Risk Factors for Recurrent Myopic Macular Hole Retinal Detachment after Silicone Oil Removal in Patients with Open Flat Macular Hole.

OBJECTIVE: To evaluate the risks that might be associated with recurrent macular hole retinal detachment (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. We divided 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 an HHF or MHI <0.9-0.5, there is a high chance of recurrent MHRD after S.O removal.

Submacular perfluorocarbon liquid: long-term follow-up.

PURPOSE: To report the long-term follow-up of patients with inadvertent retained submacular perfluorocarbon liquid (PFCL) bubbles after vitrectomy surgery. BACKGROUND: PFCL has unique chemical and physical features which facilitate displacement of subretinal fluid from central toward periphery allowing intraoperative reattachment of the mobile retina and manipulation of the anterior part of the detached retina without performing drainage retinotomy. Despite these advantages, PFCL droplets may be inadvertently retained in the submacular space. METHODS: A retrospective case series study was conducted. We reviewed 1224 consecutive patients who had undergone primary pars plana vitrectomy at one vitreoretinal center operated by single surgeon (Hammouda Ghoraba). Chart review was performed to identify patients and procedural factors that could predispose to retained submacular PFCL with anatomical and functional outcomes with follow-up at least 18 months. RESULTS: The retina was completely attached in 97% of eyes where PFCL was used after one or two vitrectomy surgeries. Submacular PFCL was found in 12 (0.98%) eyes. There was no statistical difference between perfluorodecalin and perfluoro-n-octane as regards retention rate. The possible risk factors associated with submacular retention of PFCL phenomenon are the presence of post-equatorial retinal breaks in six patients (50%) and large retinal break (2-3 clock hours) in three patients (25%). CONCLUSIONS: Submacular PFC migration occurs in nearly 1% of cases when it is used. It occurred in cases of RRD with post-equatorial or large breaks. Using perfluoro-n-octane or perfluorodecalin had no statistical difference. Different behaviors of submacular PFC droplets occurred. Some cases of small submacular PFC droplets maintained fair VA for a long period.

Silicone Oil-Related Visual Loss.

BACKGROUND: Silicone oil (SO) is used as an intravitreal tamponade agent in vitreoretinal surgery for rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy or with large, multiple retinal tears. Usually, SO is left in the eye for at least 3 months. Although its use can lead to well-known complications, intraocular SO is generally well tolerated. Some studies have reported unexpected central vision loss after SO use or removal. OBJECTIVE: To investigate and analyze the reason for visual loss after the use or removal of intraocular SO in patients who underwent vitrectomy surgeries for RRD. PATIENTS AND METHODS: A retrospective observational case series of 12 patients with macula-on RRD who reported visual loss after the use or removal of SO was reviewed. Investigations carried out included fundus fluorescein angiography, optical coherence tomography (OCT) of the macula and optic disc, perimetry, and electrophysiological study. Electrolyte levels were measured in retro-oil fluid and compared with their levels in the vitreous humor of patients who underwent vitrectomy for macular holes, floaters, dropped intraocular lenses, or dropped crystalline lens fragments. RESULTS: Visual acuity levels dropped by at least 2 Snellen chart lines. None of the 12 cases had macular detachment at any stage. Fundus fluorescein angiography and OCT results were unremarkable in most of the cases. Mean levels of electrolytes in retro-oil fluids and vitreous humor were similar. CONCLUSION: Visual loss is a possible complication after SO use or removal. This still remains a mysterious issue which needs further research and investigation.

Unprompted Closure of Spontaneous Macular Hole Secondary to Retained Subfoveal Perfluorocarbon Liquid.

Purpose: To report unprompted closure of spontaneous macular hole secondary to inadvertent subfoveal perfluorocarbon liquid (PFCL) after vitrectomy surgery. Observations. We present a case of a retained large single subfoveal PFCL droplet following vitrectomy and silicone oil injection for subtotal rhegmatogenous retinal detachment that showed spontaneous release 3 weeks postoperatively, with subsequent development of full thickness macular hole (FTMH) which completely closed later on after silicone oil removal without internal limiting membrane peeling with marvelous anatomic and visual improvement after spontaneous closure of MH. Conclusions: Different fates of subfoveal PFCL droplets may happen. Spontaneous release of subfoveal PFCL without surgical interference has rarely been reported.

Long-term follow-up of vitrectomy, with or without 360° encircling buckle, for rhegmatogenous retinal detachment due to inferior retinal breaks.

OBJECTIVE: The aim of this study was to report and compare the anatomic and functional results of primary vitrectomy with and without 360° encircling scleral buckle (SB) for the treatment of rhegmatogenous retinal detachment (RRD) due to inferior retinal break(s). BACKGROUND: A variety of options, including SB, pars plana vitrectomy (PPV) with or without SB, and pneumatic retinopexy have been described as methods to repair RRDs. The use of additional SB with vitrectomy for RRD associated with inferior breaks has been a recent controversy after the introduction of transconjunctival cannula systems. PATIENTS AND METHODS: A retrospective, interventional, comparative case study was performed. In this study, we reviewed 105 consecutive patients who underwent vitrectomy for primary RRD with inferior retinal break(s) at the vitreoretinal center, performed by a single surgeon. Ninety four patients (94 eyes) were followed up for at least 4 months after silicon oil removal (SOR), and were analyzed. They were divided into two groups: group I included 50 patients who underwent PPV alone + silicon oil (SO); and group II included 44 patients who underwent PPV with 360° SB + SO. The essential parameters were single-operation success rate (SOSR) before SOR, incidence of retinal redetachment after SOR, and final visual acuity. RESULTS: SOSR was obtained in 89 eyes (47 [94%] in group I and 42 [95.5%] in group II). From overall 59 phakic retinal detachments (RDs), SOSR was obtained in 56 eyes (30 in group I [93.8%] and 26 in group II [96.3%]) while from overall 35 aphakic or pseudophakic RDs, SOSR was obtained in 33 eyes (17 in group I [94.4%] and 16 in group II [94.1%]). Retinal redetachments after SOR occurred in three patients in group I and two patients in group II. Visual acuity improvement was greater in group I than in group II before SOR. CONCLUSION: Both surgical procedures had similar reattachment rates. The addition of 360° SB to PPV + SO might not have additional benefits in patients with RD due to inferior retinal break.