Impact of duration of silicone oil tamponade on foveal and parafoveal thickness in rhegmatogenous retinal detachment: a retrospective cohort study.

PURPOSE: To detect and analyze the influence of the duration of tamponade with silicone oil on the foveal and parafoveal thickness in cases of rhegmatogenous retinal detachment. METHODS: This is a retrospective cohort study of 64 eyes with rhegmatogenous retinal detachment in one eye who underwent pars plana vitrectomy (PPV) with silicone oil injection during the period between January 2019 and December 2021. The patients were divided into 2 groups. Group A with early removal of the silicone oil after 3-4 months and Group B with late removal of the silicone oil (SOR) after 6-8 months. The 2 groups were compared as regards the central foveal (CFT) and parafoveal (PFT) thickness changes from baseline, just before SOR, and after SOR. Changes in best corrected visual acuity (BCVA), relative risk of severe thinning. It was conducted at Kasr Alainy Hospital. RESULTS: 64 eyes were enrolled in the study. Group A included 36 eyes, and group B included 28 eyes. The mean CFT changed insignificantly from 253 ± 52 µm to 252 ± 48 µm after SOR in group A; while it changed significantly from 211 ± 52 µm to 202 ± 46 µm after SOR in group B. The mean PFT decreased insignificantly from 299 ± 39 µm to 297 ± 40 µm in group A, while it decreased significantly from 284 ± 46 µm to 273 ± 44 µm in group B. Lines of improvement of BCVA were 4.11 ± 1.88 in group A, and 2.00 ± 1.24 in group B. Relative risk of severe foveal thinning after SOR was 14.3, and severe parafoveal thinning was 15.43, in group B compared to group A. CONCLUSION: Longer period of silicone oil tamponade may carry a higher risk for severe foveal and parafoveal thinning after silicone oil removal. TRIAL REGISTRATION: The study was registered at clinical trial.gov under the title of (Duration of silicone oil tamponade on foveal and parafoveal thickness in Rhegmatogenous Retinal Detachment) with an ID NCT05817630 at April 2023 "retrospectively registered".

Position Adherence in Patients Underwent Pars Plana Vitrectomy with Silicone Oil Tamponade.

Introduction: Position adherence of patients with Pars Plana Vitrectomy with Silicone Oil Tamponade after discharge is of positive significance. However, patients undergoing a day surgery makes the quality of discharge teaching and readiness for hospital discharge is insufficient, which will influence their position adherence at home. Aim: This study aimed to find the correlation of discharge teaching, readiness for hospital discharge, and position adherence in patients who underwent PPV with silicone oil tamponade from the day ward. Methods: This was a cross-sectional survey. One hundred ninety-four patients with day surgery were recruited by convenient sampling from Zhongshan Ophthalmic Center, China. Data were collected using the quality of discharge teaching scale, readiness for hospital discharge scale, and position adherence scale. Results: Patients' education level, residence, poor postoperative vision, ophthalmic surgery history, and quality of discharge teaching are the main factors of readiness for discharge. Only 41(21%) patients had good position adherence, and education level and readiness for discharge are the main factors of position adherence. Discussion: Discharge teaching improves patients' knowledge and competence of self-care and helps patients prepare for the transition from hospital to home, and readiness for hospital discharge significantly influences position adherence after discharge and indirectly plays a vital role in postoperative vision recovery and surgical effect.

Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment.

PURPOSE: To analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either silicone oil (SO) or gas tamponade, and the effect of these changes on visual acuity. PATIENTS AND METHODS: Retrospective study which included 26 eyes in the SO Group and 32 in the Gas Group. Optical coherence tomography (OCT) scans of the affected eyes were obtained before surgery, and 3 months after PPV in the Gas Group, and during silicone oil in situ and 3 months after SO removal, in the SO Group. Qualitative assessment of photoreceptor layer and foveal contour, along with quantitative assessment of macular retinal thickness and SFCT was performed. Postoperative OCT macular microstructural changes were recorded and correlated to corrected distance visual acuity (CDVA). Intraocular pressure (IOP) was measured preoperative and at 3 months post operative. RESULTS: There was a 2-line loss (from 20/28 preoperatively to 20/40 at final follow-up) of CDVA in the SO Group (p=0.051), while there was no statistically significant change in CDVA in the Gas Group (p=0.786). There was no significant correlation between CDVA loss and duration of silicon tamponade (r=-0.031, p=0.893). There was a statistically significant increase in IOP from its baseline to final follow-up of 0.7 mmHg in the SO Group (p=0.023) while there was no statistically significant change in IOP in the Gas Group. During silicone oil tamponade, there was approximately 11% and 5% of retinal and sub-foveal choroidal thinning respectively, which was moderately resolved following silicone oil removal. 20% (5/24) of eyes in the SO Group had qualitative flattening of foveal contour during SO tamponade that resolved after SO removal. CONCLUSION: Thinning of the macula was noticed after macula-on RRD repair with SO tamponade. Such thinning was only partially reversible after the removal of SO.

Inferior implant of XEN63 Gel stent in a refractory open-angle glaucoma due to silicone oil tamponade: A case report.

BACKGROUND: To discuss the efficacy of an inferior implant of XEN 63 gel stent in a patient with refractory glaucoma after trabeculectomy failure and vitreoretinal surgery with silicone oil tamponade. CASE DESCRIPTION: We report the case of a 73-year-old man with a history of refractory open glaucoma with trabeculectomy failure. He experienced recurrent retinal detachments with silicone oil tamponade, with uncontrolled intra-ocular pressure (IOP) after silicone oil removal. Due to the presence of oil emulsion in the anterior chamber, the chosen location for XEN 63 implantation was the infero-temporal quadrant. Mild hyphema and vitreous hemorrhage were seen post-operatively, but were self-limiting. At week 1, the intraocular pressure was 8 mmHg with a well-formed bleb seen in anterior segment optical coherence tomography (AS-OCT). At 6 month follow up, the patient maintained a IOP of 12 mmHg without topical hypotensive drugs. Slit lamp examination revealed a widespread, developed bleb with no signs of inflammation. CONCLUSION: In this case of refractory glaucoma in a vitrectomized eye with previous oil tamponade, the inferior placement of the XEN 63 gel stent delivered an adequate intraocular pressure even at 6-months follow up, with a diffuse functional infero-nasal bleb seen with AS-OCT.

Unexplained Vision Loss Associated With Intraocular Silicone Oil Tamponade in Rhegmatogenous Retinal Detachment Repair.

Purpose: To evaluate the visual outcomes with unexplained vision loss during or after silicone oil (SO) tamponade. Methods: This multicenter retrospective case series comprised patients with unexplained vision loss associated with SO tamponade or its removal. Eyes with other clear secondary identifiable causes of vision loss were excluded. Results: Twenty-nine eyes of 28 patients (64% male) were identified. The mean age was 50 ± 13 years (range, 13-78 years). The mean duration of SO tamponade was 148 ± 38 days. Eighteen eyes (62%) developed unexplained vision loss while under SO; 11 (38%) had vision loss after SO removal. The most common optical coherence tomography (OCT) finding was ganglion cell layer (GCL) thinning (55%). Eyes with vision loss after SO removal had a mean logMAR best-corrected visual acuity (BCVA) of 0.6 ± 0.7 (Snellen 20/85) before SO tamponade and 1.2 ± 0.4 (20/340) before SO removal. By the last follow-up after SO removal, the BCVA had improved to 1.1 ± 0.4 (20/235). In eyes with vision loss after SO removal, the BCVA before SO removal was 0.7 ± 0.7 (20/104), which deteriorated to 1.4 ± 0.4 (20/458) 1 month after SO removal. By the last follow-up, the BCVA had improved to 1.0 ± 0.5 (20/219). Conclusions: Unexplained vision loss can occur during SO tamponade or after SO removal. Vision loss was associated with 1000-centistoke and 5000-centistoke oil and occurred in macula-off and macula-on retinal detachments. The duration of tamponade was 3 months or longer in the majority of eyes. Most eyes had GCL thinning on OCT. Gradual visual recovery can occur yet is often incomplete.

Choroidal vascular changes in silicone oil-filled eyes after vitrectomy for rhegmatogenous retinal detachments.

INTRODUCTION: The tamponade of silicone oil (SO) can affect both the structure and blood flow of the retina. However, there are few studies on the effect of SO tamponade on choroidal blood flow. Our study aimed to compare the effects of SO tamponade on the choroidal vascular index (CVI) and choroidal thickness (CT) in patients with unilateral rhegmatogenous retinal detachment (RRD) with operated eyes and fellow healthy eyes. METHODS: We retrospectively collected demographic and clinical data from 36 patients who underwent 23G pars plana vitrectomy and SO tamponade for unilateral complicated RRD. Enhanced depth imaging-optical coherence tomography (EDI-OCT) scans were performed both within 1 week before SO removal and at the last follow-up visit after SO removal. Using ImageJ software, images were binarized to segment the total choroidal area, luminal area, and stromal area, respectively. The CVI was calculated as CVI=(luminal area)/(total choroidal area), and CT was also evaluated. RESULTS: During SO tamponade, the CVI and luminal area in operated eyes were significantly lower compared to fellow eyes (57.616 ± 0.030 vs. 60.042 ± 0.019, P < 0.0001; 0.909 [0.694; 1.185] vs. 1.091 [0.785; 1.296], P = 0.007). Even after SO removal, the CVI remained lower in operated eyes than in fellow eyes (59.530 ± 0.018 vs. 60.319 ± 0.020, P = 0.031). Both CVI and luminal area were lower in operated eyes before SO removal than after SO removal (57.616 ± 0.030 vs. 59.530 ± 0.018, P = 0.0003; 0.909 [0.694; 1.185] vs. 0.994 [0.712; 1.348], P = 0.028). The duration of SO tamponade was positively correlated with the difference in CVI between fellow eyes and operated eyes during SO tamponade (P = 0.035). Total choroidal area, stromal area, and CT did not differ significantly between fellow eyes and operated eyes or between pre- and post-SO removal. CONCLUSIONS: SO tamponade reduces CVI and decreases choroidal blood circulation in patients with retinal detachments required vitrectomy combined with SO tamponade. The longer the SO tamponade time, the more CVI reduction. In future work, we will aim to reduce these side effects by shortening the duration of silicone oil filling.

Vitrectomy for retinal detachment associated with macular hole: Prognostic factor analysis under different axial length conditions.

PURPOSE: To identify prognostic factors for complete anatomical success (CAS) under different axial length (AL) conditions after vitrectomy plus internal limiting membrane (ILM) peeling for retinal detachment associated with macular hole (MHRD). METHODS: This retrospective study included 243 patients (251 eyes) with MHRD who underwent primary vitrectomy plus ILM peeling. Multivariate logistic regression explored prognostic factors for CAS in AL <30 mm and ≥ 30 mm groups. RESULTS: Overall, 113 eyes (45.0% of 251) exhibited complete CAS after initial surgery. Eyes with CAS had greater best-corrected visual acuity improvement than eyes without CAS (p < 0.001). CAS was more common in eyes with AL < 30 mm (50.3% of 155) than in eyes with AL ≥ 30 mm (36.5%, 35/96; p = 0.032). In the AL < 30 mm group, CAS was associated with ILM insertion (odds ratio [OR], 2.824, 95% confidence interval [CI], 1.189-6.710; p = 0.019), silicone oil (SO)/perfluoropropane (C3F8) tamponade (SO: OR, 0.408, 95% CI, 0.191-0.873; C3F8: OR, 2.448, 95% CI, 1.145-5.234; p = 0.021) and staphyloma (OR, 0.318, 95% CI, 0.143-0.707; p = 0.005). In the AL ≥30 mm group, CAS was associated with ILM insertion (OR, 11.621, 95% CI, 2.557-52.813; p = 0.001), SO /C3F8 tamponade (SO: OR, 5.305, 95% CI, 1.206-23.334; C3F8: OR, 0.188, 95% CI, 0.043-0.829; p = 0.027) and age (OR, 0.928, 95% CI, 0.876-0.983; p = 0.011). CONCLUSION: Vitrectomy plus ILM peeling can effectively treat MHRD but has limited efficacy in eyes with AL ≥ 30 mm. ILM insertion was associated with more frequent CAS at any AL. C3F8 tamponade yielded better outcomes with AL < 30 mm; SO tamponade yielded better outcomes with AL ≥ 30 mm.

Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT.

AIM: To describe the clinical and radiologic features of retrolaminar migration silicone oil (SiO) and observe the dynamic position of ventricular oil accumulation in supine and prone. METHODS: For this retrospective study, 29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography (CT) were included from January 2019 to October 2022. The patients were divided into migration-positive and negative groups. Clinical history and CT features were compared using Whitney U and Fisher's exact tests. The dynamic position of SiO was observed within the ventricular system in supine and prone. CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision (optic nerve, chiasm, and tract) and ventricular system. RESULTS: Intraocular SiO migration was found in 5 of the 29 patients (17.24%), with SiO at the optic nerve head (n=1), optic nerve (n=4), optic chiasm (n=1), optic tract (n=1), and within lateral ventricles (n=1). The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients (22.8±16.5mo vs 13.1±2.6mo, P<0.001). The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone. CONCLUSION: Although SiO retrolaminar migration is unusual, the clinician and radiologist should be aware of migration routes. The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.

Early vascular changes after silicone oil removal using optical coherence tomography angiography.

BACKGROUND: This study evaluated the vascular changes in the macular and peripapillary regions before and after silicone oil (SO) removal in patients with rhegmatogenous retinal detachment. METHODS: This single-center case series assessed patients who underwent SO removal at one hospital. Patients who underwent pars plana vitrectomy and perfluoropropane gas tamponade (PPV + C3F8) were selected as controls. Superficial vessel density (SVD) and superficial perfusion density (SPD) in the macular and peripapillary regions were assessed by optical coherence tomography angiography (OCTA). Best-corrected visual acuity (BCVA) was assessed using LogMAR. RESULTS: Fifty eyes were administered SO tamponade, 54 SO tamponade(SOT) contralateral eyes, 29 PPV + C3F8 eyes, and 27 PPV + C3F8 contralateral eyes were selected. SVD and SPD in the macular region were lower in eyes administered SO tamponade compared with SOT contralateral eyes (P < 0.01). Except for the central area, SVD and SPD in the other areas of the peripapillary region were reduced after SO tamponade without SO removal (P < 0.01). No significant differences were found in SVD and SPD between PPV + C3F8 contralateral and PPV + C3F8 eyes. After SO removal, macular SVD and SPD showed significant improvements compared with preoperative values, but no improvements in SVD and SPD were observed in the peripapillary region. BCVA (LogMAR) decreased post-operation and was negatively correlated with macular SVD and SPD. CONCLUSIONS: SVD and SPD are decreased during SO tamponade and increased in the macular region of eyes that underwent SO removal, suggesting a possible mechanism for reduced visual acuity during or after SO tamponade. TRIAL REGISTRATION: Registration date: 22/05/2019; Registration number, ChiCTR1900023322; Registration site, Chinese Clinical Trial Registry (ChiCTR).

Retinal Nerve Fiber Layer Changes after Intraocular Silicone Oil Tamponade in Rhegmatogenous Retinal Detachment.

Rhegmatogenous retinal detachment (RRD) is a serious and emergency condition that may cause visual disturbance. Treatment includes pars plana vitrectomy with a tamponade such as intraocular gas or silicone oil (SO). In many countries, silicone oil is still favorable compared to intraocular gases as tamponade for reattachment of retinal detachment surgery. The application provides a higher anatomical success rate, especially in cases of proliferative vitreoretinopathy (PVR) that were previously considered untreatable. Objective assessment of the retinal nerve fiber layer (RNFL) using optical coherence tomography (OCT) in the eye with silicone oil tamponade is a challenge because of the limitations and difficulties in taking images. This study aims to assess the RNFL thickness changes in rhegmatogenous retinal detachment patients using SO tamponade and its subsequent removal conducted on a total of 35 post-operative RRD patients. Central macular and RNFL thickness, as well as best-corrected visual acuity (BCVA), were recorded at the time of tamponade and after the removal of the SO at 1, 4, and 8 weeks, respectively. The results showed that the changes in RNFL thickness significantly decreased in the group of ≤6 months, especially in the superior and temporal quadrants, and BCVA increased after SO removal (p < 0.05). Central macular thickness was significant (p < 0.001) at the end of the visit. Improved visual acuity is associated with decreased RNFL and central macular thickness after SO removal.

Unexplained visual loss after primary pars-plana-vitrectomy with silicone oil tamponade in fovea-sparing retinal detachment.

BACKGROUND: To investigate the incidence and clinical characteristics of unexplained visual loss in patients with fovea-sparing rhegmatogenous retinal detachment (RRD) during or after silicone oil (SO) tamponade. METHODS: The medical charts of all patients with macula-on RRDs, who underwent pars-plana-vitrectomy (ppV) with SO tamponade were retrospectively assessed regarding unexplained visual loss (UVL) of ≥ 3 Snellen lines and alterations on optical coherence tomography (OCT) during or after SO tamponade. The clinical data analysed included visual acuity, surgical parameters, OCT images, duration of SO tamponade and the time point of visual decline. Cases with re-detachment or secondary causes of visual loss such as SO emulsification, epiretinal membranes or macular edema were excluded. RESULTS: Over a 15-year-period, 22 cases with macula-on RRD, which had primarily been treated with ppV and SO tamponade, met the inclusion criteria. In most eyes (n = 20; 91%), the RRD was caused by a giant retinal tear (GRT). In 11 of these 22 cases (50%), best-corrected visual acuity (BCVA) had dropped by at least 3 lines for no apparent reason. In these 11 cases, mean preoperative logMAR BCVA was 0.2 (SD 0.13; range 0-0.5), equal to Snellen's VA of 0.63, and mean postoperative logMAR BCVA 1.0 (SD 0.24; range 0.5-1.3), equal to Snellen's VA of 0.10. Visual decline occurred about 12 weeks postoperatively (SD 6.2; range 3-20 ) and comprised 8 lines (SD 2.3; range -11 to -4). SO was removed on average 139 (SD 50.0; range 88-271) days after the first ppV. In 9 cases visual decline occurred while the SO was in-situ. In 2 patients, BCVA decline was noted 2 weeks after SO removal. In all eyes, preoperative central foveal thickness (CFT) was 254 µm (SD 24.2), which decreased to 224 µm (SD 29.6) during SO tamponade and increased to 247 µm (SD 29.2) after SO removal, irrespective of the presence of UVL. The mean follow-up time was 20 months (SD 30.6) after SO removal. CONCLUSION: UVL after SO tamponade for macula-on RRD is more frequent than expected. The incidence in our case series was 50%. The mechanism of this phenomenon is still unknown. In general, vitreoretinal surgeons should thoroughly question the need for SO tamponade, inform their patients of possible UVL and remove SO as early as possible. TRIAL REGISTRATION: The study was approved by the local ethics committee on 6th of May 2022 (Ethikkommission der Universität Regensburg, Votum 22-2925-104) and was conducted in accordance with the ethical standards of the Declaration of Helsinki.

Pseudo second anterior lens capsule during post-vitrectomy cataract surgery: A case report.

Purpose: To report the unexpected finding of a membrane resembling a second anterior lens capsule during cataract surgery after previous pars plana vitrectomy (PPV) with silicone oil tamponade for retinal detachment. Observations: A 26-year-old male with a history of two retinal detachment repairs of the right eye over a 5-month period, presented with decreased vision. The first retinal detachment repair was performed with a 23-gauge PPV and the second with a 25-gauge PPV, scleral buckle and placement of silicone oil. Additional ocular history includes bilateral megalocornea, high myopia, and temporal lens coloboma. Upon presentation, slit lamp exam showed migration of silicone oil to the anterior chamber and a nuclear cataract. A decision was made to perform combined silicone oil removal and cataract extraction with intraocular lens (IOL) implant of the right eye. After capsulorrhexis, hydrodissection of the lens was not completed successfully since the presence of a membrane was detected. This membrane was cut, achieving partial completion of the second capsulorrhexis, which was further advanced using a forceps following the contour of the first capsulorrhexis. The cataract was removed without further difficulty and the IOL was placed into the capsular bag with good centration. The membrane was submitted to pathology, and upon microscopic examination was found to represent fibrocellular tissue with some cells expressing PAX8 and cytokeratin AE1/AE3. Conclusions and importance: This case reports the unusual finding of a membrane that behaved as a second anterior lens capsule intraoperatively and that expressed novel pathology markers. These findings may better prepare ophthalmologists for similar pathologies they may encounter during capsulorrhexis.

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy.

AIM: To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil (SO) endotamponade for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR). METHODS: This is a retrospective, interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade. Eyes with a minimum follow-up of 6mo after SO extraction were included. Eyes were classified into three PVR subgroups according to severity and extension of proliferation. The influence of several preoperative, intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis. RESULTS: A hundred and one eyes of 101 patients that met the inclusion criteria were studied. Seventy-five of 101 eyes (74.3%) had successful retinal reattachment after one operation. Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment, recurrent membrane proliferation and keratopathy. Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values, primary vitrectomy and PVR outside of the posterior pole. CONCLUSION: Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR, an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications. Primary vitrectomy, PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.

A Case of Bullous Central Serous Chorioretinopathy Treated with Surgical Removal of Submacular Fibrin and Subsequent Photodynamic Therapy under Silicone Oil.

Bullous retinal detachment is a rare complication in the chronic phase of central serous chorioretinopathy (CSC). Only a small subset of eyes with chronic CSC develops into the bullous variant of CSC (bCSC). In patients with bCSC, the elevated concentration of fibrin in the subretinal space leads to persistent retinal detachment and eventually, severe vision loss. We experienced a case of unilateral bCSC with a massive accumulation of subretinal fibrin. Multiple leakage points and dilated choroidal veins were also observed. The patient underwent surgical removal of subretinal fibrin and silicone oil injection followed by photodynamic therapy (PDT). After this treatment, the retina was successfully reattached, and the affected eye was free from recurrent exudative changes for more than 18 months. Massive subretinal fibrin could be surgically removed to prevent the formation of subretinal fibrosis and retinal fold, and PDT under silicone oil can control the underlying exudative changes in bCSC.

Change in axial length after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment.

BACKGROUND: We aimed to explore the changes in the axial length and related factors after vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: This study retrospectively evaluated patients who underwent vitrectomy with silicone oil (SO) tamponade for RRD and subsequent silicone oil removal at our clinic. Using a Zeiss IOLMaster 700, axial length was measured before vitrectomy for RRD and SO removal. The change in axial length (ΔAL) was calculated, and multivariate binary logistic regression analysis was performed to investigate the potential correlation between ΔAL and clinical factors, such as preoperative hypotony, extreme myopia, age, macular involvement, choroidal detachment, operation duration, and operation history. RESULTS: In total, 213 eyes from 213 patients were included. The mean axial length changed significantly pre- and post-vitrectomy (25.98 ± 2.87 mm and 26.25 ± 3.07 mm, respectively, P < 0.001); the mean ΔAL was 0.37 ± 0.62 mm. Multivariate binary logistic regression analysis showed that preoperative hypotony and extreme myopia were significantly correlated with the ΔAL (P = 0.001 and P = 0.001, respectively). A higher proportion of hypotonic eyes had ΔAL ≥ 0.3 mm (33/76 in hypotony eyes and 32/137 in others; P = 0.003). A higher proportion of extremely myopic eyes also had a ΔAL ≥ 0.3 mm (23/46 in extremely myopic eyes and 42/167 in others; P = 0.002). CONCLUSION: For patients with RRD and cataracts, as axial length changed significantly after vitrectomy in those with hypotony or extreme myopia, secondary lOL implantation should be considered.

Preoperative laser reduces silicone oil use in primary diabetic vitrectomy.

AIM: To identify the predictive factors and laser photocoagulation associated with the use of silicone oil as endotamponade during primary diabetic vitrectomy. METHODS: The medical and surgical records of 690 patients (798 eyes) who underwent primary diabetic vitrectomy at a tertiary eye hospital in China from January 2018 to December 2018 were reviewed in this retrospective cohort study. The patients' baseline characteristics and preoperative treatments were recorded. The binary Logistic regression model was used to evaluate the risk factors for the use of silicone oil as endotamponade agent during primary vitrectomy for proliferative diabetic retinopathy (PDR)-related complications. RESULTS: Among 690 patients with mean age of 52.1±10.5y (range: 18-85y), 299/690 (43.3%) were female. The 31.6% of the eyes received preoperative laser treatment, and 72.4% of the eyes received preoperative anti-VEGF adjuvant therapy. Non-clearing vitreous haemorrhage (VH) alone or combined with retinal detachment was the main surgical indication (89.5%) for primary vitrectomy. Silicone oil was used as endotamponade in 313 (39.2%) eyes. Lack of preoperative laser treatment [odds ratio (OR) 0.66, 95% confidence interval (CI): 0.48-0.92; P=0.015] and older age (OR 0.96, 95%CI: 0.95-0.98; P<0.001) were predictors of silicone oil tamponade during primary vitrectomy for PDR. CONCLUSION: The lack of preoperative laser treatment is a significant predictor of silicone oil tamponade during primary vitrectomy for PDR. However, the severity of PDR relevant to silicone oil use should be further evaluated.

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

PURPOSE: To report the visual and anatomic outcomes of eyes with exceedingly long-term silicone oil tamponade. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Transscleral Removal of Subretinal Strand without Vitrectomy: A Case Report.

Recurrence of inferior retinal detachment, after vitreoretinal surgery and silicone oil tamponade, along with a subretinal strand, presents a challenge for surgeons. Vitrectomy and retinotomy are the usual treatment in such cases. Here, we present a new transscleral method for addressing this problem. A 13-year-old boy with recurrent retinal detachment after silicone oil tamponade underwent scleral buckling surgery and had a transscleral subretinal strand removed without retinotomy. The retina reattached, and silicone oil was removed 3 months later. The best-corrected visual acuity was 0.4 in decimal vision at 1 year after silicone oil removal. Scleral buckling surgery combined with subretinal strand removal may be used as an alternative to retinotomy, especially for patients with an inferior retinal detachment and local subretinal strand formation.

Changes of macular vessel density and thickness in gas and silicone oil tamponades after vitrectomy for macula-on rhegmatogenous retinal detachment.

PURPOSE: To investigate the macular vessel density and thickness in macular-on rhegmatogenous retinal detachment (RRD) after vitrectomy with gas and silicone oil (SO) tamponade. METHODS: Patients with macular-on RRD eyes, treated with a single successful vitrectomy with gas or SO tamponade and a minimum 30 months follow-up, were reviewed. Best-corrected visual acuity (BCVA), macular vessel density and retinal thickness by using optical coherence tomography angiography, were compared to the contralateral eyes. RESULTS: Sixteen eyes with gas tamponade and 17 eyes with SO tamponade were included in the study. LogMAR best-corrected visual acuity (BCVA) slightly improved from 0.25 ± 0.18 (Snellen 20/36) to 0.17 ± 0.23 (Snellen 20/30) in eyes with gas tamponade, and decreased from 0.30 ± 0.22 (Snellen 20/40) to 0.49 ± 0.28 (Snellen 20/62) in eyes with SO tamponade. The parafoveal vessel densities in superficial vascular complex (SVC) and the corresponding inner retinal thickness (IRT) were similar between the affected eyes and the contralateral eyes in gas tamponade group (P = 0.578, P = 0.943), while significantly reduced in the affected eyes, compared to the contralateral eyes in SO tamponade group (P < 0.001, P < 0.001). CONCLUSION: Eyes in SO tamponade group had worse BCVA, lower SVC vessel densities and thinner corresponding IRT after vitrectomy for macular-on RRD, than those in gas tamponade group.

Retinal Changes before and after Silicone Oil Removal in Eyes with Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography.

This study aimed to evaluate and compare the retinal and choroidal thickness and vessel density (VD) changes between silicone oil (SO) tamponade and after SO removal using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). Thirty patients who underwent pars plana vitrectomy for retinal detachment (RD) with SO tamponade were included. SS-OCT and OCTA were conducted before RD surgery, during SO tamponade, and after SO removal. A 3-dimensional volumetric wide scan protocol was used for the analysis. The segmented retina, choroidal thickness map, and peripapillary thickness were then measured. For the OCTA analysis, 4.5 × 4.5 mm scans were used. Superficial and deep capillary plexus VDs in unaffected fellow eyes and eyes after SO removal were compared. During the SO tamponade period, the thickness of the parafoveal total retina, ganglion cell-inner plexiform layer, and peripapillary retinal nerve fiber layer (ppRNFL) were significantly thinner than those of unaffected fellow eyes (p < 0.05). The parafoveal layer thickness thinning recovered up to three to six months after SO removal. Moreover, six months after SO removal, the parafoveal thickness was not significantly different compared to that of unaffected fellow eyes (p > 0.05). However, the ppRNFL thickness was significantly decreased during SO tamponade and remained unrecovered six months after SO removal. There was no significant difference in the VD on the OCTA. Thus, SO tamponade and removal for RD resulted in a change in the retinal and peripapillary thickness. This may be due to the mechanical pressure effect of SO.