Silicone Oil Removal Research Articles

Punctate inner choroiditis and choroidal neovascular membrane formation following vitreoretinal surgery: A case report.

To report a case of punctate inner choroiditis (PIC) and subsequent choroidal neovascular membrane (CNVM) development in a young, high myope following vitreoretinal surgery for rhegmatogenous retinal detachment. A 44-year-old male with high myopia underwent pars plana vitrectomy for subtotal retinal detachment in the left eye, followed by cataract extraction and silicone oil removal. Three years postoperatively, he presented with blurred vision, and fundus examination revealed PIC lesions at the posterior pole. Spectral-domain optical coherence tomography (SD-OCT) showed characteristic features of PIC, including hyperreflective nodule-like elevations, disrupted ellipsoid and interdigitation zones, retinal pigment epithelium (RPE) elevations and increased choroidal hyper transmission signals. Initially, no treatment was initiated, and the patient was monitored. Three years later, the patient experienced further vision loss, and fundus examination showed progression of PIC lesions and new CNVM formation in the left eye. The patient was treated with systemic corticosteroids and an intravitreal anti-VEGF injection (Razumab® 0.5 mg/0.05 ml). Three weeks after the intervention, SD-OCT showed regression of the CNVM, and the patient's visual symptoms improved. This case underscores the importance of long-term follow-up and timely intervention in managing PIC, especially in high myopes post-retinal surgery. Early identification and treatment with systemic corticosteroids and anti-VEGF therapy are crucial to preserving visual function and preventing severe complications like CNVM.

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

Objective: 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. Method: 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. Results: 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). Conclusion: 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. Key Words: Silicone oil, Face-down positioning, Macular folds, Epiretinal membranes, Pblock glaucoma, Silicone oil in anterior chamber.

Refractive outcomes following simultaneous silicone oil removal and ciliary sulcus intraocular lens implantation.

This study aimed to assess the refractive outcomes following the combined intervention of silicon oil (SO) removal and ciliary sulcus intraocular lens (IOL) implantation in aphakic eyes after phacovitrectomy. A retrospective examination of medical records from patients who underwent a combined procedure of SO removal and ciliary sulcus IOL implantation from 2019 to 2022 was performed. The primary outcomes of interest included uncorrected distance visual acuity (UDVA), predictive error (PE) and mean absolute predictive error (MAE). Subgroup analyses were performed to compare outcomes between patients with and without intraoperative posterior capsulotomy. The cohort comprised 40 eyes from 40 patients, with a mean duration of SO tamponade of 5.17 ± 1.48 months. A significant improvement in UDVA was observed from 1.58 ± 0.31 logMAR to 0.99 ± 0.31 logMAR one month postoperatively (P < 0.01). The PE was -0.73 ± 0.86 diopters (D), and the MAE was 0.90 ± 0.67 D, with 37.50% and 57.50% of cases achieving PE within ±0.5 D and ±1.0 D, respectively. No significant differences in UDVA, PE, or MAE were found between the capsulotomy and non-capsulotomy subgroups (all P > 0.05). However, a lower proportion of eyes in the capsulotomy group achieved PE within ±1.0 D compared to the non-capsulotomy group one month postoperatively (38.90% vs. 72.70%, P = 0.03). The combined procedure of SO removal and sulcus IOL implantation resulted in a mild myopic shift in postoperative refraction. Intraoperative posterior capsulotomy seems to increase the lability of postoperative refractive outcomes.

A Modified Intravitreal Methotrexate Protocol for the Prevention of Proliferative Vitreoretinopathy after Silicone Oil Removal

ObjectiveTo utilize a modified intravitreal (IVT) methotrexate (MTX) protocol for the prevention of proliferative vitreoretinopathy (PVR) after silicone oil (SO) removal (SOR). DesignSingle-center nonrandomized retrospective comparative case series. SubjectsEyes with grade C PVR who underwent retinal detachment repair and SO placement between 2019-2022 with at least 6 months of follow-up after SOR. A control group of age- and sex-matched eyes was included. MethodsEyes were treated with one of two MTX protocols. Eyes in Group 1 received 6 IVT MTX injections following SO placement, and another 6 IVT MTX injections following SOR. Eyes in Group 2 received 6 IVT MTX following SO placement only. Each series of 6 IVT MTX injections (400 μg/0.1 mL) consisted of 3 injections every 2 weeks followed by 3 injections every 4 weeks. Main Outcome MeasuresThe primary outcome was the retinal attachment rate at 6 months post-SOR without re-detachment or re-operation. Secondary outcomes included change in visual acuity (VA) and rates of complications after SOR. ResultsFifty-two eyes of 52 patients (13 Group 1, 13 Group 2, 26 control) (mean age 59.8 years, 80.8% male) were included with a mean follow-up of 31.0 months. In aggregate, Group 1 and Group 2 eyes received a median (IQR) of 6 (5.25, 7) IVT MTX injections pre-SOR; eyes in Group 1 received a median (IQR) of 5 (3, 6) IVT MTX injections post-SOR. Twelve (92.3%) Group 1 eyes, 11 (84.6%) Group 2 eyes, and 21 (80.8%) control eyes had primary retinal attachment at 6 months post-SOR (P > 0.05). VA outcomes did not significantly differ between groups (P > 0.05). Rates of epiretinal membrane (ERM) and cystoid macular edema (CME) were significantly lower in Group 1 eyes (7.7% and 15.4%) compared to Group 2 (53.8% and 92.3%) and control (44.3% and 65.4%) eyes, respectively (P < 0.05). ConclusionsThe use of IVT MTX injections in eyes with PVR undergoing RD repair was associated with a high rate of primary retinal attachment after SOR. Eyes that received IVT MTX injections after SOR had significantly lower rates of ERM and CME than eyes that did not.

Retinal vascular changes after Silicon Oil removal in the Eye with Rhegmatogenous Retinal detachment

BackgroundThis study aims to examine vessel density changes in the optic nerve and macula following silicone oil removal (SOR) surgery in eyes with rhegmatogenous retinal detachment (RRD) at different time points by Optical Coherence Tomography Angiography (OCTA) in compared to the contralateral eye.MethodsA total of 43 eyes from 43 patients with silicone oil in their eyes for 3–9 months underwent OCT-A using AngioVue and optic disc-associated vessel density (VD) and thickness, macular-associated VD and thickness, Foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), Acircularity index (AI), vessel density within a 300 μm wide region of the FAZ were compared between eyes. OCTA scans were performed one week before SOR and one month and three months after SOR.ResultsThe mean age of participants was 52.8 years (SD = 15.85) and a median visual acuity was 0.8 (range: 0.5-1.0). Notably, male participants constituted 67.4% of the sample. The preoperative mean value BCVA (logMAR) of patients was 0.73, and 3 months post-oil removal was 0.7727. Regarding optic disc parameters, RNFL thickness and vessel density (VD) measurements Peripapillary, whole disc, inside disc, and Disc Angio (superior, Nasal, inferior, temporal) did not change.In analyzing macular thickness parameters, all of them (Whole and Fovea, parafoveal, and Perifovea) remained unchanged. Examining macular vessel density parameters revealed no significant changes across superficial and deep retinal layers. Finally, the comparison of the foveal avascular zone (FAZ) area and flow density (FD) parameters demonstrated consistent measurements with non-significant alterations observed in FAZ size (p = 0.6) and FD values (p = 0.49) over the monitored duration.ConclusionThere was no change in peripapillary VD and macular vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after silicone oil removal. FAZ and full retinal thickness remained stable 3 month after SOR. Clinical trial number: Not applicable.

Surgical Outcomes of Rhegmatogenous Retinal Detachment Associated with Regressed Retinopathy of Prematurity.

To evaluate the characteristics and surgical outcomes of late-onset rhegmatogenous retinal detachment (RRD) associated with regressed retinopathy of prematurity (ROP) and the status of fellow eyes. Retrospective review of consecutive cases undergoing surgery for regressed ROP-related RRD and the fellow eyes between 2012-2022. Demographic data, fundus findings, retinal detachment characteristics, surgical procedures, and anatomic and functional outcomes were analyzed. Anatomic success was defined as retinal attachment after silicone oil removal at final follow-up. Fifteen eyes of 14 patients with a history of regressed ROP underwent surgical repair for RRD at a mean age of 12 (range, 3-26) years. Primary surgical intervention yielded a 53% failure rate overall. This rate was 33% for scleral buckling (SB), 100% for pars plana vitrectomy (PPV), and 40% for combined SB-PPV surgery. Eyes with posterior cicatricial changes and/or proliferative vitreoretinopathy (PVR) demonstrated a higher tendency for recurrence. The final anatomic success rate was 73% after a mean number of 2.3 (range, 1-5) surgeries. The chances of restoring useful vision diminished with repeated surgery despite the improvement in anatomic success. In the fellow eyes, peripheral retinal pathologies were universally observed, with posterior cicatricial changes noted in 33%. The study reveals a significant initial failure rate in surgical treatment of cases with late-onset RRD associated with regressed ROP, particularly in eyes with posterior cicatricial changes or PVR, suggesting the need for a combined surgical approach as an initial strategy in such high-risk cases. The consistent presence of retinal abnormalities in fellow eyes calls for proactive monitoring and potential prophylactic intervention.

Comparative Analysis of Macular and Optic Disc Perfusion Pre and Post Silicone Oil Removal: A Machine Learning Approach.

In the realm of ophthalmic surgeries, silicone oil is often utilized as a tamponade agent for repairing retinal detachments, but it necessitates subsequent removal. This study harnesses the power of machine learning to analyze the macular and optic disc perfusion changes pre and post-silicone oil removal, using Optical Coherence Tomography Angiography (OCTA) data. Building upon the foundational work of prior research, our investigation employs Gaussian Process Regression (GPR) and Long Short-Term Memory (LSTM) networks to create predictive models based on OCTA scans. We conducted a comparative analysis focusing on the flow in the outer retina and vessel density in the deep capillary plexus (superior-hemi and perifovea) to track perfusion changes across different time points. Our findings indicate that while machine learning models predict the flow in the outer retina with reasonable accuracy, predicting the vessel density in the deep capillary plexus (particularly in the superior-hemi and perifovea regions) remains challenging. These results underscore the potential of machine learning to contribute to personalized patient care in ophthalmology, despite the inherent complexities in predicting ocular perfusion changes.

Retinal redetachment after silicone oil removal: a risk factor analysis

PurposeTo report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors.MethodsRetrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes.ResultsThe median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06).ConclusionA retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate.Trial registration numberID NCT05647928 (12th April 2022)

Xen gel stent implant for persistent glaucoma after silicone oil removal.

To evaluate the effectiveness and safety of the XEN-Stent for managing unresponsive to medical therapy secondary glaucoma after silicone oil (SO) removal. This retrospective chart reviewed 12 patients who underwent vitrectomy and SO endotamponade. They experienced intraocular pressure (IOP) elevation after SO removal despite taking the maximum tolerated glaucoma medication. Eleven eyes underwent an XEN-implant, while 1 underwent an XEN-implant with phacoemulsification/IOL implantation. The primary outcome was to achieve success criteria: IOP <18 mmHg and >20% IOP reduction without medication (complete success) or with medication (qualified success) and without a secondary IOP-lowering procedure. IOP, best-corrected visual acuity (BCVA), and the number of glaucoma medications (Glaucoma Medication Score-GMS) were recorded at baseline, 1 day, 1 week, 1 (M1), 3 (M3), 6 (M6), and 12 (M12) months postoperatively. Baseline characteristics included males percentage 66.6%, mean age of 61.8 ± 5.7 years, BCVA 0.69 ± 0.3 logMAR, IOP 30 ± 4.2 mmHg, and GMS 3.1 ± 0.5. There was a significant reduction in IOP by 14 ± 1.9 mmHg and GMS by 0.27 ± 0.6 at M12 compared to baseline (p < 0.01), but no significant change in BCVA (p = 0.21). Complete success dropped to 50% (M3), rising to 75% (M6, M12) after needling. Two patients achieved qualified success at M12. Needling was performed in 6 eyes, with 3 requiring a second procedure. Ex-PRESS was required in 1 eye. One eye experienced hypotony and hyphema, which resolved within a week. XEN implant may be an initial treatment for persistent post SO removal glaucoma with minimal complications. Needling procedures can help maintain or restore surgical success.

Development and Resolution of Subfoveal Lucency and Hyperreflective Deposits Following Silicone Oil Insertion and Removal.

Silicone oil (SO) is commonly used as a retinal tamponade during pars plana vitrectomy for complicated retinal detachments. Although fairly inert, complications such as cataract formation, intraocular pressure elevation, corneal changes, inner retinal thinning, and optic neuropathy have been noted. We report two cases of postoperative subfoveal outer retinal lucency and hyperreflective deposits following SO insertion and resolution following removal. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Fellow eye data for intraocular lens calculation in eyes undergoing combined phacovitrectomy.

To evaluate whether the intraocular lens (IOL) calculation of the fellow eye (FE) can be used in eyes undergoing combined phacovitrectomy. In this retrospective, consecutive case series, we enrolled patients who underwent combined phacovitrectomy with silicone oil removal and IOL implantation at the Goethe-University. Preoperative examinations included biometry (IOLMaster 700; Carl Zeiss). We used the IOL calculation of the FE (FE group) to calculate the prediction error compared with the IOL calculation using only the axial length (AL) of the FE (AL-FE group), as well as using the AL of the operated eye (OE group) in addition to the measurable biometric parameters. IOL calculation was performed using the Barrett Universal II formula. We compared the mean (MAE) and median absolute prediction error (MedAE) with each other. Furthermore, the number of eyes with ±0.50, ±1.00 and ±2.00 dioptres (D) deviation from the target refraction was compared. In total, 79 eyes of 79 patients were included. MedAE was lowest in the OE group (0.41 D), followed by FE group (1.00 D) and AL-FE group (1.02 D). Comparison between the AL-FE and FE groups showed no statistically significant difference (p = 0.712). Comparing eyes within ±0.50 D of the target refraction, the OE group (63.3%) performed best, followed by the AL-FE group (27.8%) and the FE group (26.6%). Our results indicate no clinically relevant difference between using the IOL calculation of the FE versus using only the AL of the FE in addition to the measurable parameters for the IOL calculation. A two-step procedure should always be strived for.

A challenging case of scleral buckle-related restricted strabismus with unexpected good postoperative outcomes: A case report

Abstract Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.

Resolution of diabetic macular edema following silicone oil removal

Resolution of diabetic macular edema following silicone oil removal

Clinical trial to test the safety of the EVA Nexus surgical platform

BackgroundThe EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for removal of the valve from the infusion cannula. The chamfered leading edge of the cannula also reduces the insertion force needed. The new EquiPhaco needles in combination with SmartIOP provide excellent anterior chamber stability during phaco-emulsification surgery, enabling to work at lower infusion pressures, and the multiburst phaco mode allows easier removal of hard cataracts. The system offers a secondary active infusion line for independent control of pressure to the anterior and posterior chambers, monitoring of flow rate/reflux and warning of infusion bottle emptying. This study evaluated whether these technical improvements result in improved surgical safety.MethodsIn total, 250 eyes that underwent vitrectomy (53%) or phaco-vitrectomy (47%) using the EVA Nexus system were prospectively included. The occurrence of intraoperative adverse events was compared to that of historically operated eyes using the EVA system.ResultsThe average age of the patients was 63 years. A total of 33% of the patients were operated on for retinal detachment, 17% for macular pucker, 11% for treating floaters, 9% for removing silicone oil, 8% for macular hole repair and 22% for other diseases. In 75% of surgeries, 23 G instruments were used, and 27 G instruments were used in 25% of cases. Device issues that occurred included priming cycle issues (n = 4), eye pressure stability problems (n = 6) and vitrectome performance issues (n = 1), all of which in the first 100 patients who were included and were fixed with software updates. The frequency of surgical complications in the anterior segment was lower than that in the historically recorded surgical reports. Intraoperative events in the posterior segment included hemorrhage from retinal vessels, choroidal hematoma, iatrogenic retinal damage/tear, and subchoroidal infusion. Again, these events occurred rarely and less frequently than in the historical surgical reports.ConclusionsThe EVA Nexus provides a surgical platform that reduces the incidence of intraoperative adverse events and iatrogenic complications in both anterior and posterior segment surgery. This could increase surgical safety during cataract and vitrectomy surgery.Trial Registration number Clinicaltrials.gov: NCT05229094 Data 22/5/2021.

Accuracy of using the axial length of the fellow eye for IOL calculation in retinal detachment eyes undergoing silicone oil removal

PurposeEvaluate whether the axial length of the fellow eye can be used to calculate the intraocular lens (IOL) in eyes with retinal detachment.DesignRetrospective, consecutive case series.MethodsOur study was conducted at...

Prognostic Factors for Recurrent Rhegmatogenous Retinal Detachment after Silicone Oil Removal.

To investigate the prognostic factors for recurrent rhegmatogenous retinal detachment following silicone oil removal. This retrospective review included 147 consecutive patients with rhegmatogenous retinal detachment treated with silicone oil tamponade at a high-volume referral-based tertiary hospital between January 2012 and May 2022. All patients underwent follow-up for a minimum of 6 months after subsequent silicone oil removal. The primary outcome measure was the rate of recurrent retinal detachment following silicone oil removal, and the secondary outcome was best-corrected visual acuity after silicone oil removal. The mean silicone oil tamponade duration was 4.7 ± 5.01 months (range, 1-38 months; median, 3 months), and the recurrent retinal detachment rate after silicone oil removal was 15.6%. Logistic regression analysis revealed that argon endolaser photocoagulation during silicone oil removal (odds ratio [OR], 0.309; 95% confidence interval [CI], 0.106-0.898; p = 0.031) was associated with a lower rate of anatomical success after silicone oil removal. Demographics, preoperative ocular characteristics, proliferative vitreoretinopathy, previous scleral encircling or buckling, previous retinectomy, concomitant phacoemulsification, duration of silicone oil tamponade, and gas tamponade after silicone oil removal were not significantly associated with recurrent retinal redetachment after silicone oil removal. Duration of silicone oil tamponade (OR, 1.226; 95% CI, 1.073-1.402; p = 0.003) and recurrent retinal detachment after silicone oil removal (OR, 3.400; 95% CI, 1.311-8.817; p = 0.012) were associated with poor visual outcomes after silicone oil removal. Among all factors examined in this study, including the duration of silicone oil tamponade, laser retinopexy was the only significant prognostic factor for recurrent retinal detachment after silicone oil removal. A longer duration of silicone oil tamponade was associated with worse visual outcomes and a lower rate of visual improvement after silicone oil removal.

Vision loss associated with silicone oil endotamponade in vitreoretinal surgery - a review.

To clarify the definition, prevalence and classification of different types of unexplained vision loss associated with silicone oil (SO) endotamponades (SO in situ (SOIS) or after removal of SO (ROSO)) in vitreoretinal surgery and identifying the most specific clinical findings and suggesting possible causes. Review of the literature regarding randomized clinical trials (RCTs), retrospective case-control, cohort studies and case series evaluating the risk of using SO, published in English between 1994 and 2023, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus and Embase. The search was supplemented using the Medline option 'Related Articles' and consulting review articles on the topic. Findings from reported clinical examinations in SOIS and ROSO are analyzed and finally different theories regarding the underlying pathophysiology are described. From the clinical point of view, findings have been found in OCT, OCTA, microperimetry and electrophysiological studies. Other clearly identifiable causes of vision loss related to the use of SO are listed and commented as differential diagnosis. Finally, the different physiopathological theories of the two types of causes of unexplained vision have been analyzed. Unexpected vision loss under or after SO tamponade (SOIS and ROSO) is a significant concern which is probably underestimated because it is not a clearly defined and known entity. The most frequently described changes were in the ganglion cell complex but this unexpected vision loss remains a serious and unexplained concern for vitreoretinal surgeons and should be identified by clinicians, addressed by manufacturers and reported to Health Authorities as a serious incident according to the new regulation.

Transcorneal Vitrectomy in Eyes with Regressed Retinoblastoma

Purpose: Current treatments for retinoblastoma facilitate globe salvage but can result in vitreoretinal disorders that may require surgery. There is controversy on surgical approaches in eyes with retinoblastoma. Here we describe a transcorneal vitrectomy approach that avoids the use of chemotherapy or cryotherapy. Methods: Retrospective chart review was performed on five consecutive patients with regressed retinoblastoma for &gt;12 months (Group D/ct2b) at Children’s Hospital Los Angeles who had vitrectomy between November 2022 and December 2023. Results: Five patients underwent 8 vitrectomies for various indications including IOL fibrosis, vitreous hemorrhage, cataract, retinal detachment, and silicone oil removal. Mean age at first vitrectomy was 6.2 years (range: 2-9 years); mean time from last retinoblastoma treatment was 50.4 months (range: 20-82 months). Radially oriented corneal incisions were made with the 23-gauge or 25-gauge trocar system and the Versa HD LenZ (Oculus) was utilized with the RESIGHT (Zeiss) for top-down visualization. Neither chemotherapy nor cryotherapy were utilized. Wounds were sutured parallel to the limbus with 10-0 polyglactin 910 suture (Vicryl, Ethicon), and a final water rinse was performed to lyse any potential retinoblastoma cells. Surgical objectives were achieved, vision remained stable, and no retinoblastoma spread was noted with a mean follow-up of 7.6 months (range: 3-12 months). Conclusions: This vitrectomy technique for eyes with regressed retinoblastoma permits top-down viewing with the Versa HD LenZ. Radial placement of corneal wounds avoids suturing through the uveal tract, and a postsurgical water rinse lyses any retinoblastoma cells. This approach may obviate the need for chemotherapeutics or cryotherapy.

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

Efficacy and safety of large-scale use of vancomycin injection in infusion bottle during vitreoretinal procedures.

The purpose of this study was to assess the safety and efficacy of large-scale use of vancomycin injection in an infusion bottle during vitreoretinal procedures. This was a retrospective evaluation of all vitreoretinal procedures done in the last 70 months, where intraoperatively vancomycin injection (0.2 mg/mL) was used in an infusion bottle prophylactically as standard care. Vitreoretinal procedures were categorized as major (duration >30 min), minor (duration <30 min), and silicone oil removal. Postoperatively, a detailed ocular examination was done to rule out hemorrhagic occlusive retinal vasculitis (HORV) or signs of postoperative bacterial endophthalmitis. Over the last 70 months, a total of 31,720 vitreoretinal procedures were performed, which included 24,371 major vitreoretinal procedures, 1401 minor vitreoretinal procedures, and 5948 silicone oil removal cases. None of these cases developed HORV or bacterial endophthalmitis. Vancomycin (0.2 mg/mL) in infusion fluid during vitreoretinal procedures is safe and can be advocated as a prophylactic measure against postvitrectomy bacterial infections.