.73 mmHg using GAT. For Group A, the average IOP was 17.09±7.0 mmHg with APT and 15.61±6.43 mmHg with GAT. In Group B, the average IOP was 16.71±4.93 mmHg using APT and 15.13±4.63 mmHg using GAT. The P-value was >0.05 in all groups, indicating that the differences were not statistically significant. Conclusion the results showed a correspondence between the Goldmann applanation tonometer (GAT) and the airpuff tonometer (APT) in siliconized eyes. The differences in intraocular pressure (IOP) measurements between the two instruments were minimal and not statistically significant, with APT measurements being slightly higher than GAT measurements. The study also concluded that there is a greater chance of increased IOP following pars plana vitrectomy (PPV) and silicone oil (SO) injection with SO 1000 cSt compared to 5000 cSt, but this difference was not statistically significant. Furthermore, this IOP difference between the two methods was not correlated with age, gender, CCT, or lens status of the patients. Thus, there is good agreement between the two methods.

Двухэтапное хирургическое лечение регматогенной отслойки сетчатки, осложненной выраженной пролиферативной витреоретинопатией, с применением первичной круговой ретинотомии и отсроченной эндолазеркоагуляцией сетчатки в уменьшенном объеме

Abstrakt Primary retinotomy in the surgical treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy D.O. Shkvorchenko, B.E. Malyugin, A.Yu. Kornienko, E.S. Khrisanfova, O.B. Klepinina S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To develop a method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy (stage C) using primary circumferential retinotomy, short-term perfluorocarbon liquid (PFCL) endotamponade and deferred laser endophotocoagulation in a reduced volume. To evaluate the effectiveness of the developed method in the treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy. Material and methods. 12 patients (12 eyes) with the diagnosis of rhegmatogenous retinal detachment with severe proliferative retinopathy were operated using developed method of two-stage surgical treatment with a reduced volume of laser endophotocoagulation. All 12 patients had a concomitant diagnosis of complicated cataract. Results. A new method of two-stage surgical treatment with reduced volume of laser endophotocoagulation was developed in the S. Fyodorov Eye Microsurgery Federal State Institution. After the follow-up period of 12 months retina was attached in all 12 cases, best corrected visual acuity (BCVA) was 0.38±0.08; 5 eyes had silicone oil endotamponade, in 7 cases silicone oil was removed. Conclusion. Primary 360-degree retinotomy is an effective method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy. The most preferable in these cases is to carry out surgical treatment in several stages with short-term PFCL tamponade, which allows to achieve maximum adaptation of the retina. Laser retinopexy in the PFCL environment during the second stage of surgery allows it to be carried out fully and at the same time in a minimal volume. Key words: retinal detachment, proliferative vitreoretinopathy, primary retinotomy, circumferential retinotomy, perfluorocarbon liquid, laser endophotocoagulation

Practice of postoperative face-down positioning and its duration after silicone oil tamponade in vitreoretinal surgery: Results of a survey

Abstract PURPOSE: This survey was conducted among practicing vitreoretinal (VR) surgeons to determine their practice of postoperative face-down positioning (FDP) of patients and its duration after silicone oil (SO) tamponade. METHODS: A web-based SurveyMonkey platform (San Mateo, CA, USA) was used for this cross-sectional study. Up to 80 practicing VR surgeons in the Kingdom of Saudi Arabia (KSA) and Pakistan were contacted via SurveyMonkey link using WhatsApp and emails. RESULTS: Of the 80 practicing VR surgeons, 71 responded to the survey. All VR surgeons in both countries use SO in their surgical practice. While operating on complicated retinal detachments (RDs) that include cases with advanced proliferative vitreoretinopathy, 75% of VR surgeons choose SO tamponade, while 9% of VR surgeons prefer gas tamponade. Up to 63% of VR surgeons advise FDP to their patients whenever they use SO as tamponade. When operating on complicated RDs with SO tamponade, 79% of VR surgeons advise postoperative FDP. Roughly half of the VR surgeons advise FDP for 6 to 10 days. The duration of postoperative FDP varies from 1 day to 21 days. CONCLUSION: All VR surgeons use SO in their practice in KSA and Pakistan. While the vast majority of VR surgeons in both countries use SO as tamponade for complicated RDs, the practice of postoperative FDP and its duration appears to be quite variable. This highlights a lack of uniformity in postoperative care of these patients.

Silicone Oil Associated Complications in Vitreoretinal Surgery

Silicone oil is an effective tamponade that is still preferred in complicated retinal detachment cases such as giant retinal tears, proliferative vitreoretinopathy (PVR), diabetic tractional detachment, and traumatic detachment. After a variable period of tamponade, it is standard practice to remove the silicone oil. Because silicone oil stays in the eye for a long time causes many complications and problems in the intraocular structures. In this review, complications associated with silicone oil in vitreoretinal surgery are discussed.

Морфофункциональные особенности пигментного эпителия сетчатки в норме и при возрастной макулярной дегенерации

Relevance. The retinal pigment epithelium performs a number of highly specialized functions. The relevance of studying morphological changes in the pigment epithelium is associated with an increased number of patients with age-related macular degeneration (AMD), polypoid choroidal vasculopathy, central serous retinopathy and retinitis pigmentosa. The increase in the number of patients with these pathologies is associated both with the general trend of aging of the world's population and with modern opportunities for mass diagnostics. Pathomorphological changes in the pigment layer are an important indicator of the development of AMD. Purpose. To analyze features of retinal pigment epithelium in normal and pathological conditions. Material and methods. The literature review was carried out using PubMed and Sochape Library. Results. Several authors present data about the complication of retinal detachment with development of the retinal pigment epithelium tear. The key criterion for tear treatment is the height of the pigment layer detachment. Violation of the integrity of the pigment layer in the long term is a factor in decrease or complete loss of vision. This is especially characteristic when a tear is formed in the central area of the retina. Also, visual impairment is observed in cases of submacular hemorrhage and fibrous scar formation. Conclusion. An important point, at present, is guidelines development for patients with pigment epithelium tears, it will allow to manage this condition on the background of concomitant disease. Key words: retinal pigment epithelium, age-related macular degeneration, pigment epithelium tear

Acute and Chronic Manifestations of Sympathetic Ophthalmia on Multimodal Imaging

ABSTRACT Purpose To report the clinical and multimodal imaging features of sympathetic ophthalmia in the acute and chronic phases. Methods Retrospective cohort study of consecutive patients with sympathetic ophthalmia seen at a tertiary referral center. Charts, imaging studies, and histopathological specimens were reviewed. The clinical features and multimodal imaging in the sympathizing eye were analyzed by sorting features into those seen in the acute and chronic phase. Results Ten patients were included in the analysis and all of them had previous ocular trauma or complicated retinal detachment. In the acute phase, 70% had anterior uveitis, 70% had vitritis, and 100% had active posterior uveitis; posterior uveitis included multifocal choroiditis (80%), optic disc swelling (40%), multiple serous retinal detachments (20%), MEWDS-like findings (10%), and retinal vasculitis with chorioretinitis (10%). In the chronic phase, posterior manifestations included widespread patches of chorioretinal atrophy in the mid- and far-periphery (80%), peripapillary subretinal fibrosis (50%), and nummular perivascular atrophy (50%). Conclusions Sympathetic ophthalmia shows different posterior segment manifestations in the acute and chronic phase. Active sympathetic ophthalmia should be ruled out in eyes with a MEWDS-like presentation or rapidly progressing chorioretinitis, and history of trauma in the fellow eye. Peripapillary subretinal fibrosis and perivascular nummular atrophy may be useful features to suspect SO once acute inflammation has resolved.

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

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). 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. 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. 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.

Effect of the Presence of Silicone Oil in the Anterior Chamber After Complicated Retinal Detachment Surgery on Corneal Morphology by In Vivo Confocal Microscopy

Purpose This study evaluated the corneal endothelium, stromal keratocytes, subbasal nerve number and density in patients with silicone oil transferred to the anterior camera after pseudophakic complicated retinal detachment surgery by in vivo laser scanning confocal microscopy (IVLSCM). Methods Sequential measurements were made by IVLSCM between 3–6 months after surgery in two groups of patients: a) with silicon oil migration (Group 1) and without silicone oil migration (Group 2). Results A total of 63 cases (Group 1: 32 and Group 2: 31) were examined. The mean ages of patients were 65 ± 12 and 61 ± 11 and M/F ratio was 18/14 and 17/14, respectively. Mean intraocular pressures were 16.60 ± 4.60 and 15.75 ± 5.70 mm Hg, respectively. Changes were detected by IVLSCM mostly on the superior part of the cornea. A significant decrease in endothelial cell density and the number was detected in group 1 (2072 ± 116.2 cells/mm2 vs 2752 ± 512.3 cells/mm2; p < 0.001). Significant increases in posterior keratocyte density and stromal hyperreflective deposits were observed in group 1 (887 ± 45.8 cells/mm2 vs 725 ± 65.8 cells/mm2; p < 0.001). A significant negative correlation was observed between the size of stromal deposits and endothelial cell density (r=–0.758; p < 0.001). The number and density of corneal subbasal nerves were significantly lower in group 1 (1.8 ± 0.8 and 4.8 ± 1.2 vs 420 ± 101 and 701 ± 112 µm/square; p < 0.001). Conclusion IVLSCM is a useful tool for the early detection of corneal abnormalities caused by silicone oil injection. This study verified silicone oil’s detrimental effect on the corneal endothelium and revealed stromal changes in the anterior chamber, which we believe can be also been associated with the presence of silicone oil.

Epiretinal Amniotic Membrane in Complicated Retinal Detachment: a Clinical and In Vitro Safety Assessment.

Amniotic membrane (AM) is a popular treatment for external ocular diseases. First intraocular implantations in other diseases reported promising results. Here, we review three cases of intravitreal epiretinal human AM (iehAM) transplantation as an adjunct treatment for complicated retinal detachment and analyze clinical safety. Possible cellular rejection reactions against the explanted iehAM were evaluated and its influence was assessed on three retinal cell lines in vitro. Three patients with complicated retinal detachment and implanted iehAM during pars plana vitrectomy are retrospectively presented. After removal of the iehAM at subsequent surgery, tissue-specific cellular responses were studied by light microscopy and immunohistochemical staining. We investigated the influence of AM in vitro on retinal pigment epithelial cells (ARPE-19), Müller cells (Mio-M1), and differentiated retinal neuroblasts (661W) . An anti-histone DNA ELISA for cell apoptosis, a BrdU ELISA for cell proliferation, a WST-1 assay for cell viability, and a live/dead assay for cell death were performed. Despite the severity of the retinal detachment, stable clinical outcomes were obtained in all three cases. Immunostaining of the explanted iehAM showed no evidence of cellular immunological rejection. In vitro, there was no statistical significant change in cell death or cell viability nor were proliferative effects detected on ARPE-19, Müller cells, and retinal neuroblasts exposed to AM. iehAM was a viable adjuvant with many potential benefits for treatment of complicated retinal detachment. Our investigations could not detect any signs of rejection reactions or toxicity. Further studies are needed to evaluate this potential in more detail.

Anatomical and functional outcomes of short-term DensironXTRA heavy silicone oil for rhegmatogenous retinal detachments: a comparative case series

To assess the safety and efficacy of short-term DensironXTRA tamponade for repair of complicated rhegmatogenous retinal detachments (RRD). This is a retrospective consecutive case series of patients undergoing pars plana vitrectomy (PPV) with intravitreal DensironXTRA and a comparator group with gas (sulfur hexafluoride (SF6) or perfluoropropane (C3F8)) tamponades by a single surgeon between January 2017 and November 2020 at a tertiary care centre. A total of 121 eyes with DensironXTRA and 81 comparator eyes with a gas tamponade were included. The DensironXTRA group had a significantly higher number of cases with inferior breaks (82% vs. 48%; p < 0.0001) and a history of previous PPV for RRD (64% vs. 12%; p < 0.0001). DensironXTRA was removed after a median period of 70 (IQR: 48.5–105.5) days. There was similar anatomical success in both the comparator gas tamponade and DensironXTRA groups (98.8% vs. 97.5%, p = 0.6506). Although both groups experienced a significant improvement in visual acuity, this change was significantly higher in the comparator gas tamponade group versus DensironXTRA group (p = 0.0017). There was no significant change in IOP in the DensironXTRA group (mean difference − 0.7; 95% CI − 1.753 to 0.331, p = 0.1785). The rates of complications were low and not significantly different between the two groups. There was no evidence for central macular thinning with DensironXTRA compared to the contralateral eye without RRD as well as with DensironXTRA in situ versus after its removal. DensironXTRA is a promising short-term tamponade agent with good anatomical and functional outcomes and low rates of complications for the repair of complicated RRDs.

Silicone oil retention sutures in a patient with open ocular trauma associated with aniridia and complicated retinal detachment: a case report

We present the clinical case of a 48-year-old male patient with a history of penetrating ocular trauma in the left eye (OS). The patient presented to the clinic with a sclerocorneal wound treated in another center, aniridia, aphakia, and retinal detachment. His best-corrected visual acuity was hand motion in the injured eye. After a complete ophthalmological evaluation, C3 proliferative vitreoretinopathy was evidenced. The elected surgical technique was scleral buckling plus silicone oil retention sutures plus pars plana vitrectomy (PPV) plus 270° retinectomy plus silicone oil (SO) as tamponade. After 10 months, the patient presented a clear cornea, formed anterior chamber (AC) was present, and a red reflex with attached retina was also present.

Long-term anatomical and functional outcomes of surgical treatment of retinal complications in children and adolescents with Stickler syndrome between 2004 and 2021.

Stickler syndrome (STL) is an inherited progressive connective tissue collagen disorder. STL is the most common hereditary cause of retinal complications, retinal tears, and the development of retinal detachment (RD) in childhood. The aim of the study was to evaluate the long-term anatomical and functional results of surgical treatment of retinal complications in children and adolescents affected by STL. A retrospective, single-center study was performed a cohort of children with STL who underwent retinal surgery between 2004 and 2021. The study group consisted of nine children; the mean age at the time of the retinal tear with/without retinal detachment was 7.2 (2-10) years, and the mean follow-up period was 9.6 (5-16) years. Pathogenic variants COL2A1 (5 children) and COL11A1 (3 children) were confirmed in our cohort. In total, we operated on 13 eyes, 11 eyes with complicated RD and two eyes with multiple retinal defects, but without RD. At the end of the follow-up period, an attached retina was achieved 77% (10 eyes) with or without silicone oil tamponade: cryopexy alone was successful in one eye (10%), scleral buckling (EB) in five eyes (50%), and vitrectomy with silicone oil tamponade combined with EB in four eyes (40%). The mean number of surgeries was 2.3 per eye. The resulting best corrected visual acuity ranged from 0.03 to 0.1 in one eye, from 0.16 to 0.4 in two eyes, and from 0.5 to 1.0 in 7 eyes. Repair of retinal tears with/without retinal detachment in patients with Stickler syndrome often requires multiple surgeries with combinations of cryopexy, scleral buckling, and/or vitrectomy with silicone oil tamponade. Treatment of the ocular complications arising from STL requires long-term comprehensive care.

Silicone oil tamponade in surgical treatment of rhegmatogenous retinal detachment

The article presents a literature review regarding the use of silicone oil tamponade (ST) in rhegmatogenous retinal detachment (RRD) treatment. Vitrectomy, which produces a stable anatomical result in most patients, is currently recognized as one of the main methods of treating RRD. In complicated retinal detachments, vitrectomy is followed by ST tamponade of the vitreous cavity (VC). Despite the many benefits of ST, it carries the risk of a number of complications arising at different times after surgery. The duration of ST presence in the vitreous cavity during RRD treatment may vary substantially. The review presents ST complications, including an unexpected and hard to explain vision deterioration after silicone oil removal, and the correlation between the complications and the duration of ST presence in the vitreous cavity.

Predictors for Visual Outcome After Silicone Oil Removal in Eyes with Complicated Retinal Detachment.

To determine the predictors for visual outcome after silicone oil removal (SOR) in eyes with complicated retinal detachment. A total of 182 eyes with complicated retinal detachment that had undergone SOR were retrospectively reviewed. Snellen best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded at baseline, 1 day, 1 month and 3 months postoperatively. Good visual outcome was defined as best-corrected visual acuity of ≥20/200 at 3 months visit. Factors predicting visual outcome were evaluated using univariate and multivariate analysis. After SOR, anatomical retinal reattachment was noted in 165 eyes (90.66%). Good visual outcome (VA ≥ 20/200) was achieved in 104 eyes (57.14%) at 3 months after SOR. For the eyes that remained attached after SOR, the percentage of good visual outcome was 63.03%. With univariate and multivariate analysis, visual acuity before SOR (p<0.001), circumferential peripheral retinopexy (p=0.037), additional endolaser during SOR (p=0.004), and pseudophakia status at the last follow up (p=0.021) were associated with visual outcome. Complications after SOR included redetachment (9.4%), hypotony (6.6%) and bullous keratopathy (1.7%). While anatomically attached retina was achieved in most of the patients, the functional outcomes were still much lower. Good BCVA before SOR and pseudophakia status at the last follow up were predictors for good visual outcomes, whereas circumferential peripheral retinopexy and additional endolaser during SOR were predictors for poor visual outcomes after SOR in eyes with complicated retinal detachment.

Evaluation of Foldable Capsular Vitreous Body Implantation Surgery.

BackgroundFoldable capsular vitreous body (FCVB), a novel artificial vitreous substitute product, has been used clinically in recent years. The aim of this study was to evaluate the outcomes and complications of FCVB implantation surgery during the postoperative period.MethodsWe performed a prospective, nonrandomized study from November 2021 to March 2022. Eight patients with severe retinal detachment that could not be easily reattached were included in this study. Before and after surgery, visual acuity (VA), intraocular pressure (IOP), slit-lamp microscopy, optical coherence tomography (OCT), B-scan and CT were performed.ResultsAfter the operation, the FCVB was well distributed in the vitreous cavity and supported the retina according to the B-scan and CT images. During the follow-up period, no vitreous hemorrhage or retinal detachment was found in any of the patients. On the first postoperative day, the average IOP increased from 9.6 ± 7.7 mmHg preoperatively to 13.8 ± 14.3 mmHg. Although the IOP of two patients fell outside the normal range, IOP was finally held steady after the fifth postoperative day in all cases. In addition, three patients (37.5%) experienced eye ache, and after taking a Saridon tablet, the pain was greatly alleviated. Moreover, no adverse events, such as silicone oil (SO) spillage and emulsification or serious complications, were observed.ConclusionThe current vitreous substitute FCVB is effective and safe for treating complicated retinal detachments in ophthalmic applications. Further multiple-center clinical designs should focus on indications and complications of FCVB during long-term follow-up periods.

Efficacy and Safety of Micropulse Transscleral Laser Therapy in Silicone Oil-induced Glaucoma.

The purpose of this study was to assess the efficiency and safety of micropulse transscleral laser therapy (MP-TLT) in the management of silicone oil-induced glaucoma (SOG). A prospective case series of 33 eyes with uncontrolled SOG was enrolled at the Department of Ophthalmology of Mohamed Taher Maamouri Hospital, Nabeul, Tunisia. Patients were treated with MP-TLT using the IRIDEX Cyclo G6 Glaucoma Laser System with the MicroPulse P3 fiberoptic handheld probe. Patients underwent complete ophthalmologic examination during the 12-month follow-up period. The study included 33 eyes of 33 patients. The mean age was 50.39 years old. We included patients with SOG. Silicone oil tamponade was indicated for complicated rhegmatogenous retinal detachment in 22 cases, diabetic tractional retinal detachment in 10 cases, and posttraumatic retinal detachment in 1 case. Silicone oil was already removed before the procedure in 23 eyes. Silicone oil tamponade duration varied between 3 and 26 months. Intraocular pressure (IOP) measurements at enrollment; days 1, 7, and 15; and months 1, 3, 6, and 12 was respectively 37.94±13.61, 19.03±10.98, 16.5±6.17, 19.45±9.73, 19.27±8.33, 19.39±9.52, 19.97±10.03, and 19.7±9.58 mm Hg. The percentage of IOP lowering was 45.38% at 6 months and 45% at 12 months. The success rate was 93.93% at 6 months, remaining stable at 12 months. No major side effects were observed, in particular, no phthisis bulbi nor prolonged inflammation. There was no difference in IOP lowering between patients with silicone oil or those after silicone oil removal ( P =0.99). MP-TLT was safe and effectively lowered IOP in uncontrolled SOG.

FOLDABLE CAPSULAR VITREOUS BODY IMPLANTATION FOR COMPLICATED RETINAL DETACHMENT CAUSED BY SEVERE OCULAR TRAUMA.

To explore the effectiveness, safety and psychological impact of foldable capsular vitreous body (FCVB) implantation for complicated retinal detachment caused by severe ocular trauma. This was a prospective, single-arm, surgical interventional case series study. A standard 3-port 23-gauge pars plana vitrectomy was performed, and the FCVB was implanted into the vitreous cavity. Observed indicators, including the best-corrected visual acuity, intraocular pressure (IOP), retinal reattachment, complications, and patient satisfaction, were analyzed to evaluate the study. A total of 28 cases (eyes) were enrolled, with a mean follow-up of 16.93 ± 9.67 months and an average age of 51.11 ± 10.14 years, including 22 men (78.57%). The FCVB was successfully implanted, and the retina was reattached in all cases. The postoperative best-corrected visual acuity improved in 7 cases, and remained unchanged in 21 cases ( P > 0.05). The average IOP was 7.01 ± 2.43 mmHg before surgery and 8.54 ± 2.93 mmHg after surgery ( P < 0.05). Complications such as FCVB displacement, endophthalmitis, secondary glaucoma, silicone oil emulsification, and escape did not occur during the follow-up period. Patients with FCVB implantation are highly satisfied. Most patients feel hope, positive, and optimistic about life. Foldable capsular vitreous body implantation for complicated retinal detachment caused by severe ocular trauma is effective and safe, and it allows patients to face life positively and optimistically.

Heavy Silicone Oil as an Endotamponade in Recurrent or Complicated Retinal Detachment and Macular Hole

Objectives:To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.Materials and Methods:Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded.Results:The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients’ median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%).Conclusion:Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.

Retinal Tacks for Complicated Retinal Detachment: Retinal Tacks in the Times of Modern Small-Gauge Vitrectomy.

Purpose To investigate the efficacy and safety profile of retinal tacks (RTs) in cases of retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR). Materials and Methods In this single-center, retrospective study medical record, optical coherence tomography and ultra-widefield fundus images of patients with complex PVR-related and RT surgery were reviewed. All cases underwent 23G pars plana vitrectomy (PPV), RT implantation, retinectomy, circumferential intraoperative laser retinopexy, and silicone oil tamponade. Results Fourteen eyes of 14 patients with complex rhegmatogenous RD with PVR were included: 7 cases showed PVR grade C type P and 7 combined grades A and P. RTs were positioned at contracted, stiffened retinal areas to achieve attachment of retinectomy borders after extensive PVR peeling. Patients underwent on an average of 1.3 PPVs (range 0–3) prior RT surgery. An average of 2.5 RTs (range 1–4) were implanted. Only in a single eye, a recurrent RD occurred. In 10 eyes, the silicone oil tamponade was still in place at the last follow-up. In 5 eyes, the silicone oil could be removed without redetachment in all of these cases (average of 31.3 weeks, range 11.4–53). No RT-related intraoperative or postoperative complications like dislocation or bleedings were observed. Conclusion RTs have the potential to improve the treatment of complex PVR-associated RD. RT can be a useful surgical tool to reattach borders of retinectomies in advanced PVR. No RT-associated complication were observed in this study.