Silicone Removal Research Articles

Integrative Review on Silicone Breast Implants and ASIA Syndrome: What is the relationship?

OBJECTIVE: The study aims to indicate the correlation between breast implants and the occurrence of ASIA Syndrome. METHODOLOGY: The articles were selected from the PubMed database, published between 2016 and 2021. The research used the Health Science Descriptors (DeCS) and their synonyms, in English: breast implants, silicones, autoimmune diseases and rheumatic diseases . RESULTS: Despite the divergent results between the studies analyzed, in most cases the correlation is evident between breast implants and the occurrence of autoimmune diseases. DISCUSSION: ASIA syndrome is involved as an adjuvant factor for the development of autoimmunity, as there is an exacerbation of the immunological response, with the release of cytokines and defense cells in the body with the presence of breast implants. The diagnosis is made based on the patient's symptoms and past history, in which there are characteristic symptoms. The main treatment is the extraction of breast implants. There is an important correlation between low vitamin D levels and ASIA syndrome, in addition to the presence of other autoimmune diseases. CONCLUSION: Breast implants can be an adjuvant for the occurrence of ASIA syndrome, being reaffirmed by the improvement factors after silicone removal.

Removal Large Fragment of Metal Wire from Eye Using Vitrectomy. Clinical Case

Purpose. Demonstration of non-standard clinical case of removing large fragment of metal wire from the eye. Patient and methods. Patient, 37 years old, with penetrating right eye injury with intraocular foreign body (IOFB) introduction — a fragment of metal wire. After unsuccessful attempt to remove IOFB during primary repair of eye injuries lacerations by ophthalmologist of the surgical department of the district hospital, he was sent to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution. On admission: VIS OD — 0.01 uncorrected, intraocular pressure (IOP) — 16 mm Hg (noncontact tonometer TOMEY, Japan). OD — metal IOFB protrudes by 1.0 mm from the corneoscleral laceration in projection of corneal limbus at the 13 o’clock position, postoperative aphakia; according to B-scan ultrasonic data: metallic foreign body of linear shape, 14.3 mm long, about 1.5 mm thick. There is hemorrhage in the vitreous cavity. Results. Initially, conditions for visualization of the vitreous cavity were created by performing 25G vitrectomy. The course of wire location was specified: under the choroid and retina, going out through the sclera in the equatorial region. After conjunctival tweezers expanded wound edges, the embedded fragment of wire was delicately remove: 25 mm in length and 2 mm in diameter. A single retinal break was delimited by cryotherapy and laser photocoagulation. On the 2nd day: VIS OD — 0.3 with diaphragm, uncorrected; IOP — 13 mm Hg. After 3 months: VIS OD — 0.01 sph + 13.0 D = 0.7, IOP — 14 mm Hg. Silicone removal was combined with intraocular lens implantation model RSP-3 (+23D). The next day: VIS OD — 0.3 with diaphragm, 0.5 cyl — 6.0 D ax 170 = 0.5; IOP — 16 mm Hg. Conclusion. Use of 25G vitrectomy for removal IOFB localized between the inner membranes of the eye created optimal conditions for visualizing depth of its penetration, which minimized traumatic impact and avoided severe intra- and postoperative complications.

Facial Feminization Surgery: Anatomical Differences, Preoperative Planning, Techniques, and Ethical Considerations.

Facial Feminization Surgery (FFS) is a transformative surgical approach aimed at aligning the facial features of transgender women with their gender identity. Through a systematic analysis, this paper explores the clinical differences between male and female facial skeletons along with the craniofacial techniques employed in FFS for each region. The preoperative planning stage is highlighted, emphasizing the importance of virtual planning and AI morphing as valuable tools to be used to achieve surgical precision. Consideration is given to special circumstances, such as procedure sequencing for older patients and silicone removal. Clinical outcomes, through patient-reported outcome measures and AI-based gender-typing assessments, showcase the efficacy of FFS in achieving proper gender recognition and alleviating gender dysphoria. This comprehensive review not only offers valuable insights into the current state of knowledge regarding FFS but also emphasizes the potential of artificial intelligence in outcome evaluation and surgical planning to further advance patient care and satisfaction with FFS.

Synergetics Versavit 2.0 Vitrectomy System

The Synergetics VersaVIT 2.0 (Bausch and Lomb) unit has been introduced as a portable system that can be easily moved from the operating room to the office environment and can also run on battery power. Although the VersaVIT 2.0 system is frequently preferred for uncomplicated and long-lasting cases such as vitreous hemorrhage, vitreous condensation, epiretinal membrane, and macular hole, especially in private practice and outpatient surgery centers, complicated vitreoretinal surgeries can also be performed with the system. The installation of the system is provided in a very short time, such as 10 seconds, and due to its simplicity of use, it is possible to perform surgery with personnel who do not have vitrectomy training. VersaVIT 2.0® is a unique portative vitrectomy system that has a cut rate of 6000 cpm. The entire unit is quite light. It can run on electric current power or up to 60 minutes on a rechargeable internal battery. This system includes the entire vitreoretinal product line, including endolaser probes, endoilluminators, chandeliers, and packs. It allows working with 23, 25, and 27g trocar systems and product bases. Illuminated options of laser probe, vitrector, and infusion cannula are available. Endoilluminators have options that provide both focal, Middlefield, and widefield panoramic lighting. Unlike the first model, VersaVIT 2.0 also has the option of silicone injection and removal features. It has a new trocar system for faster and more practical application. Special trocars are available for pediatric cases. VersaVIT 2.0 is a vitrectomy machine that is portable due to its small size and is preferred in selected cases and also allows advanced vitreoretinal surgeries with its sufficient fluidity and good cutting properties.

Клинический анализ эффективности анатомического восстановления фовеолярной сетчатки в витреоретинальной хирургии сквозных макулярных разрывов

Purpose. To compare the anatomical and functional results of various techniques macular hole (MH) closure. Material and methods. 24 patients (age from 67 to 81 years; 6 men and 18 women): stage III MH, complete detachment of the posterior hyaloid membrane. MH sizes were from 427x202 to 1392x758 µm. Initial best-corrected visual acuity (BCVA) were from 0.03 to 0.2. Endovitreal intervention 27G with removal of the posterior hyaloid membrane, complete membrane peel was performed. In 18 patients, tamponade was performed with silicone oil, in the remaining 6 patients – with air. 2 groups were formed, comparable in age, sex, MH diameter. In the 1st group (12 patients) vacuum massage was performed, in the 2nd group (12 patients) – partial membrane peel with inverted internal limiting membrane flap technique. Results. All surgery perfomed without complications. In 18 eyes with silicone oil tamponade, all MH were completely closed, BCVA was from 0.15 to 0.5. In 2 of 3 eyes of the 1st group with combination of vacuum massage and pneumotamponade, incomplete closure of the edges of the MH with residual defects 112 µm and 84 µm, respectively, was noted. BCVA ranged from 0.1 to 0.2. In the third case of combination of vacuum massage with pneumotamponade, the MH completely closed, the BCVA increased from 0.2 to 0.6. In all 3 eyes, using the inverted flap technique and pneumotamponade, the MH were completely closed, the BCVA ranged from 0.45 to 0.55. After 1 month after ended of silicone oil tamponade in all 18 patients, the MH were closure, BCVA values increased from 0.25 to 0.5. Conclusion. After a month of follow-up, better anatomical results of complete MH closure were shown by the inverted flap technique in combination with air or silicone oil tamponade. After silicone removal, complete MH closure occurred in 10 eyes of the 1st group and 12 eyes of the 2nd group. In the future, the terms of dynamic observation of these patients will be continued for more objective assessment of the long-term effectiveness of both methods. Keywords: macular hole, vacuum massage, vitreous tamponade

Частичная тампонада витреальной полости стерильным воздухом как способ профилактики послеоперационного гемофтальма у пациентов после удаления силиконового масла

Purpose. To improve the technique for silicone oil removal from vitreal cavity. Material and methods. A technique for silicone oil removal with simultaneous prevention of intravitreal bleeding in the early postoperative period was developed and tested on 44 patients. For a comparative assessment of the effectiveness of the proposed methodology, a pilot prospective case-control study was conducted. The total number of observations was 40 patients with a diagnosis of operated retinal detachment, avitria, silicone tamponade. The main group (20 observations) included patients who underwent surgery using the proposed technique. The control group (20 observations) included patients who underwent surgery in the traditional way (after silicone removal, the vitreal cavity was filled only with saline solution). Results and discussion. All patients from the first group were discharged on the first day after the operation; only 80 % of patients from the control group were discharged on the first day. In the main group of patients, there were no cases of postoperative hemophthalmos; in the control group, this complication was noted in 20 % of the study participants. The proposed technique allows to significantly reduce the frequency of intravitreal bleeding in the early postoperative period after the silicone oil removal from the vitreal cavity, which helps to reduce the time of postoperative rehabilitation of patients and improve visual acuity – a key criterion for the quality of medical care for patients with vitreoretinal pathology. Keywords: silicone oil removal, hemophthalmos

LONG-TERM MICROVASCULAR REMODELING AND CYSTIC CHANGES AFTER RETINAL DETACHMENT TREATED WITH SILICON OIL TAMPONADE.

To determine the long-term microvascular alterations associated with macular cystic changes after retinal detachment surgery with silicone oil tamponade. The results of two optical coherence tomography angiographies performed at 11 months and 38 months after silicone removal were retrospectively analyzed for 30 eyes. The data were compared between both measurements and between eyes with macular cysts (MC+) and without macular cysts (MC-). Two patterns of cysts were identified and compared: cysts exclusively involving the inner nuclear layer (INLc) and cysts present in all retinal layers. At both end points, 20 eyes (67%) presented with macular cysts, 12 of them (40%) had INLc. At the first end point, vascular density of superficial capillary plexus was higher and superficial foveal avascular zone was smaller in MC+ eyes than in MC- eyes (P = 0.04 and P = 0.017, respectively). At the second end point, vascular density of superficial capillary plexus significantly decreased in MC+ eyes as compared with the first end point (P < 0.001) and superficial foveal avascular zone enlarged (P < 0.001). Macular central thickness decreased between follow-ups only in eyes with INLc (P < 0.01). The final best-corrected visual acuity was better in eyes with INLc than in eyes with cysts present in all retinal layers (P < 0.01). There was no difference between the final best-corrected visual acuity in eyes with INLc and MC- eyes. Macular cysts are a common finding long after silicon removal. Vascular remodeling seems characterized by an initial increase of the vascular density of superficial capillary plexus in eyes with cysts, which is followed by its progressive decrease. The INLc is the most common pattern of cysts. They are associated with a progressive decrease of the central macular thickness without visual impairment.

Logbook of a Retinal Autograft.

This study aimed to evaluate the prognosis of a retinal autograft that was used to treat a macular hole that occurred after repeated vitreoretinal surgeries. A patient underwent repeated vitreoretinal surgery due to retinal detachment in the right eye, and the internal limiting membrane was also removed during the surgeries. After silicone oil removal, the patient developed recurrent retinal detachment and macular hole, and for this reason a retinal autograft was applied to the macular hole and silicone tamponade was administered. The silicone oil was removed at postoperative 7 months, and the macular hole was observed to be closed on fundus examination at 18 months. The final visual acuity was 5/100. On optical coherence tomography (OCT), the hole in the detached retina was measured as 600 µm in diameter preoperatively, 1020 µm on the first postoperative day, gradually narrowed to 765 µm, and graft integration occurred. During follow-up, the accumulation of hyperreflective spots persisted on the inner surface of the graft tissue and in all vertically extending sections. In en face sections, it appeared as a hyperreflective arc between the graft and host retina with a shadowing artefact. In OCT angiography evaluation, a punctate multiple blood flow signal in the vertical axis of the graft was detected in the early phase at 3 months. This finding persisted at 1 month after silicone removal, and the flow signal disappeared with resorption of the cystic edema. These flow signals were in the same location as the areas of hyperreflective spots on structural OCT. In conclusion, structural OCT and OCT angiography are effective methods for the follow-up of retinal autograft integration into host tissue.

Causes and Managements of Early-Onset Ocular Hypertension Following Pars Plana Vitrectomy with Silicone Oil for Retinal Detachment and Exploration of Trabeculectomy as a Viable Alternative Management: A Pilot Study.

This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy with silicone oil (PPV with SO) procedure for retinal detachment. Additionally, to explore the outcome of trabeculectomy in managing such patients. This is a retrospective exploratory pilot study. We studied 23 patients who underwent the procedure then subsequently developed ocular hypertension within a month of the procedure. The probable causes for their early-onset ocular hypertension were identified and addressed with medicine, peripheral iridotomy (PI), complete or partial silicone removal. Trabeculoplasty was done in irretractable causes. This study aimed to evaluate the causes of early onset ocular hypertension after pars plana vitrectomy with silicone oil and explore the outcome of different managements including trabeculectomy. Inflammation (n=11, 47.8%) was the most common cause of early-onset ocular hypertension. Other causes were overfilling/spilling of silicone oil in anterior chamber (n=5, 21.7%), pupillary block (n=4, 17.4%) and angle-recession glaucoma (n=2, 8.69%). Majority of the cases responded to intraocular pressure (IOP) lowering medications (n=11). Three eyes with persistently high intraocular pressure underwent trabeculectomy after which the intraocular pressure was controlled. Even though prior studies have reported that trabeculectomy does not address late-onset ocular hypertension, our study shows that the procedure might be helpful in early-onset ocular hypertension. This is probably because at the time of presentation for early-onset ocular hypertension, silicone has not emulsified, which will not be the case in late-onset ocular hypertension. If a large study also shows that trabeculectomy can correct early-onset ocular hypertension, this information can guide the practices of ophthalmologists whose patients cannot afford expensive glaucoma drainage devices.

The effect of longstanding silicone oil on retina choroid and optic nerve in eyes with retinal detachment: an optical coherence tomography study

BackgroundThe study aims to evaluate peripapillary retinal nerve fiber layer thickness (RNFL-T), central macular thickness (MT), choroidal thickness (CT), and thickness of each retinal layer after automatic segmentation in patients who underwent retinal detachment (RD) repair with longstanding silicone oil tamponade.MethodsWe enrolled 33 patients who underwent complicated primary rhegmatogenous RD surgery and followed up with a long-term silicone tamponade were included in this retrospective comparative (case–control) study. RNFL-T, CT, and thickness of each retinal layer after automatic segmentation analysis were measured after the longstanding silicone removal surgery.ResultsThe mean silicone oil removal time was 15.1 ± 15.2 (7–70) months. The overall average thickness of the RNFL was 90.7 ± 13.6 μm in the operated eyes and 118.3 ± 35.6 μm in the sound eyes, with a statistically significant difference. The overall average central MT was 186.3 ± 57.7 μm and was significantly lower in the operated eyes than in the sound eyes. Inner retinal layers of the study group showed a significant thinning in the nerve fiber layer, ganglion cell layer, inner plexiform layer, and inner nuclear layer as compared to that of the sound eyes. The subfoveal CT was 213.7 ± 86.6 μm in the study eyes and 217.7 ± 115.5 μm in the control eyes. There was no significant difference between the study eyes and controls.ConclusionThe effects of silicone oil on the retina remain uncertain; however, morphological results in our study have shown direct or indirect silicone oil–induced toxicity, especially in the inner retinal layers.

Assessment of pathologies detected on retinal imaging simultaneous with silicone removal surgery

Assessment of pathologies detected on retinal imaging simultaneous with silicone removal surgery

Evaluation of the Effects of Silicone Oil on the Macula with Optical Coherence Tomography in Patients with Rhegmatogenous Retinal Detachment

Objectives:The effects of silicone endotamponade duration on the macula were evaluated in patients with rhegmatogenous retinal detachment.Materials and Methods:Sixty-five eyes of 65 cases with rhegmatogenous retinal detachment that underwent pars plana vitrectomy and silicone endotamponade were included in the study. All cases were classified in three groups according to duration of silicone tamponade: ≤3 months, 3-6 months, and ≥6 months. All cases were evaluated at 1 week, 1 month, and 3 months after silicone injection, just before and at 1 month after silicone removal in terms of intraretinal pathologies in the macula by using spectral-domain optical coherence tomography (SD-OCT).Results:Sixteen (26.6%) of the patients were female and 49 (75.4%) were male. The mean age of the patients was 58.1±12.1 years (18-82); the mean follow-up time was 12.4±4 months (6-20). The mean duration of silicone tamponade was 6.7±2.3 months (2-12). In 26.6% of patients with ellipsoid zone/outer limiting membrane defect, a statistically significant improvement in reflectivity was detected after silicone oil removal (p=0.016). There was a significant increase in central foveal thickness after silicone removal in eyes with duration of silicone more than 3 months (p=0.003 for 3-6 months, p=0.006 for ≥6 months). The prevalence of cystoid macular edema before and after silicone removal was also significantly higher in the eyes with silicone duration of 6 months or longer (p<0.001).Conclusion:In eyes with silicone endotamponade, structural changes in the macula may differ according to the duration of silicone oil in the eye.

Retinal electrophysiological changes related to early versus late silicone oil removal.

To compare between the effect of early (3months) and late (6months) silicone removal on the electroretinogram records. Thirty-four eyes with complex primary rhegmatogenous macula off retinal detachment undergone vitrectomy. Silicone oil was removed after 3months in group I and after 6months in group II. Scotopic and photopic ERGs, pattern electroretinogram (PERG) and multifocal ERG (mfERG) and best-corrected visual acuity (BCVA) were recorded for all eyes RESULTS: Preoperative mean best corrected visual acuity (BCVA) measured was 0.93 ± 0.05 in group I and 0.9 ± 0.08 in group II. One month after silicone removal, mean BCVA was 0.20 ± 0.04 and 0.18 ± 0.02 in groups I and II respectively. Before silicone oil removal the electroretinographic a- and b-waves were greatly reduced in both groups with no significant difference between them. One month after removal of silicone oil, the electroretinographic a- and b-waves increased in both groups with no significant difference between the two groups (p = 0.46 and 0.23 respectively). The amplitudes of the ERGs increase after removal of silicone oil tamponade with no difference between early (3months) and late (6months) removal.

Changes in Eyelid Position Following Silicone Tube Insertion and Removal in Dacryocystorhinostomy.

The authors sought to assess the changes in eyelid position after silicone tube insertion and removal in endoscopic dacryocys-torhinostomy. The authors retrospectively reviewed 60 eyes of 48 consecutive patients who underwent endoscopic dacryocystorhinostomy operation at Korea University Guro Hospital, Seoul, Republic of Korea, between April 2019 and November 2019. All cases were evaluated to discern eyelid positioning, focusing on the marginal reflex distance 1, medial palpebral fissure, central palpebral fissure (PF-2), lateral palpebral fissure (PF-3), and medial canthal angle (MCA) before surgery and at 1 week and 1, 2, 3, and 4 months postoperatively. Twelve patients (25%) were operated on bilaterally and 36 patients (75%) were operated on unilaterally. The average patient age was 56.5years and 9 men (18.8%) and 39 women (81.3%) were included in this study. At 2 months postoperatively, all values of interest (marginal reflex distance 1, medial palpebral fissure, PF-2, PF-3, and MCA) had decreased significantly (p < 0.05, Friedman test), but the changes in PF-3 immediately after surgery were not significant (P = 0.062, Wilcoxon rank-sum test). From 2 to 3 months after surgery, all 5 indicators of interest increased significantly. After silicone tube removal, whereas there was no statistically significant difference in medial palpebral fissure, PF-3, and marginal reflex distance 1 values; the changes in PF-2 and MCA values as compared with before surgery was 0.47 mm (p = 0.02, Wilcoxon test) and 3.25° (p = 0.000, Wilcoxon test), respectively, which was significantly different. However, with these small gaps, it will be difficult to notice the changes in PF-2 and MCA values during clinical examination. Insertion of a silicone tube during endoscopic dacryo-cystorhinostomy leads to temporary deformation of the lid position. However, after silicone tube removal, all eyelids recovered to their original shape.

Vitrectomy and silicone oil tamponade with and without phacoemulsification in the management of rhegmatogenous retinal detachment: A comparative study

Background: A cataract inevitably develops after pars plana vitrectomy (PPV) with silicone tamponade. In patients with rhegmatogenous retinal detachment (RRD) of presbyopic age and without significant cataracts, phacoemulsification can be deferred to the time of silicone removal. Alternatively, it can be performed with PPV. Sparse evidence exists to choose one option over the other; this is usually left to the surgeon’s preference. Aim: To compare PPV with silicone tamponade alone, or combined with phacoemulsification for primary RRD, in patients without significant cataracts. Setting: This is a comparative prospective randomised interventional study that was conducted in Cairo University hospitals. Methods: The patients were randomised to two groups, each with 20 phakic patients presenting with RRD. Patients in Group A were randomised to PPV, followed by the phaco-silicone removal. Patients in Group B were randomised to phaco-vitrectomy, followed by silicone removal. Results: No statistically significant difference existed between the groups regarding the rate of intraoperative complications. Group B patients had a higher rate of early postoperative complications (intraocular pressure [IOP], corneal oedema and anterior chamber reaction). At final follow-up there was no statistically significant difference between the groups regarding the rate of retinal attachment or the best corrected visual acuity. Calculation of lens power was significantly more accurate in Group A, as evidenced by the difference in the mean spherical equivalent (Group A: –0.75 dioptre [D] vs Group B: –2.5 D, p = 0.031). Conclusion: This study suggests that no difference exists between the surgical options regarding anatomical success and intraoperative complications. Deferring phacoemulsification until the time of silicone oil removal offers an option with fewer early postoperative complications and more accurate lens power calculation.

The effect of silicone oil presence time on macular and choroidal thickness with macula-off rhegmatogenous retinal detachment

To investigate the effects of silicone oil (SiO) on macular thickness (MT) and subfoveal choroidal thickness (SFCT) in patients with macula-off rhegmatogenous retinal detachment (RRD) undergoing pars plana vitrectomy (PPV). In this prospective study, 70 eyes of 70 patients who received SiO tamponade for the treatment of macula-off RRD were treated with PPV and a 5000-cSt SiO endotamponade followed by subsequent SiO removal. MT and SFCT were measured 1 day before and 3 months after SiO removal using spectral-domain optical tomography (SD-OCT) and enhanced depth imaging optical tomography (EDI-OCT). The patients were divided into 3 groups according to the length of time that the SiO was present: group 1 (3-6 months), group 2 (6-9 months), and group 3 (9-18 months). A total of 70 eyes of 70 patients with a mean age of 57.22±9.83 years (range: 30 years to 75 years) were included in the SiO (5000-cSt) study. SiO was extracted after a mean duration of 8.67±5.33 months (range, 3-18 months) after PPV. In the 1st group, BCVA increased from 1.83±0.32 log MAR before PPV to 0.85±0.41 log MAR at 3 months after silicone removal (P<0.001). In the 2nd group, BCVA increased from 1.76±0.38 log MAR before PPV to 0.86±0.48 log MAR at 3 months after silicone removal (P<0.001). In the 3rd group, BCVA increased from 1.89±0.28 log MAR before PPV to 1.08±0.63 log MAR at 3 months after SiO removal (P=0.001). There was no statistically significant change in MT in the difference values of each group. As the length of SiO presence in the eye increased, significant thinning was observed on measurement of SFCT. Differences in the SFCT values were -14.91μm, -18.76μm, and -51.50μm in groups 1, 2, and 3 respectively (P=0.004). A significant decrease in macular and choroidal thicknesses after SiO removal was observed. Presence of SiO endotamponade for 9 months was associated with subfoveal choroidal thinning and decreased final visual acuity in eyes undergoing RRD surgery. SD-OCT and EDI-OCT may be recommended for the treatment and follow-up of patients with complications caused by the use of SiO tamponade.

Management of Capsular Contracture in Cases of Silicone Gel Breast Implant Rupture with Use of Pulse Lavage and Open Capsulotomy.

Pulse lavage (PL) irrigation of prosthesis pockets has prior been described for breast implant salvages. However, PL for removal of leaked silicone from prosthesis pockets after implant ruptures has not been studied yet. Since open capsulotomies are regarded as equal treatment of capsular contracture (CC) than capsulectomies, this study analyzed the clinical outcome of PL for silicone removal and subsequent capsulotomy in cases of concurrent CC and breast implant rupture. Between 2012 and 2017, 55 patients (75 breasts) with suspected silicone implant rupture and CC (Baker grade III/IV), after primary breast augmentation or implant-based breast reconstruction, were included in a retrospective, observational study. Mean patient follow-up was 12.2 ± 3.6months. In all preoperatively suspected ruptured silicone breast implants, around a quarter were intact. In contrast to previously published data, implant exchanges in cases of implant ruptures did not lead to significantly higher CC recurrence rates (27.6% vs. 22.2% in cases of intact implants, p = 0.682), if the prosthesis pockets were treated with PL irrigation followed by open capsulotomy. PL reduced the amount of encapsulated silicone remnants histologically. The age of patients with CC after failed implant-based reconstruction was significant lower for salvage surgeries with flap reconstruction than for implant exchanges, p < 0.05. PL irrigation of prosthesis pockets prior to open capsulotomy is a safe and effective treatment of CC with concurrent silicone leakage. Remaining silicone remnants in breast capsules may affect the development of a recurrent CC. To avoid CC recurrences, patients should consider conversion to autologous tissue. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Retinal Sensitivity before and after Silicone Oil Removal Using Microperimetry.

The purpose of the study is to assess the retinal sensitivity, using microperimetry, before and after silicone removal. It included 22 patients admitted for silicone removal after vitrectomy for macula-off retinal detachment. Patients were divided into 2 groups according to the duration of silicone tamponade: Group A: <3 months (included 10 patients), and Group B: 3–6 months (included 12 patients). Retinal sensitivity was tested, using microperimetry, one day before and one month after silicone removal. The best-corrected visual acuity (in LogMAR) significantly improved postoperatively (0.69 versus 1.06 and 0.69 versus 1.07 in Groups A and B, respectively). The mean intraocular pressure (IOP) was 12.89 ± 1.05 mmHg postoperatively versus 14.89 ± 1.76 mmHg preoperatively in Group A (p=0.011) and was 13.33 ± 1.30 mmHg postoperatively versus 15.33 ± 3.11 mmHg preoperatively in Group B (p=0.008). In Group A, the mean postoperative overall retinal sensitivity was 8.70 ± 2.56 dB versus 5.68 ± 2.00 dB preoperatively (p=0.008). In Group B, it was 9.83 ± 3.36 dB versus 7.00 ± 2.55 dB (p=0.002). No statistically significant difference was found between the two groups as regards improvement in overall retinal sensitivity. We concluded that the overall retinal sensitivity significantly increased following silicone removal in both groups. This trial is registered with ISRCTN43187564.

Use of bilayer matrix wound dressing in the exenterated socket

ABSTRACTTo describe the novel use of a bilayer dermal substitute to reconstruct exenterated orbits. A retrospective chart review was performed in the practices of two surgeons (RET and PDL) of all patients who had undergone orbital exenteration between April 2014 and June 2016 and whose subsequent reconstruction included lining the socket with Integra bilayer. Patient demographics, pathologic diagnoses, surgical and post-operative complications, graft integrity, and patient acceptance were recorded. The charts of 7 patients (4 men and 3 women, ages 60–87 years) were reviewed. In all cases, the Integra graft had taken well to the socket bed at the time of silicone removal 3-4 weeks after surgery. Epithelialization of the socket occurred rapidly over the Integra graft (within several weeks) without incident in each case and with minimal postoperative management. No intraoperative or postoperative complications were noted. Integra dermal substitute is an ideal graft for the lining of an exenterated orbit. It is readily available in large quantities, handles easily, lines the socket smoothly, epithelializes rapidly, and requires minimal postoperative care. It offers minimal morbidity compared to skin grafting or free flap reconstruction, but greatly speeds epithelialization compared to laissez faire management. Surgeons should consider reconstructing exenterated orbits with the Integra matrix, both for its ease of use and its ability to epithelialize rapidly.

Silicate and silicone removal by pretreatment to prevent membrane fouling in garment washing wastewater treatment

Membrane technology is being increasingly used in reclamation of textile wastewater. High concentration of silicate and silicone auxiliaries in garment washing wastewater can cause detrimental and unbearable fouling on membrane. Chemical pretreatment before membrane separation is feasible to prevent fouling. Experiments of coagulation were conducted to investigate the characteristics of silicate and silicone removal for reclamation of garment washing wastewater. Two precipitants were tested: iron salt TW-19 and calcium oxide. The optimum precipitant dose is 400 ppm TW-19 in combination with 75 ppm calcium oxide with pH = 9·8 for the garment washing wastewater. Polyacrylamide (PAM) as precipitant aid was also tested with optimum precipitant doses. 2 ppm of PAM is helpful to reduce the metal ions concentration to decrease membrane fouling potential.