New technique for removal of perfluorocarbon liquid related sticky silicone oil and literature review

AIM: To investigate the safety and efficacy of sticky silicone oil (SSO) removal using a 22-gauge vein detained needle and inner limiting membrane (ILM) wrap-and-peel technique. METHODS: This retrospective consecutive case series reviewed the records of patients with a history of retinal detachment who had received silicone oil and perfluorocarbon liquid (PFCL) as intraocular tamponades. Patients were included in the analysis if they exhibited SSO remnants during silicone oil removal. The aspiration of most of the SSO remnants was performed by a 22-gauge vein detained needle. The small amounts of droplets adhered to the macula and epi-macular membrane were subsequently removed by the ILM warp-and-peel technique. The anatomical and functional outcomes, and postoperative complications were recorded. In vitro experiments were performed to simulate the formation of SSO remnants in four groups. RESULTS: Of 711 patients who underwent silicone oil removal during the study period, 9 patients exhibited SSO remnants and underwent follow-up for at least 3mo. Seven eyes (78%) underwent the ILM wrap-and-peel technique to completely remove small droplets of SSO that were glued to the macula and epi-macular membrane. No obvious complications occurred. Postoperative optical coherence tomography revealed normal retinal structure in all patients. In vitro analyses showed that balanced salt solution and prolonged vibration (for 1wk) had the strongest effects on silicone oil and PFCL compound opacities. CONCLUSION: SSO remnants could be removed in an intact manner and without complications, using a vein detained needle-assisted and ILM wrap-and-peel technique. The findings suggest that PFCL and infusion fluid should be completely removed before silicone oil injection to prevent SSO formation.

A novel design silicone oil removal cannula

Background: Silicone oil, which is one of the most commonly used endotamponades in vitreoretinal surgery, is removed after a certain period of time in most cases. In this study, we present our results with a unique cannula that provides effective and safe silicone oil removal. Aims and Objectives: To assess the aids and success of silicone oil removal with a novel 23-gauge cannula for the patients who underwent pars plana vitrectomy and silicone oil injection before. Materials and Methods: 72 eyes of 64 patients who operated by the same surgeon (FA) between May 2017 and May 2019 were involved in the study. The primary indications were proliferative diabetic retinopathy in 46 (63.9%) eyes and retinal detachment in 26 (36.1%) eyes. Phacoemulsification and intraocular lens implantation (23 eyes), membrane peeling (23 eyes), internal limiting membrane peeling (5 eyes), and argon laser endo-photocoagulation (37 eyes) performed in the same session. Furthermore, perfluorocarbon remnants aspirated in 9 eyes and 17 eyes needed suturing. Descriptive statistical analyses achieved by SPSS 10.5 statistical software. Results: The mean follow-up time was 11.7 + 2.5 months (between 3 and 23 months), and the mean age was 61.4 + 8.52 years (between 44 and 69 years). 1000 centistokes (cSt) silicone oil was removed from 61 (84.7%) eyes, and 5000 cSt silicone oil was removed from 11 (15.3%) eyes. The mean removal time was 2.04 + 0.1 min for 1000 cSt silicone oil and 5.11 + 0.3 min for 5000 cSt silicone oil. 4 re-detachment and 3 vitreous hemorrhage observed in follow-up period. Post-operative silicone oil remnants were not detected in any patient. Conclusion: The unique 23-gauge cannula provides silicone oil removal without any conjunctival cut-down and sclerotomy enlargement. Thus, it reduces the duration of surgery and post-operative recovery period.

Phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients.

BACKGROUND: The «gold standart» for surgical treatment of patients with proliferative diabetic retinopathy (PDR is vitreoretinal surgery. However, the question of the timing of the removal of primary cataract in this category of patients remains open.AIM: To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patientsMETHODS: 67 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsifi tion surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsifi tion performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity.RESULTS: Visual functions improved in 88.6% of cases in group 1, and in 68.7% in group 2.CONCLUSIONS: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.