Long-term Silicone Oil Tamponade Research Articles

Cryotherapy versus Laser Does Not Influence Anatomic Success after Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair: Registry Analysis of 2413 Patients

To determine whether a difference exists between cryotherapy and endolaser photocoagulation retinopexy in terms of the rates of anatomic success after primary rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV). Registry-based, nonrandomized, observational cohort study. Eyes with primary RRD in a binational retinal surgery registry that underwent repair with PPV and had a minimum of 3 months of follow-up. Cases were recorded prospectively by participating surgeons, and the outcomes were recorded at 3 months. A generalized mixed model approach was used to compare the effect of retinopexy type on the outcomes. Variables known to be associated with retinal surgical success were considered as covariates for the final model. The eyes were divided into 2 groups: Cryo group (receiving cryotherapy as the only form of retinopexy) and Laser group (receiving endolaser as the only form of retinopexy). The primary endpoint was the proportion of patients with stable retinal reattachment without the need for further retinal detachment surgery, assessed 3 months after the surgery. Failure was defined as either retinal redetachment or foveal attachment with long-term silicone oil tamponade at the endpoint. The secondary outcome measured was visual acuity at 3 months compared with baseline measurements. A total of 2413 patients were included, and the overall single-procedure success rate was 85%. There was no statistically significant difference in surgical success between the adjusted proportion of successful reattachment for the Cryo group (87%) and that of successful reattachment for the Laser group (82%) (P= 0.84; odds ratio, 1.04; 95% confidence interval, 0.74-1.46). There was no difference in the mean change in the visual outcomes at 3 months between the groups (adjusted mean change of-0.48 logarithm of the minimum angle of resolution [logMAR] for the Cryo group vs.-0.50 logMAR for the Laser group, P= 0.82). The choice of cryotherapy versus endolaser retinopexy was observed to influence neither the anatomic success of PPV for RRD nor the visual acuity outcomes at 3 months after the surgery.

Лечение последствий длительной тампонады силиконовым маслом при рецидивирующей отслойке сетчатки у пациента с ретинопатией недоношенных

Objective. To present the clinical and functional results of combined treatment of the complications of long-term silicone oil tamponade in a patient with retinopathy of premature. Materials and methods. A 24-year-old patient diagnosed with stage 4b retinopathy of premature in a single seeing right eye. Between 2011 and 2020 underwent 5 microinvasive revisions of the vitreous cavity with replacement of silicone oil and median duration of silicone oil tamponade of 19+25.5 months over this entire period. Because of the constant migration of emulsified silicone oil to anterior chamber due to weakness of iridolenticular ligaments, band keratopathy developed in the right eye, opacity of the IOL due to the adhesion of precipitates on its anterior and posterior surfaces, pupillary membrane, and aggravation of the proliferative membrane on the ocular surface. UCVA was proectio incerta and IOP was 17 mmHg. The median thickness of the cornea was 853 μm, the average thickness of the corneal calcifications is 57 μm. The patient underwent revision of the vitreous cavity with removal of the pupillary membrane, the next steps were to install bandage sutures in the anterior chamber parallel to iris in two mutually perpendicular surfaces to create additional barriers to silicone oil migration. Then we used 27 mg of K3-EDTA to produce 0.1% chelating solution and to remove corneal calcium deposits. Final stage was YAG – laser discision of precipitates from the IOL surfaces. Results. Postoperatively UCVA of the right eye in 1-month was 0.05, IOP was 17 mmHg and endothelial cell density was 1200 cells / mm2. According to OCT data the median corneal thickness was 640 μm, the thickness of the epithelial layer was 39 μm. Biomicroscopically, cornea was transparent, a single silicone oil vesicle in the lower segment of anterior chamver, the bandage sutures are consistent, the IOL is centered with a transparent optical zone, silicone oil visualized on the fundus, epi- and subretinal proliferates were delimited by laser coagulates, epiretinal membrane was in the macular region. Key words: retinopathy of prematurity, silicone oil, emulsification, ribbon-like keratopathy, bandage threads, EDTA.

Long-term silicone oil tamponade in eyes with complicated retinal detachment.

To report the visual and anatomic outcomes of eyes with exceedingly long-term silicone oil tamponade. A retrospective chart review of 43 eyes of 41 patients with silicone oil tamponade for 5 years or more. Rates of retinal reattachment, visual acuity, and complications are presented. Further analysis was performed to identify if silicone oil complications are more common in eyes with lower vision. For this, cases were divided into group A-visual acuity of 20/400 or better and group B-visual acuity of less than 20/400. Mean silicone oil duration was 12.6 ± 6.3 years. The etiology at presentation included: recurrent RRD (60.46%), RRD secondary to trauma (25.58%), and TRD (13.95%). Ninety-three percent of eyes underwent at least one ocular surgery before the vitrectomy with silicone oil tamponade. The retinal attachment rate was 55.8%. Mean visual acuity at presentation was 2.03 ± 0.6 logMAR, and at the final follow-up, 1.85 ± 0.78 logMAR (p = 0.166). Emulsification developed in 33.3% of cases, glaucoma in 28.6%, band keratopathy in 21.4%, and corneal decompensation in 16.7%. In 26.2% of eyes, the final visual acuity was 20/400 or better (group A). In 73.8% of eyes, final visual acuity was worse than 20/400 (group B). The rates of silicone oil emulsification and glaucoma were not statistically significant between groups. Long-term silicone oil tamponade is a possible option in eyes with complicated retinal detachment following multiple intravitreal procedures, although the complication rates are relatively high. In 26.2% of eyes, visual acuity of 20/400 or better can be preserved for many years.

Characteristics, fates and complications of long-term silicone oil tamponade after pars plana vitrectomy

BackgroundSilicone oil tamponade has become a mainstay in treatment of advanced retinal detachment due to multiple etiologies. The aim of this study is to assess the characteristics, fates and complications of long-term silicone oil tamponade after par plana vitrectomy (PPV), and to compare the outcomes of different silicone oil viscosities used in a cohort of consecutive patients.MethodsThis is a retrospective comparative case series of eyes undergoing vitrectomy with silicone oil tamponade for retinal detachment by a single surgeon using different oil viscosities that were followed for one year with the silicone oil in situ. Visual acuity (VA), intraocular pressure (IOP) and complications associated with the follow up period were analyzed and compared.ResultsEighty-five eyes of 85 patients were included in this study. Forty three patients had 1000 centistoke (cs) oil injected and 42 patients had 5000cs oil utilized. Demographic, cause of retinal detachment and preoperative ocular characteristics were similar in both groups. Long term complications in both groups included ocular hypertension (67.4% vs 66.7%), keratopathy due to silicone oil emulsification and migration to the anterior chamber (7.0% vs 11.9%), recurrent retinal detachment (4.7% vs 19%) and epiretinal membrane formation (7% vs 19%). In the 1000cs oil group, there was no significant difference between baseline IOP and any subsequent visit. There was a significant difference between baseline IOP and visits at day 1 (with IOP difference of 2.61 mmHg (±6.5)) (p = 0.028), 1 month (with IOP difference of 3.52 mmHg (±8.1)) (p = 0.026), 4 months (with IOP difference of 6.38 mmHg (±9.3)) (p = 0.005), and one year (with IOP difference of 4.24 mmHg (±11.1)) (p = 0.048), all higher in the post-operative period in the 5000cs oil group. Excluding the first post-operative day, no significant difference was found for VA between baseline visits and subsequent visits for either silicone oil groups.ConclusionIn this cohort of patients with long-term silicone oil tamponade after PPV to treat retinal detachment, IOP increased significantly in patients who received 5000cs silicone oil. There was no significant difference between other complication rates in patients receiving either oil viscosities. Long term silicone oil tamponade remains a viable option in certain cases, and a vigilant follow up for complications is necessary to limit any adverse effects and improve visual and surgical outcomes.

Evaluation of emulsified silicone oil with spectral domain-optical coherence tomography and fluorescein angiography.

To report emulsified particles and related complications after removal of silicone oil (SO) by spectral domain-optical coherence tomography (SD-OCT) and fluorescein angiography (FA). A prospective, single-center investigation was performed using SD-OCT, FA and flare cell photometry measurements to evaluate in a cohort of eyes with emulsified silicone particles after removal of long-term SO tamponade. Nineteen eyes of the 19 patients with emulsified silicone particles detected in ophthalmoscopic exam were included in the study: 13 (68%) were male, and 6 (31.6%) were female, and their mean age was 52.75 ± 16.06years. Preoperative diagnoses were rhegmatogenous retinal detachment in all eyes. The mean duration of the silicone oil's presence in the eye was found as 12.63 ± 4.87 (7-26) months. SD-OCT examination postoperatively showed small, round and hyper-reflective structures compatible with emulsified silicone particles on preretinal surface in 7 (36.8%) eyes, intraretinally in 6 (31.6%) eyes and in the vitreous in 12 (63%) eyes. FA imaging demonstrated pearl-like hyper-fluorescence at early and late phases on the large blood vessels in 9 (47.4%) eyes. Late phase hyper-fluorescence due to leakage on the macula was observed in 17 (89.5%) eyes. Diffuse peripheral leakage and hyper-fluorescence was detected in 11 (57.9%) eyes. Flare levels were higher in eyes with emulsified SO compared to unaffected fellow eyes (p < 0.05). Emulsified silicone particles that remain in the eye may lead to retinal complications and inflammation in addition to their known complications such as keratopathy and glaucoma. The particles that lead to inflammation and presence of inflammation may be examined by imaging methods such as SD-OCT and FA. Removing the SO before emulsification would be suitable for avoiding such complications.

Inverted internal limiting membrane peeling technique with silicone oil tamponade for repair of recurrent large macular holes in vitrectomized Diabetic patients

Purpose : To present a new approach to treatment of large macular holes in already vitrectomized eyes of patients with proliferative diabetic retinopathy, whose ILM has not been removed during primary surgery. Patients and methods : Two eyes of two different patients with proliferative diabetic retinopathy which had undergone vitrectomy with endolaser 1.5 to 2 years before admittance to our department. No data for ILM peeling during surgery were available. Our OCT examinations showed macular holes with upper diameter of 765 I¼m in the first patient and 1160 I¼m in the second one. In both cases we combined two well-known surgical approaches: first, inverted ILM flap technique; second, long-term silicone oil tamponade for a period of 4 months. Results : The macula of both patients was followed up by photographs and regular OCT-s on day one, month one and three months after silicone oil removal. The macular holes remained closed after removal of the tamponade agent. BCVA was 0.5 three months after the last surgery in both patients. During the final examination, macular contour seemed almost normal. Discussion : Large, long-standing macular holes are less likely to be closed after pars plana vitrectomy. The inverted ILM flap technique has been recently reported to be successful in nearly 99% of patients with macular holes more than 400 I¼m in diameter. The position of the inverted ILM flap is much more controllable under silicone oil than under gas tamponade.

CORNEAL ENDOTHELIAL CELL DENSITY AFTER VITRECTOMY WITH SILICONE OIL FOR COMPLEX RETINAL DETACHMENTS

To evaluate the endothelial cell density changes in eyes with silicone oil tamponade after vitrectomy for complex rhegmatogenous retinal detachment. A prospective controlled study with 81 eyes with complex rhegmatogenous retinal detachment undergoing vitrectomy and silicone oil tamponade. Fellow eyes that fulfilled specific inclusion criteria served as controls. Endothelial cell density (in cells per square millimeter), coefficient of variance (standard deviation per mean cell area × 100), percentage of hexagonal cells, and corneal thickness were documented preoperatively and compared with values obtained at 3, 6, and 12 months postoperatively. For the purpose of the study analysis, all study eyes were divided into 5 groups, according to their lens status during the follow-up. High endothelial cell density loss was found in Group 3, (eyes that underwent an additional phacoemulsification procedure) and Group 4 (eyes that underwent lens and/or intraocular lens removal during the follow-up) at 12 months with a mean cell loss of 19% and 39%, respectively (P < 0.001). An intact natural or artificial lens-iris diaphragm may provide a protective barrier against corneal endothelial cell damage from long-term silicone oil tamponade.

Surgical Outcomes Following Repair of Traumatic Retinal Detachments in Cognitively Impaired Adolescents With Self-Injurious Behavior

To assess anatomic outcomes following repair of traumatic retinal detachment (RD) among a cohort of cognitively impaired adolescents with self-injurious behaviors. Main outcome measures in this retrospective, consecutive, interventional case series were retinal attachment and postoperative complications. Complete retinal reattachment was initially achieved in all 9 eyes of 9 patients. Six (67%) eyes had chronic RD at initial presentation, and 7 (78%) patients had limited vision from inoperable RD in the fellow eye. Proliferative vitreoretinopathy led to recurrent RD in 4 (44%) eyes at a mean of 2.7 months. Final total or partial retinal attachment was achieved in 6 (67%) and 3 (33%) eyes, respectively, with a mean of 1.7 procedures over a mean follow-up of 22.4 months. Silicone oil emulsification led to progressive glaucoma in 4 (50%) of 8 eyes in which it was used, requiring silicone oil exchange (2 eyes) or removal (2 eyes). Recurrent RD developed in both eyes from which silicone oil was removed despite prior retinal anatomic stability for more than 6 months. Cognitively impaired adolescents with self-injurious behaviors typically presented with severe visual impairment from chronic traumatic RD in one or both eyes. Despite initial anatomic success, formation of proliferative vitreoretinopathy and further ocular trauma from continued self-injurious behaviors led to a high rate of recurrent RD. Long-term silicone oil tamponade may prevent recurrent RD in this challenging scenario but is associated with vision loss from progressive glaucoma and corneal decompensation.

Clinical outcome of the artificial iris diaphragm in silicone oil surgery

BackgroundSome eyes require long-term silicone oil tamponade. Problems arise in aphakic eyes with iris defects or hypotony, because an inferior iridectomy can not prevent silicone oil from entering the anterior...

Retrospective review of 50 eyes with long-term silicone oil tamponade for more than 12 months

Silicone oil (SO) is an established tamponade in treating complex vitreoretinal diseases. Although SO is intended to be removed after several weeks to months, permanent SO might be unavoidable in a small subgroup of patients with an extremely complicated clinical course. The aim of this study is to describe the long-term effects of intraocular SO tamponade. This retrospective study included 50 patients with intraocular SO (Oxane 5700 Bausch & Lomb, Kingston-upon-Thames, UK) for at least 12months. The most common reasons for long-term SO tamponade were: retinal re-detachment (re-RD), proliferative diabetic retinopathy (PDR), ocular trauma, and persistent hypotony. Mean age was 59.2 ± 18.4years, and mean duration of silicone oil in the eye was 54.5 ± 58.6months (median, 30months). The average number of previous surgeries were 2.2 ± 1.5. Anatomic success was achieved in 37/50 (74%) of patients. Visual acuities (logMAR) were 1.8 ± 0.6, 1.6 ± 0.6, 2 ± 0.7 and intraocular pressures (mmHg) were 15.6 ± 7, 15.7 ± 5.5, 16.5 ± 7.1 at 3months, 1year and at last follow-up respectively. The main long-term silicone-oil-related complications observed were: band keratopathy (8%), corneal decompensation (12%), iris rubeosis (14%), and optic neuropathy (28%). Forty percent of patients achieved ambulatory vision in the SO-filled eye at final follow-up. Long-term silicone oil can be a last-resort option in selected patients with severe vitreoretinal disease. Anterior and posterior segment complications did occur at significant rates. Forty percent of our patients maintained ambulatory vision. The actual number of patients that achieved satisfactory stereopsis and benefited functionally from long-term SO was much less [7/50 (14%)].

Permanent Keratoprosthesis Combined With Pars Plana Vitrectomy and Silicone Oil Injection for Visual Rehabilitation of Chronic Hypotony and Corneal Opacity

To present outcomes of combined pars plana vitrectomy, silicone oil (SO) injection, and permanent keratoprosthesis (Kpro) procedure in prephthisical eyes. All 3 patients were monocular with chronic severe hypotony, aphakia, and total corneal opacity in their vital eye. Preoperative visual acuity ranged from light perception to counting fingers at 1 foot. Two patients had a history of failed corneal grafts because of SO, and one had funnel retinal detachment. Pars plana vitrectomy and long-term SO tamponade were performed, and a permanent Boston type 1 Kpro was used in lieu of a donor corneal transplantation. No unexpected intraoperative complications were encountered. Patients were followed for a period of 11-13 months. All patients had anatomic success with an attached retina and a clear visual axis. The procedures resulted in increased visual function in all patients ranging from hand motions to 20/800. No case has progressed to phthisis bulbi during the follow-up period. At the last visit, biomicroscopic examination revealed clear Kpro with an attached retina. Boston type 1 Kpro implantation, as the primary corneal procedure with pars plana vitrectomy and intraocular SO, may be a viable option in selected patients with prephthisical eyes.

40 Jahre inkomplette Silikonöltamponade nach Ablatiochirurgie

Since the early 1970 s, silicone oil injection was used for the treatment of complicated retinal detachments. Especially in this early period, the possible complications of silicone oil tamponade were difficult to assess. Today, we strive to reduce the duration of silicone oil tamponade - aiming at a removal within 3 - 6 months. A permanent tamponade is reserved for special situations. We report on a 53-year-old male patient, who underwent retinal surgery and was followed-up for 40 years. After a blunt trauma at the age of 13 the patient developed a macula-off retinal detachment. An encircling procedure (Arruga suture) with combined incomplete silicone oil injection was performed. Best corrected visual acuity (BCVA) preoperatively was 20 / 60 and 20 / 100 was attained postoperatively. As a complication of silicone oil tamponade a localised cataract formation was observed. At the last visit BCVA was 20 / 200. No other silicone oil-related complications were noticed. Long-term silicone oil tamponade over a considerable period of 40 years was well tolerated without significant complications. The incomplete silicone oil filling of the vitreous cavity may be responsible for the lack of serious side effects and segmental cataract.

Immunohistochemical Findings in Epiretinal Membrane after Long-Term Silicone Oil Tamponade: Case report

To report pre- and post-operative macular optical coherence tomography (OCT) and immunohistochemical findings in a case of long-lasting silicone oil tamponade followed by silicone oil removal and epimacular membrane peeling. A 69-year-old man with long-standing silicone oil tamponade and an epiretinal membrane at the posterior pole in his right eye (RE) underwent silicone oil/BSS exchange with epiretinal membrane peeling. Preoperatively, RE best-corrected visual acuity was 20/200 and macular OCT examination revealed a small increase in foveal thickness (250 microm) with the appearance of a linear hyper-reflective signal at the foveal vitreoretinal interface and a thicker (440 microm) hyperreflective finding causing posterior shadowing at the vitreoretinal interface inferiorly to the fovea. Histopathologic and immunohistochemical study of the specimen including the epiretinal membrane was performed. Light microscopy revealed extensive rounded empty spaces interpreted as silicone oil bubbles in the preretinal membrane. Macrophages marker (CD68) positive staining cells were found surrounding the empty spaces within the preretinal membrane and several empty spaces were observed intracellularly within macrophage cytoplasm. Thirty days after surgery best-corrected visual acuity was 20/60 and OCT examination showed an evident decrease in foveal thickness (220 microm) with the disappearance of any hyper-reflective signal at the vitreoretinal interface referable to an epiretinal membrane. The immunohistochemical study showed both silicone oil droplets and macrophagic cells embedded in the epiretinal membrane. Postoperative OCT demonstrated retinal recovery after silicone oil removal and epiretinal membrane peeling, thus justifying an unexpected visual acuity recovery despite the very long term tamponade.

Sudan staining of impression cytology retinal specimen

Long-term silicone oil tamponade may cause increased numbers of vacuoles in the retina. Conventional methods of histological preparation dissolve silicone oil and optically empty spaces are seen. We examined the retinas of 20 human eyes after silicone oil injection. We obtained the material by peripheral retinectomies during vitrectomy for recurrent retinal detachment. The material was prepared by impression cytology. The time between silicone oil injection and vitrectomy was 3-18 months. The non-fixed cell sheets were stained with Sudan III, followed by a counterstaining with hematoxyline. Sudan III stained silicone oil 1000 mPa orange-yellow. Sudan-III-stained vacuoles in the retina were found in eight eyes with intraocular silicone oil instillation; in five of these eyes an emulsification of silicone oil was observed. The staining of retinal vacuoles seemed to be caused by the presence of silicone oil in the vacuoles. Using impression cytology and the Sudan staining procedure, it was possible to stain vacuoles in non-fixed retinal preparations. A long-term silicone oil tamponade induces these vacuoles in the retina, especially if the silicone oil is emulsified. In order to prevent this complication, removal of emulsified silicone oil should be performed as early as possible.