Silicone Oil in the Management of Retinal Detachment with Acute Retinal Necrosis

Introduction: Alemtuzumab is a humanized monoclonal antibody used as a treatment of multiple sclerosis (MS) and chronic lymphocytic leukemia. It decreases T cell count leading to significant immunosuppression, with increased risk of systemic and ocular infections. Herein, we report a unique case of bilateral acute retinal necrosis (ARN) caused by varicella-zoster virus (VZV) in a patient affected by MS under treatment with alemtuzumab. Case description: A 36-year-old man with a relapsing-remitting MS under treatment with alemtuzumab developed bilateral visual loss. Anterior segment examination displayed granulomatous keratic precipitates and 3+ cells in the anterior chamber, while fundoscopy showed bilateral 1+ vitritis and peripheral retinal necrosis, complicated by retinal detachment in the left eye. The high viral load for VZV in aqueous humor samples had a univocal interpretation for viral reactivation. In addition to systemic therapy with acyclovir, the patient was treated with bilateral intravitreal injections of foscarnet and underwent pars-plana vitrectomy and silicone oil tamponade for retinal detachment in the left eye. Conclusion: This report shows a unique case of bilateral ARN caused by VZV associated with alemtuzumab. Any visual loss in MS patients under biologic therapy should not be underestimated, performing an accurate differential diagnosis with optic neuritis.

Download Full-text

An algorithm for managing surgical patients with acute retinal necrosis

Russian Ophthalmological Journal ◽

10.21516/2072-0076-2018-11-4-29-35 ◽

2018 ◽

Vol 11 (4) ◽

pp. 29-35

Author(s):

V. V. Neroev ◽

P. A. Ilyukhin ◽

V. E. Tankovsky ◽

R. A. Fedotov

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Retinal Detachment ◽

Comparison Group ◽

Silicone Oil ◽

Clinical Manifestations ◽

Main Group ◽

Acute Retinal Necrosis ◽

Surgical Patients ◽

Irreversible Damage

Purpose. To increase the efficiency of surgical treatment and develop an algorithm for managing patients with the consequences of acute retinal necrosis (ARN).Material and methods. The study included 35 patients (42 eyes) aged 18 to 74 with acute retinal necrosis. All patients underwent a microinvasive (23 Ga) vitrectomy with membrane peel, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. The operated eyes were divided into 2 groups. The main group consisted of 17 eyes with a clinical picture of fibrosis of the vitreous without retinal detachment (10 eyes) and retinal detachment without pronounced fibrosis of the vitreous (7 eyes). The comparison group included 25 eyes which had retinal detachment and fibrosis of the vitreous at the time of surgery. The visual acuity varied between incorrect light projection and 0.15 with correction.Results. A stable anatomical and optical result was achieved in all cases. Complete adhesion of the detached retina was achieved in 94.1 %, which is explained by the fact that surgical treatment was in most cases performed in the absence of pronounced stages of proliferative vitreoretinopaty. In all cases of the main group, an increase in visual acuity was noted. In 53 % of cases, visual acuity achieved 0.1 to 0.3 and in the remaining 47 % it was 0.3 % or above. This can be accounted for by the prevalence of peripheral necrotic lesions, as well as a lower incidence of macular edema and optic neuropathy. However, in the comparison group, an increase in visual acuity was only observed in 56 % cases, with visual acuity reaching 0.1 or higher only in 24 % of the eyes. A high frequency (72 %) of necrosis expansion to the posterior eye pole with an irreversible damage to the optic nerve and the macular region was revealed.Conclusion. Active dynamic observation of patients with ARN helps detect changes requiring surgical treatment, which leads to higher functional and anatomical outcomes, as well helps avoid the disability of the patients. Surgical treatment prior to the formation of retinal detachment in severe traction syndrome with or without retinal tears is advisable. An algorithm was proposed for managing surgical patients, depending on the clinical manifestations of ARN effects.

Download Full-text

Biomedical Materials to Repair Retinal Detachments

MRS Proceedings ◽

10.1557/proc-55-55 ◽

1985 ◽

Vol 55 ◽

Author(s):

Miguel F. Refojo

Keyword(s):

Retinal Detachment ◽

Silicone Rubber ◽

Methyl Acrylate ◽

Silicone Oil ◽

Vitreous Body ◽

Light Sensitivity ◽

Scleral Buckling ◽

Intraocular Injection ◽

Other Substances

ABSTRACTImplants are essential for the repair of retinal detachments. The implant buckles the wall of the eye and apposes the detached retina with the choroid, thus restoring light sensitivity to the retina. The scleral buckling also relieves traction on the retina from a shrinking vitreous body. The implant materials most commonly used are solid silicone rubber and silicone sponges, but both types have some disadvantages. A poly(hydroxyethyl acrylate-co-methyl acrylate) hydrogel implant with improved properties of softness and antibiotic absorption is also available for retinal detachment surgery. Proliferative vitreoretinopathy involves various conditions of retinal detachment complicated by vitreous fibrosis, which, after vitrectomy, may be treated with intraocular injection of fluids that support the retina against the choroid. For conditions requiring a long-term implant, silicone oil although controversial is the material of choice. Many other substances have been investigated but none better has yet been found.

Download Full-text

Extrascleral Filling Using Endoillumination the First Experiencethe

Russian ophthalmology of children ◽

10.25276/2307-6658-2020-3-43-49 ◽

2020 ◽

pp. 43-49

Author(s):

V.Y. Markevich ◽

◽

T.A. Imshenetskaya ◽

O.A. Yarmak ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Subretinal Fluid ◽

Crystalline Lens ◽

Vitreous Cavity ◽

Macular Area ◽

General Group ◽

Anatomical Outcome

Purpose. To study the effectiveness of extrascleral filling (ESF) using endoillumination in the surgical treatment of patients with primary rhegmatogenous retinal detachment (RRD). Material and methods. The material for the study was the data of a comprehensive clinical examination and surgical treatment by ESF method using endoillumination in 17 patients (17 eyes) with RRD. In 7 cases (41%), the macular area was involved in the detachment process. In 5 cases (29.4%), local scleral filling was performed. In the remaining 12 cases (70.6%), the local ESF was supplemented with a circling silicone element. Surgical intervention was supplemented by transscleral drainage of subretinal fluid (SRF) in 10 cases (59%) and pneumatic retinopexy with SF6 gas 50% in 8 cases (48%). Results. In the general group of patients, best corrected visual acuity (BCVA) increased from 0.35 to 0.46. In the subgroup of patients with a detached macular area, the positive dynamics is more pronounced, BCVA increased from 0.1 to 0.28. The progression of proliferative vitreoretinopathy caused the recurrence of retinal detachment in two patients (11.8%). Recurrences were diagnosed after 3 and 5 months, respectively. In both cases, a vitrectomy with tamponade of the vitreous cavity with silicone oil 5000 Cst was performed. The percentage of successful anatomical outcome after the first operation in our study was 82%. The percentage of successful achievement of the final anatomical result was 94%. In two cases, additional injection of SF6 gas into the vitreous cavity was required. Conclusion. This type of surgical treatment is an effective method of surgical treatment of patients with RRD. In our study, the successful anatomical outcome after the first operation was recorded in 82% of patients, which correlates with the data of the authors who also used this method (83–92%). Surgeons who performed surgical treatment using this technique in our study note improved workplace ergonomics when visualizing the fundus using an operating microscope and endoillumination compared with indirect ophthalmoscopy. Other teams of authors came to this conclusion as well. In our study, there were no complications associated with the introduction of a light pipe into the vitreous cavity (iatrogenic crystalline lens injury, endophthalmitis), which indicates the safety of this type of surgical treatment.

Download Full-text

Refractory Myopic Retinal Detachment and Macular Hole Closure with Autologous Neurosensory Retinal Free Flap

Case Reports in Ophthalmology ◽

10.1159/000500275 ◽

2019 ◽

Vol 10 (2) ◽

pp. 160-164 ◽

Cited By ~ 1

Author(s):

Filipe Sousa Neves ◽

Joana Braga ◽

Paula Sepúlveda ◽

Miguel Bilhoto

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Free Flap ◽

Vision Loss ◽

Silicone Oil ◽

Modified Technique ◽

Alternative Approach ◽

Retinal Atrophy ◽

One Year ◽

Hole Closure

The purpose of this case report is to describe a modified technique involving the use of an autologous neurosensory retinal free flap for closure of a macular hole (MH) during retinal detachment (RD) surgery. A 50-year-old female presented with sudden vision loss (light perception only) and a recurrent myopic RD associated with an MH. An autologous neurosensory retinal free flap was obtained and moved toward the MH. Silicone oil was used as an endotamponade and removed after 6 months. Two months after oil removal visual acuity improved to 20/400 and remained stable thereafter; however, the patient developed central retinal atrophy. One year after surgery the MH was closed and the retina attached. This modified technique with the use of an autologous neurosensory retinal flap provides an alternative approach for recurrent MH in RD procedures.

Download Full-text

Risk Factors For Recurrent Myopic Macular Hole Retinal Detachment After Silicone Oil Removal In Patients With Open Flat Macular Hole

Ophthalmologica ◽

10.1159/000514495 ◽

2021 ◽

Author(s):

Hamouda Hamdy Ghoraba ◽

Hosam Othman Mansour ◽

Mohamed Ahmed Abdelhafez Elsayed ◽

Adel Galal Zaky ◽

Mohamed Amin Heikal ◽

...

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Macular Hole ◽

Silicone Oil ◽

Significant Risk ◽

Minimum Diameter ◽

Univariate Logistic Regression Analysis ◽

Macular Hole Retinal Detachment ◽

Myopic Macular Hole ◽

Group 2

Purpose: To evaluate the risks that might be associated with recurrent macular hole retinal detachment (Re MHRD) after silicone oil (S.O) removal in myopic patients with open flat macular hole (MH). Methods: In this retrospective series, we assessed the different factors that might be associated with recurrent MHRD after S.O removal in 48 eyes with open flat MH that underwent S.O removal after successful MHRD repair by dividing the enrolled eyes into 2 groups: group 1 included 38 eyes with flat open MH and flat retina after S.O removal and group 2 included 10 eyes with flat open MH and recurrent MHRD after S.O removal. Results: Ten of 48 eyes (20.8%) with open flat MH developed recurrent MHRD after S.O removal. Univariate logistic regression analysis revealed that MH at the apex of PS, MH minimum diameter, hole form factor (HFF) and MH index (MHI) were significant risk factors for recurrent MHRD after S.O removal in myopic patients with open flat MH. Conclusions: If there is a "flat open" MH that is large, located at the apex of PS or with HHF or MHI of less than 0.9-0.5, it has a high chance of recurrent MHRD after S.O removal.

Download Full-text

Intravitreal Silicone Oil Migration Into the Lateral Cerebral Ventricles

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419875298 ◽

2019 ◽

Vol 3 (6) ◽

pp. 466-473

Author(s):

Jessica L. Cao ◽

Andrew W. Browne ◽

Thomas Clifford ◽

Sumit Sharma ◽

Vivek Patel

Keyword(s):

Case Report ◽

Retinal Detachment ◽

Literature Review ◽

Current Literature ◽

Symptom Management ◽

Silicone Oil ◽

Cerebral Ventricles ◽

Oil Migration ◽

Intraocular Tamponade ◽

History Of

Purpose: Silicone oil (SO) is often used as an intraocular tamponade in repairs of retinal detachments. It may be associated with complications such as cataract, glaucoma, keratopathy, subretinal migration of oil, fibrous epiretinal and sub retinal proliferations, and oil emulsification. The purpose of this report is to describe a rare phenomenon of intraocular silicone oil migration into the cerebral ventricles, which may later be mistaken for intraventricular hemorrhages on neuroimaging. Methods: Case report with literature review. Results: A patient with a history of retinal detachment repair with intraocular SO presented with headaches. Neuroimaging revealed SO migration to the cerebral ventricles. The patient was treated conservatively with symptom management and headaches resolved. Conclusions: We present a case of intraocular SO migration to the cerebral ventricles and review the current literature. We also propose two mechanisms for this phenomenon.

Download Full-text