Intravitreal Conbercept Injection as an Adjuvant in Vitrectomy with Silicone Oil Infusion for Severe Proliferative Diabetic Retinopathy.

Purpose: To assess the clinical effects of preoperative, intraoperative, or preoperative combined with intraoperative intravitreal conbercept (IVC) injection in vitrectomy with silicone oil tamponade for severe proliferative diabetic retinopathy (PDR). Methods: Ninety-eight eyes of 98 severe PDR patients undergoing vitrectomy with silicone oil tamponade were randomly assigned to 3 groups: Group 1 (34 eyes) received IVC injections 3 to 5 days before surgery; Group 2 (35 eyes) received IVC injections at the end of surgery; and Group 3 (29 eyes) received IVC injections 3 to 5 days before and at the end of operation. Follow-up examinations were performed for 6 months. Results: The incidence and severity of intraoperative bleeding were not significantly different (P = 0.233). However, the duration of surgery was significantly shorter in Group 1 and Group 3 compared with Group 2 (P < 0.001). The incidences of early and late recurrent vitreous hemorrhage (VH) were 32.35%, 28.57%, and 13.80%, respectively. At 6-month follow-up, mean best-corrected visual acuity had significantly increased to 1.25 ± 0.45 logMAR in Group 1, 1.29 ± 0.46 logMAR in Group 2, 1.16 ± 0.44 logMAR in Group 3 (all P < 0.001). The incidence of postoperative VH, neovascular glaucoma, and retinal detachment in Group 3 was slightly lower, however, no significant differences were observed (all P > 0.05). In young patients, similar results were observed and Group 3 had better visual improvements (P = 0.037). Conclusions: Preoperative IVC injection could be a safe and effective adjunct in pars plana vitrectomy with silicone oil tamponade for severe PDR. Preoperative combined with intraoperative IVC are promising, especially in young patients.

Conbercept and Ranibizumab Pretreatments in Vitrectomy with Silicone Oil Infusion for Severe Diabetic Retinopathy.

PURPOSE: We compared the efficacies of intravitreal ranibizumab (IVR) and intravitreal conbercept (IVC) as the adjuvant pretreatments for vitrectomy with silicone oil infusion for tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy. METHODS: This retrospective study comprised 74 patients (79 eyes) who underwent vitrectomy with silicone oil tamponade for diabetic TRD. They received IVC (37 eyes) or IVR (42 eyes) at standard doses 3-5 days preoperatively and were followed up for ∼6 months. Anatomic success rate, intra- and postoperative complications, and visual outcomes were compared between both groups. RESULTS: Initial (IVC vs. IVR: 97% vs. 98%) and final anatomic success rates (100% in each group) and mean visual acuity changes were not significantly different (P = 0.46). Intraoperative complications [iatrogenic retinal breaks (P = 0.58) and intraoperative bleeding (P = 0.66)], postoperative complications [fibrin formation (P = 0.51), postoperative preretinal bleeding (P = 0.88), progressing or persistent neovascular glaucoma (P = 0.63), progressive fibrovascular proliferation (P = 0.93), and recurrent retinal detachment (P = 0.93)], and surgical variables [surgical time (P = 0.53)] were similar between both groups. CONCLUSIONS: Conbercept and ranibizumab are equally effective surgical adjuvants for vitrectomy with silicone oil infusion in patients with diabetic TRD.

Synthetic Fillers for Facial Rejuvenation.

Soft tissue filler procedures have increased dramatically in popularity in the United States. Synthetic fillers such as calcium hydroxyapatite (CaHA), polymethyl methacrylate (PMMA), and poly-l-lactic acid (PLLA), and silicone provide initial volume replacement but have an additional biostimulatory effect to supplement facial volumization. Indications include human immunodeficiency virus lipoatrophy and nasolabial folds for CaHA and PLLA and atrophic acne scars for PMMA. Most clinical use of these synthetic fillers is in an off-label fashion. Beyond the proper choice of a synthetic filler, careful consideration of dilution, injection method, and postprocedural care allows for successful and consistent results.

Ozurdex (a slow-release dexamethasone implant) in proliferative vitreoretinopathy: study protocol for a randomised controlled trial.

BACKGROUND: Proliferative vitreoretinopathy (PVR) is the commonest cause of late anatomical failure in rhegmatogenous retinal detachment. Visual and anatomical outcomes remain poor despite advances in vitreoretinal surgical techniques with reported primary failure rates of up to nearly 50%. Numerous adjunctive medications have been evaluated in clinical trials with no agent gaining widespread acceptance and use.This study was designed to investigate the benefits of using a slow-release dexamethasone implant delivered intra-operatively in patients undergoing vitrectomy surgery for retinal detachment with established PVR. METHODS/DESIGN: For the study, 140 patients requiring vitrectomy surgery with silicone oil for retinal detachment with established PVR will be randomised to receive either standard treatment or study treatment in a 1:1 treatment allocation ratio. Both groups will receive the standard surgical treatment appropriate for their eye condition and routine peri-operative treatment and care, differing only in the addition of the supplementary adjunctive agent in the treatment group. The investigated primary outcome measure is stable retinal reattachment with removal of silicone oil without additional vitreoretinal surgical intervention at 6 months. DISCUSSION: This is the first randomised controlled clinical trial to investigate the use of an adjunctive slow-release dexamethasone implant in patients undergoing vitrectomy surgery for retinal detachments with proliferative vitreoretinopathy. TRIAL REGISTRATION: EudraCT No: 2011-004498-96.

Heavier-than-water silicone oil mixture as a long-term tamponade agent: a pilot study.

PURPOSE: To evaluate the tamponade effect on the retina of a heavier-than-water silicone oil mixture and to compare it with the effect of silicone oil. METHODS: Prospective, non-randomised, comparative pilot study. Phakic/pseudophakic patients with retinal detachment undergoing vitrectomy with Densiron 68 or silicone oil were recruited. The 'separation volume', defined as the relative volume of the space between intraocular tamponade agent and retina, was estimated using magnetic resonance imaging in both groups and compared. RESULTS: Nine participants were included; 4 received silicone oil and 5 Densiron 68. The mean separation volume was statistically significantly larger in the silicone oil group (0.477 ± 0.419 cm(3)) than in the Densiron group (0.042 ± 0.013 cm(3); p = 0.014). CONCLUSIONS: In this study Densiron achieved an excellent tamponade effect in the retina.

[Dynamic phototherapy with silicone oil in treating choroidal subfoveal neovascularization in high myopia]. / Photothérapie dynamique sous huile de silicone pour traiter des néovaisseaux choroïdiens du myope fort.

UNLABELLED: We report a case of a high myopic patient, treated with photodynamic therapy for macular neovascularization in the presence of silicon oil. Four months later, the patient's vision was again at 4/40, with no active neovascularization. INTRODUCTION: Retinal detachment and macular neovascularization are common complications in high myopia patients. Sometimes these two conditions occur simultaneously and their treatment can become more problematic. OBSERVATION: We report the case of a high myopia patient treated with photodynamic therapy for subfoveal neovascularization through a vitreous cavity filled with silicone oil. The treatment was successfully completed with no problems. CONCLUSION: Photodynamic therapy can be achieved successfully through a vitreous cavity filled with silicone oil.

Attenuation of iodine 125 radiation with vitreous substitutes in the treatment of uveal melanoma.

OBJECTIVE: To demonstrate attenuation of radiation from iodine 125 ((125)I) to intraocular structures using liquid vitreous substitutes. METHODS: Four candidate vitreous substitutes were tested for attenuation using empirical measurement and theoretical calculation. In vitro and ex vivo cadaveric dosimetry measurements were obtained with lithium fluoride thermoluminescent dosimeters to demonstrate the attenuation effect of vitreous substitution during (125)I simulated plaque brachytherapy. Theoretical dosimetry calculations were based on Monte Carlo simulation. RESULTS: In a cylindrical phantom at a 17-mm depth, liquid vitreous substitutes as compared with saline showed significant reduction of radiation penetration (48% for 1000-centistoke [cSt] silicone oil [polydimethyl-n-siloxane], 47% for 5000-cSt silicone oil [polydimethyl-n-siloxane], 40% for heavy oil [perfluorohexyloctane/polydimethyl-n-siloxane], and 35% for perfluorocarbon liquid [perfluoro-n-octane]). Human cadaveric ex vivo measurements demonstrated a 1000-cSt silicone oil to saline dose ratio of 35%, 52%, 55%, and 48% at arc lengths of 7.6, 10.6, 22.3, and 28.6 mm from the plaque edge, respectively, along the surface of the globe. Monte Carlo simulation of a human globe projected attenuation as high as 57% using 1000-cSt silicone oil. CONCLUSIONS: Intraocular vitreous substitutes including silicone oil, heavy oil, and perfluorocarbon liquid attenuate the radiation dose from (125)I. Cadaveric ex vivo measurements and Monte Carlo simulation both demonstrate radiation attenuation using 1000-cSt silicone oil at distances corresponding to vital ocular structures. Clinical Relevance Attenuation of radiation with silicone oil endotamponade in the treatment of uveal melanoma may significantly reduce radiation-induced injury to vital ocular structures.

The use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery.

BACKGROUND: Conventional silicone oil provides suboptimal support of the inferior retina. In this study we evaluated the efficacy of Oxane HD in the management of complex retinal detachments involving lower quadrants of the retina. METHODS: A prospective, interventional, comparative study. Eighteen patients were recruited. Treatment outcomes were compared with a historical control group of 14 patients. Patients with grade C3 PVR or greater and inferior retinal breaks, recurrent inferior retinal detachments (with or without PVR) and giant retinal tears were included. In those patients who re-detached under heavy silicone oil (n = 4), retro-oil epiretinal membranes (ERMs) were obtained at the time of subsequent surgery to analyse the immunopathological response to oxane HD. Immunohistochemistry was used to detect glia, retinal pigment epithelium cells (RPE), macrophages, T lymphocytes, or neural elements in the tissue using well-characterised monoclonal antibodies. RESULTS: Retinal attachment of the posterior pole following removal of silicone oil was achieved in 66.6% of the treatment group (n = 12) and 64.3% of controls (n = 9) (p = 1.0). Post-operative PVR developed in five patients in the treatment group (27.8%) and five control patients (35.8%). Following removal of silicone oil, residual oil was observed in 27.8% of the treatment group and 7.1% of controls. Median visual acuity, 3 months following removal of silicone oil, was 2.0 (IQR 0.9-2.0) in the treatment group and 1.0 (IQR 0.6-1.8) in the control group. Complications in the treatment group included, hypotony (n = 3), uveitis (n = 2), glaucoma (n = 1). All ERMs analysed demonstrated microscopic appearances typical of PVR. The membranes were fibrocellular in nature, contained RPE and glial cells, and variable amounts of intracellular and extracellular pigment. In addition, all had a dense infiltrate of vacuolated (presumed oil-filled) macrophages. CONCLUSION: We failed to observe an advantage following the use of Oxane HD in the treatment of inferior retinal detachments. Moreover, Oxane HD was difficult to remove and was associated with a higher incidence of complications.

[Vitreous substitutes as drug release systems]. / Glaskörperersatz als Möglichkeit zur protrahierten Freisetzung von Medikamenten im Glaskörper.

Despite major improvements of vitreo-retinal surgical techniques proliferative vitreoretinopathy (PVR) remains a major challenge. Surgical therapy alone may not be sufficient in complicated cases of PVR. A combination of standard techniques such as pars plana vitrectomy with a vitreous substitute and a simultaneous adjuvant pharmacological treatment for the suppression of undesired proliferation of retinal cells and retinal scarring may be a promising therapeutic approach. However, due to the narrow therapeutic range and the short biological half-life of most anti-proliferative or anti-inflammatory drugs in the vitreous cavity, intravitreal slow-release systems for extended drug delivery are desirable. Vitrectomy for PVR normally requires a vitreous substitute. Consequently, a vitreous substitute that could also serve as a slow-release system for anti-proliferative or anti-inflammatory drugs would provide several advantages. This review gives an overview of recent developments of slow-release systems that may also be suitable as vitreous substitutes. Even standard internal tamponades such as silicone oils or gases may serve as extended drug-release systems under certain conditions. In the mean time polymerised hydrogels have been developed, which apart from providing an adequate tamponade effect, may facilitate an extended intravitreal release of various anti-proliferative and anti-inflammatory drugs for several weeks.

[Inferior retinal detachment with silicone oil tamponade]. / Le décollement de rétine inférieur sous silicone.

Silicone oil is a valuable surgical tool to treat severe retinal detachment (RD). However, following surgery, remaining RD or the appearance of inferior RD with silicone tamponade is a delicate situation. Anamnesis and careful examination should provide a suitable treatment. Silicon oil removal will be considered after treatment of this residual RD. The endocular approach may be required: dissection of vitreoretinal proliferation, phakoexeresis, or retinectomy, whereas complementary indentation, subretinal fluid puncture, and scleral shortening are external therapeutic methods. One of the frequent causes of these persistent RDs is the presence or the progression of a more or less large and extended anterior vitreoretinal proliferation, which will sometimes require extended silicon oil tamponade. Indeed, after a certain time has elapsed, the existence of a genuine retinal adhesion disease makes a durable reapplication without internal tamponade impossible.

A pilot study on the use of silicone oil-RMN3 as heavier-than-water endotamponade agent.

AIMS: This work was conducted to report an interventional non-comparative pilot study using Oxane HD, a mixture of ultra-purified silicone oil and RMN3, a partially fluorinated olefin, as heavier-than-water internal tamponade. METHODS: Twenty-eight consecutive patients were recruited for this study. Indications included recurrent retinal detachment (RD) with proliferative vitreoretinopathy (PVR) (stage > or =C2) arising from inferior or posterior tears, recurrences after vitreoretinal surgery, penetrating trauma and combined rhegmatogenous and choroidal detachment. The patients underwent a pars plana vitrectomy, membrane peeling, and Oxane HD was used as long-term internal tamponade. RESULTS: Oxane was removed after 88 days (range 45-96 days) and exchanged with BSS in five eyes, long-acting gas in 14 eyes and with silicone oil in nine eyes. Retinal reattachment was achieved in 15 eyes. The overall anatomical success rate obtained using Oxane HD was 53.5%. In 15 patients with previous marked scleral buckling, the success rate was 26%: in nine patients recurrent RD occurred in the inferior sector, in five patients new tears were detected in the lower sectors; membrane formation was observed in 15 eyes. In 13 patients without marked scleral indent, the success rate was 84.6%. There was no evidence of dispersion and excessive inflammation. CONCLUSION: Oxane HD may be a useful tool in complicated RD with large inferior breaks, inferior PVR or combined rhegmatogenous, and choroidal detachment without marked scleral buckling, which put the eye profile out of shape, led to a higher failure rate and reduced the tamponading effectiveness of Oxane HD.

A pilot study on the use of a perfluorohexyloctane/silicone oil solution as a heavier than water internal tamponade agent.

AIMS: To report a prospective two centred non-comparative interventional pilot study of a solution of perfluorohexyloctane and silicone oil (Densiron-68) as a heavier than water internal tamponade. METHODS: 42 consecutive patients were recruited. The indications include proliferative vitreoretinopathy, retinal detachments arising from inferior retinal breaks, and inability to posture. RESULTS: The success rate with one operation using Densiron was 81% and with further surgery 93%. At the end of the study all tamponade agents were removed in 90% of patients. Visual acuity improved from mean logMAR of 1.41 (SD 0.64) to 0.94 (SD 0.57), p = 0.001. There was little evidence of dispersion and excessive inflammation. CONCLUSION: This new tamponade agent is being compared to conventional silicone oil in a prospective international randomised trial.

Anatomic and functional results of vitrectomy and long-term intraocular tamponade for stage 2 macular holes.

PURPOSE: To investigate the results of pars plana vitrectomy combined with long-term intraocular tamponade in patients with a stage 2 macular hole. METHODS: In a retrospective study, 50 consecutive eyes operated on for stage 2 macular hole were reviewed. The surgical technique included pars plana vitrectomy, separation of the posterior hyaloid, and intraocular tamponade with either 12.5% perfluropropane (C(3)F(8)) gas or silicone oil. Patients treated with C(3)F(8) were instructed to keep face-down positioning for 3 or 4 weeks. Removal of silicone oil took place 4 or 5 weeks after the vitrectomy. RESULTS: Closure of the macular hole was achieved in all 50 eyes after one operation. The mean postoperative best-corrected distance visual acuity was 20/32 (range, 20/63-20/20), with 49 eyes (98%) having a postoperative visual acuity of 20/50 or better. Visual acuity improved in all eyes postoperatively, with a mean gain of 4.84 +/- 1.95 ETDRS lines. CONCLUSION: For stage 2 macular holes, vitrectomy combined with long-term intraocular tamponade can result in a very favorable anatomic and functional outcome that is as good as or better than the results described for other modalities. This approach simplifies the surgical technique, and both adjuvant-related complications and potential retinal damage related to internal limiting membrane peeling or use of indocyanine green are avoided.

Primary use of silicone oil tamponade in the management of perforating globe injury secondary to inadvertent local anaesthesia injection for ophthalmic surgery.

Perforating and penetrating globe injuries secondary to peribulbar and retrobulbar anaesthesia are often complicated by vitreous haemorrhage and retinal detachment. We describe the effectiveness of primary silicone oil tamponade in the repair of three perforated globes secondary to local anaesthesia for ophthalmic surgery. Three patients with axial myopia had peribulbar and retrobulbar anaesthesia for extracapsular cataract extraction (two patients) and cryotherapy (one patient). All eyes sustained a vitreous haemorrhage obscuring the view to the fundus. Retinal detachments were detected by B-scan ultrasound. In all eyes, scleral buckling, pars plana vitrectomy and silicone oil tamponade were performed as a primary surgical procedure. All the patients had complete anatomic reposition. In two patients, after two years follow-up, visual acuity was between 6/12 to 6/36 with the retina attached and no proliferative vitreoretinopathy (PVR). The third patient had blind painful eye and enucleation was performed. Primary use of silicone oil tamponade, in the management of perforated globe with retinal detachment due to local anaesthesia injection, is recommended.