Intravitreal Tamponade Research Articles

Contemporary Management of Rhegmatogenous Retinal Detachment Due to Giant Retinal Tears: A Consecutive Case Series

To investigate outcomes of contemporary surgical techniques for repair of rhegmatogenous retinal detachments (RRD) associated with giant retinal tears (GRT). Retrospective, consecutive case series including 58 eyes of 58 patients. Mean age was 52 years (range: 16 to 83 years). All patients underwent 23-gauge pars plana vitrectomy with use of perfluorocarbon liquid and intravitreal tamponade (28 with silicone oil, 25 with octafluoropropane gas, and five with sulfur hexafluoride gas). Scleral buckle (SB) was placed in 30 eyes (52%). At a mean follow-up of 17 months, mean visual acuity improved from 20/500 preoperatively to 20/88 at final follow-up. Fifty-one patients (88%) had single-surgery anatomic success, and all patients achieved final retinal reattachment. Use of SB (P = 1.0), silicone oil (P = .1), or 360° endophotocoagulation (P = .7) did not correlate with higher rates of successful repair. Contemporary vitreoretinal surgery techniques achieve high rates of primary anatomic success in GRT-related RRDs.

The Effect of Gas Tamponade with Vitrectomy in Lamellar Macular Hole

Purpose: To investigate the effect of gas tamponade with vitrectomy for lamellar macular hole. Methods: This study included 18 eyes of 18 patients with lamellar macular hole who reported visual acuity loss or distorted vision. All patients underwent vitrectomy, epiretinal membrane removal and internal limiting membrane peeling. Intravitreal gas tamponade was performed only in 8 eyes of 8 patients. The patients were divided into 2 groups: 8 eyes in the gas tamponade with vitrectomy group and 10 eyes that did not receive gas tamponade in the control group. The best-corrected visual acuity (BCVA) and appearance based on optical coherence tomography (OCT) were obtained retrospectively. Results: Epiretinal membranes were observed in all cases. Average visual acuity of the gas tamponade group improved from log MAR 0.50 ± 0.24 to log MAR 0.25 ± 0.14 (p = 0.041). In the control group, average visual acuity improved from log MAR 0.53 ± 0.36 to log MAR 0.32 ± 0.28 (p = 0.041), however, no significant difference was observed in visual acuity between the 2 groups (p = 0.584). Anatomical closure or normalized foveal contour after surgery was confirmed in 6 of 8 eyes in the gas tamponade group and in 7 of 10 eyes in the control group. No significant difference between the 2 groups was observed (p = 1.00). Conclusions: Gas tamponade combined with vitrectomy for lamellar macular hole did not affect postoperative anatomical and functional recovery. J Korean Ophthalmol Soc 2015;56(9):1371-1376

Preoperative intravitreal bevacizumab and silicone oil tamponade for vitrectomy in diabetic retinopathy

Preoperative intravitreal bevacizumab and silicone oil tamponade for vitrectomy in diabetic retinopathy

Visual loss after use of intraocular silicone oil associated with thinning of inner retinal layers

To investigate the incidence and cause of severe visual loss following use and removal of intraocular silicone oil (SiO) after uncomplicated vitrectomy and SiO injection for primary rhegmatogenous retinal detachment (RRD). Consecutive case series of 216 patients operated with vitrectomy for primary RRD in 2004-2005. In 162 eyes, SiO (5500 centiStoke) had been used as intravitreal tamponade and in 54 eyes gas (perflouropropane, C(3) F(8) ) had been used. Following chart review, we identified 16 eyes in 16 patients (nine SiO eyes, seven gas eyes) with macula-on and documented visual acuity ≥6/12 before surgery, where SiO had been removed, cataract surgery performed and no re-detachment had occurred. Examinations included best-corrected visual acuity (BCVA) and high-definition optical coherence tomography (OCT) of the macular area. Preoperative characteristics were identical between SiO and gas eyes. Postoperative BCVA was significantly worse in SiO eyes (>6/24) compared to gas eyes (>6/7.5), p = 0.005. Three of 9 (33%) SiO eyes had final BCVA ≤6/60 and 67% had final BCVA ≤6/12. No gas eyes had final BCVA <6/9. Macular OCT revealed thinning of inner retinal layers in SiO-operated eyes (5148 pixels) compared to gas-operated eyes (6897 pixels), p < 0.002. No other visually significant structural differences were found. Severe visual loss after SiO use was observed in 1/3 of patients with otherwise good visual potential. The visual loss was associated with a significant reduction in inner retinal thickness indicating neuronal cell loss in the macular area as a possible explanation.

VITREOUS HEMORRHAGE AFTER THE 25-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY FOR PROLIFERATIVE DIABETIC RETINOPATHY

To address the incidence, clinical course, and risk factors for postoperative vitreous hemorrhage (PVH) after a 25-gauge transconjunctival sutureless vitrectomy for proliferative diabetic retinopathy. A consecutive series of eyes underwent 25-gauge transconjunctival sutureless vitrectomies for proliferative diabetic retinopathy. The best-corrected visual acuities and intraocular pressures were measured, and the complications were prospectively evaluated 1 day, 1 week, 1 month, and 3 months postoperatively, then as needed. The mean postoperative follow-up was 11.0 ± 6.3 months (range, 6-28 months). Of 93 eyes, 42 had PVH on Day 1 (immediate PVH) but the presence and degree of PVH did not affect visual recovery and only 4 eyes did not clear for 1 month (persistent PVH). Recurrent PVH occurred in 11 eyes. Eight eyes had hypotony on Day 1, and patients who experienced postoperative hypotony had an 11.20-fold increased risk of immediate PVH > Grade 2. In the cases that needed intravitreal tamponade, the risk of recurrent PVH was 3.03-fold higher. After 25-gauge transconjunctival sutureless vitrectomies for proliferative diabetic retinopathy, postoperative hypotony and the need for tamponade increased the rates of immediate and recurrent PVH, respectively. Immediate PVH occurred in 45.2% of the patients but did not affect early visual recovery. A 25-gauge transconjunctival sutureless vitrectomy resulted in a favorable incidence of recurrent PVH (11.8%) during the first 6 months.

Safety and feasibility of a novel intravitreal tamponade using a silicone oil/acetyl-salicylic acid suspension for proliferative vitreoretinopathy: first results of the Austrian Clinical Multicenter Study

The safety and efficacy of a new surgical method of intravitreal tamponade using silicone oil suspended with aspirin (acetylsalicylic acid) was investigated for the treatment of proliferative vitreoretinopathy. The study was designed as a prospective, randomized, controlled, double-blind multicenter study. A total of 29 patients were included; 15 patients were treated with the silicone oil suspended with aspirin, and 14 patients represented the control group receiving only silicone oil. A standard three-port pars plana vitrectomy was performed in 29 eyes of 29 patients. In cases in which the natural lens was present, simultaneous phacoemulsification was required. The control group received as standard therapy a vitreous tamponade with pure 5000 mPas silicone oil and the treatment group received silicone oil containing 0.2 mg/ml aspirin (AS SiO). At 6 months after surgery, the tamponade was removed from all eyes. The main outcome measure was the incidence of retinal redetachment requiring reoperation. Secondary outcome measures were visual acuity and ophthalmic examination results. The rate of redetachment, defined as the primary outcome parameter, was the same for both groups. The AS SiO was well tolerated and remained clear during the 6-month study period. Clinical examination revealed no signs of local or systemic adverse effects. The visual acuities were well matched before inclusion in the study and there were no significant differences during the follow-up period and in the final visual outcome between the two groups. Aspirin delivery by intravitreal silicone oil in the human eye is safe and also may provide a delivery vehicle for other antiproliferative agents to the posterior pole.

Visusminderung unter Silikon

Silicone oil is used as intravitreal tamponading agent in surgery for rhegmatogenous retinal detachment (RRD) cases complicated with proliferative vitreoretinopathy (PVR). Recently, a number of case series have appeared where profound central visual loss has been found in eyes after uncomplicated vitrectomy with silicone tamponade for RRD in eyes with seemingly good visual potential. Several reports have demonstrated the migration of silicone oil droplets into the retina and the optic nerve, others the widespread loss of myelinated optic nerve fibres. These reports are reviewed, and it is concluded that caution is warranted when silicone oil is used in eyes with good visual potential. Finally the additional danger of central visual loss should be taken into consideration when deciding to use silicone oil or gas as intravitreal tamponade.

Role of residual vitreous cortex removal in prevention of postoperative vitreous hemorrhage in diabetic vitrectomy

To evaluate whether residual vitreous cortex removal has a role in the prevention of postoperative vitreous hemorrhage in diabetic vitrectomy. Retrospective, comparative, nonrandomized study on a consecutive series of patients who underwent vitrectomy for diabetic eye disease. Recurrence of postoperative vitreous hemorrhage was compared in patients following surgery with and without residual vitreous cortex removal. During the study period, 59 patients had vitrectomy for diabetic disease. In 31 patients (group 1), the residual vitreous cortex was not removed and in 28 patients (group 2) the residual vitreous cortex was removed during surgery. Both groups were matched for number of patients, age, sex, duration of follow-up, and diagnosis. Recurrent postoperative vitreous hemorrhage (RVH) was noted in ten patients in group 1 (10/31, 32.25%) and in two patients in group 2 (2/28, 7.14%). The difference in postoperative vitreous hemorrhage between the two groups was statistically significant (P = 0.017). Logistic regression analysis showed that residual vitreous cortex removal and presence of intravitreal gas tamponade were associated with reduced risk of postoperative vitreous hemorrhage. However, only residual vitreous cortex removal was statistically significant factor in reducing risk of postoperative vitreous hemorrhage [odds ratio = 0.174; confidence interval (CI) = 0.0331-0.919; P = 0.040]. Residual vitreous cortex removal may be beneficial in reducing recurrence of postoperative vitreous hemorrhage following diabetic vitrectomy. Further randomized studies should be performed to evaluate the potential of this surgical technique in preventing postoperative recurrent vitreous hemorrhage following diabetic vitrectomy.

The Surgical Results of Stages 2 and 3 Macular Hole With Internal Limiting Membrane Peeling and Intravitreal Air

Purpose: To examine the results of macular hole surgery using pars plana vitrectomy (PPV), triamcinolone-assisted peeling of the internal limiting membrane (ILM), and intravitreous air in idiopathic stage 2 and 3 macular holes. Methods: Thirteen eyes of 13 consecutive patients with idiopathic macular hole underwent a PPV with triamcinolone-assisted ILM peeling and intravitreous air tamponade. An air-fluid exchange was performed and the patient was asked to maintain a face-down position at home for 4 days. The follow-up period was 6 months or more in all cases. If a significant cataract was present before surgery, a combined phacoemulsification with posterior chamber lens implantation was performed at the time of the macular hole surgery. The closure of the macular hole was determined by biomicroscopy and Optical Coherence Tomography (OCT). Results: The idiopathic macular hole was closed after the primary operation in all 13 patients. The postoperative visual acuities (0.1 to 0.9) significantly improved from the preoperative visual acuities (0.02 to 0.4) in all eyes. There was no recurrence of the macular hole and there were no adverse effects of the intraoperative use of triamcinolone and ILM peeling during the follow-up period. Conclusions: This study suggests that triamcinolone-assisted ILM peeling with intravitreous air may be an effective technique for stage 2 and 3 macular holes. This procedure could reduce the face-down position time and improve early visual rehabilitation by using air instead of long-acting gas tamponade.

Feasibility study of chitosan as intravitreous tamponade material

Chitosan can inhibit fibroblastic proliferation by suppressing fibroblast cells, and has the similar physiological characteristics as normal vitreous body, so it might have the potential to become vitreous filling material and might possibly inhibit proliferative vitreous retinopathy. To investigate the possibility of chitosan as vitreous filling material, this study was designed to investigate retina, ciliary body, lens and cornea morphology changes, intraocular pressure and intraocular inflammatory factors fluctuating after chitosan intravitreous tamponade. Fifteen healthy chinchilla rabbits were chosen; three of them were a blank (negative) control group without any surgical procedure. The remaining 12 rabbits received vitrectomy on both eyes; all the right eyes (experimental group) were given 1.2-1.8 ml (average 1.5 ml) of chitosan intravitreously, while sodium hyaluronate were given in the left eyes (control group). All eyes underwent slit-lamp biomicroscope and indirect ophthalmoscope examination and intraocular pressure measurement pre- and post-op. The concentration of IL-6, IL-8 (radioimmunoassay), NO (nitrate reductase method) in aqueous humor and vitreous body were tested at day 15 and day 30 post-op. At day 30 post-op, the cornea, ciliary body, and lens were dissected for light microscopy examination, and the retinal tissues 2PD away from the optic disc on the vertical orientation of posterior pole were dissected for light- and electro-microscope examination. The conjunctival congestion and slight inflammatory response in the anterior chamber disappeared within 7 days post-op. During the 30-day experiment, cornea, lens and the filling material in vitreous cavity were transparent in all animals. The retina was attached without proliferation. The intraocular pressure in the experimental group post-op fluctuated between 4.55 +/- 2.94 and 6.25 +/- 2.37 mmHg, which was not significantly different from the situation pre-op (6.18 +/- 1.19 mmHg) (P > 0.05). The intraocular pressure in the control group post-op fluctuated between 5.10 +/- 2.51 and 5.90 +/- 2.49 mmHg, which was not significantly different from the situation pre-op (6.50 +/- 0.94 mmHg) (P > 0.05). There was also no significant difference in the intraocular pressure post-op at different time points between the experimental group and control group (all P > 0.05). At day 15 post-op, IL-6 concentration in aqueous humor were 37.31 +/- 8.59 ng/ml and 39.52 +/- 9.69 ng/ml in experimental group and control group respectively, both higher than those in the blank control group (26.55 +/- 9.34 ng/ml) (P < 0.05). IL-8 concentration were 7.00 +/- 3.79 ng/ml and 6.32 +/- 3.68 ng/ml respectively, no significant difference to the blank control group (4.72 +/- 1.71 ng/ml) (P > 0.05): the concentrations of NO were 63.94 +/- 26.80 micromol/ml and 51.81 +/- 13.19 micromol/ml respectively, no significant difference to the blank control group (50.36 +/- 15.67 micromol/ml) (P > 0.05). At day 30 post-op, the concentrations of IL-6, IL-8 and NO in aqueous humor showed no significant difference among all three groups (P > 0.05). In vitreous body at day 30 post-op, the concentrations of IL-8 in experimental group and control group were 10.17 +/- 3.63 ng/ml and 10.69 +/- 3.52 ng/ml, and those of NO were 50.23 +/- 19.69 micromol/mL and 50.60 +/- 12.72 micromol/mL respectively, all higher than in the blank control group (30.37 +/- 14.63 micromol/ml) (P < 0.05); the concentrations of IL-6 were 24.51 +/- 10.71 ng/ml and 26.36 +/- 13.00 ng/ml, no significant difference to the blank control group (24.06 +/- 5.98 ng/ml) (P > 0.05). At various time points, there was no significant difference in the concentrations of IL-6, IL-8 and NO in aqueous humor and vitreous body in the experimental group and the control group (P > 0.05). There was no morphological change found under light microscopy in cornea, ciliary body and lens. The outer plexiform layer of retina was thinner, but no significant degeneration, necrosis, karyopyknosis or lysis were found under the ultrastructural microscopy. Chitosan intravitreous tamponade has no significant effect on the histology of the eye, doesn't cause intraocular pressure to fluctuate, and slightly increases inflammatory factors (IL-6, IL-8, NO) in comparison to the normal levels, but with no significant difference from the effects caused by sodium hyaluronate, which indicated chitosan might not lead to a clinically significant inflammatory response. It suggests that chitosan could be used as intravitreous tamponade material.

Acetylsalicylic acid–silicone oil suspension for proliferative vitreoretinopathie: First results of Austrian clinical multicentre study

BACKGROUND: A new surgical method of intravitreal tamponade with silicone oil suspended with acetylsalicylic acid (AS) was investigated for safety and efficiency in the treatment of proliferative vitreoretinopathie. The study was designed as a prospective randomized, controlled double-blind Multicentre Study. METHODS: A standard three-port pars plana vitrectomy was performed in 29 eyes of 29 patients. In case a natural lens was present simultaneous phacoemulsification was obligatory. The control group received standard therapy vitreous tamponade with pure 5000centistoke silicone oil while the silicone oil was suspended with AS to a concentration of 0.2 mg/ml in the study group. After 6 months follow up the tamponade was removed in all eyes. RESULTS: The safety of AS SiO could be demonstrated: the AS SiO was well tolerated and stayed clear during the study period of 6 months. The clinical examination revealed no signs of local or systemic adverse effects in the study eyes. The visual acuities were well matched before inclusion into the study and there was no evidence of significant differences during the follow up period and in final visual outcome between the two groups. The rate of redetachments defined as the primary outcome parameter was the same for both groups. CONCLUSIONS: Acetylsalicylic acid delivery by intravitreal silicone oil in the human eye was shown a safe method that may offer a delivery route for other antiproliferative agents into the posterior pole.

A New Method of Treating Macular Holes

To evaluate the effect of pars plana vitrectomy (PPV) combined with joining of the hole edges on the closure of full-thickness macular holes. In a prospective consecutive clinical trial, standard PPV with internal limiting membrane (ILM) maculorhexis was performed in 25 eyes from 25 patients with stage 3 or 4 idiopathic macular holes (Group A). The retina was massaged gently around the hole from the periphery to the center in order to approximate the edges as closely as possible. The edges of the macular hole were then joined with forceps and gently pressed together. At the end of surgery, air was used for intravitreal tamponade. Patients were required to remain in a face-down position for 1 day postoperatively. For the comparison, a retrospective analysis of outcomes of surgical treatment of 27 eyes of 27 patients with stage 3 to 4 idiopathic macular hole (Group B), whose surgery included standard three-port PPV, followed with ILM peeling, was performed. The closed macular holes were categorized into two patterns based on optical coherence tomography: flat/closed and flat/open. The overall closure rate was 92+/-5.4% over a minimum follow-up period of 6 months in Group A, and 86+/-6.2% in Group B. Best-corrected visual acuity improved from 0.1+/-0.014 (ranged from 0.02 to 0.5) before surgery to 0.29+/-0.03 (ranged from 0.2 to 0.7) after surgery in Group A, and from 0.1+/-0.05 (ranged from 0.05 to 0.4) before surgery to 0.22+/-0.04 (ranged from 0.05 to 0.4) after surgery in Group B. No significant difference was found in absolute light sensitivity of macula, intraocular pressure, or lens opacification. A common postoperative complication in Group A was retinal pigment epitheliopathy, which developed in 18 cases (72%). Mechanical joining and compression of the retinal edges during surgery for stage 3 or 4 idiopathic macular holes appears to yield a promising anatomic and functional result.

Predictors of Success in Macular Hole Surgery With Emphasis on the Internal Limiting Membrane (ILM) and ILM Peeling

To study the predictors of success in macular hole surgery. Twenty-two eyes of 21 patients underwent macular hole surgery. The hole closure rate and the visual improvement were studied based on the preoperative visual acuity, stage and duration of the macular hole, the type of intravitreal tamponade used, and internal limiting membrane peeling. The internal limiting membrane was peeled only when it was clinically prominent. Macular holes were closed in 19 of the 22 eyes and visual improvement of 2 lines or more was achieved in 17 eyes. Preoperative visual acuity, duration of the macular hole, type of intraocular tamponade used, and internal limiting membrane peeling did not affect the outcome. A final visual acuity of 20/70 or better was more common after surgery for stage 2 holes (P = .019). The best predictor of outcome was the stage of the hole, with best results obtained in stage 2 holes.

Discussion by William E. Smiddy, MD

The authors have presented a series of 58 nearly consecutive eyes in which there was a 91% anatomic success rate and a 53% visual success rate with an acceptably low complication rate. The four notable aspects of surgical technique include a universal peeling of the internal-limiting membrane, intravitreous tamponade with air only, face-down positioning for only 4 days after surgery, and combined cataract extraction in 45% of cases.

Electrophysiological Responses After Vitrectomy and Intraocular Tamponade

Earlier reports of changes in the electroretinogram (ERG) following intravitreal liquid silicone in animal eyes have been conflicting. There is little information on the effects of vitrectomy and intravitreal tamponade by gas or liquid silicone on retinal function in humans. The effects on retinal function of intraocular tamponade by liquid silicone (1,000 cs) or SF6 gas (20 per cent)/mixture were studied in a series of consecutive patients undergoing vitrectomy for recent rhegmatogenous retinal detachment. Patients without retinal detachment requiring vitrectomy served as controls. Serial electroretinography was performed immediately preoperatively, postoperatively and subsequently over a period of 6 months. In the early postoperative period there was a reduction of both a- and b-waves through these recovered progressively in all the patients. The recovery of the ERG was accelerated by the absorption of the gas or by the removal of the liquid silicone. The results of our study indicate that the initial depression of the ERG is due to vitrectomy and subsequent recovery occurs even in the presence of intraocular gas or liquid silicone. It is suggested that the relative reduction of the amplitude of a- and b-waves in the study patients is due to the insulating effect of the tamponading agent and that neither intraocular gas nor liquid silicone adversely affects retinal function.

Perfluoro-n-butane. A gas for a maximum duration retinal tamponade.

The behavior of the gas perfluoro-n-butane (C4F10) in the rabbit vitreous suggests that the gas might be useful as a long-term intravitreal tamponade in retinal detachment surgery. Perfluoro-n-butane was found to expand more and remain in the eye longer than any gas previously reported. A 0.3-mL bubble expanded five times and displaced the entire rabbit vitreous in three days. The volume of the bubble began to shrink after one week, but still filled more than half the eye at three weeks. The time for total disappearance was more than three months.