Deferred laser photocoagulation of relaxing retinotomies under silicone oil tamponade to reduce recurrent macular detachment in severe proliferative vitreoretinopathy.

PURPOSE: This study sought to investigate whether, in patients with retinal detachment complicated by proliferative vitreoretinopathy, we can re-attach the retina with a posterior relaxing retinotomy and silicone oil tamponade while postponing laser retinopexy for several months. METHODS: In 13 consecutive patients we applied laser coagulation of the retinotomy edge 15 ± 12 weeks after surgery. Silicone oil was removed 9 ± 6 weeks after laser application. RESULTS: After the retinotomy without laser, some degree of central shifting was seen in all patients, followed by obvious curling in 10 patients. The total follow-up was 24 ± 7 months after retinotomy and 13 ± 9 months after oil removal. The retina was attached in 12 patients at the last visit, with the oil still in situ in three patients. Seven patients, however, required additional surgery. Function remained stable with a mean preoperative and postoperative Snellen visual acuity of 0.09. CONCLUSIONS: Not anchoring retinotomy edges with a laser at the time of surgery allows inward curling and central slippage of retinal edges under silicone oil. This appears to compensate for the retinal fibrosis occurring in the weeks following surgery and may result in less macula-off re-detachments under oil, and potentially, in better visual outcome.

Slit-lamp visualization of aqueous flow through an inferior iridectomy.

PURPOSE: To demonstrate how an inferior iridectomy prevents a pupillary block in aphakic patients with a silicone oil tamponade. DESIGN: Observational case series. METHODS: Photographs of two patients who had undergone vitrectomy, lensectomy, membrane peeling, silicone oil tamponade, and inferior iridectomy for a complex retinal detachment were evaluated. RESULTS: In the thin layer of erythrocytes covering the endothelium, we observed an arc clear of erythrocytes anterior to the inferior iridectomy. CONCLUSIONS: With silicone oil blocking the pupil, aqueous humor was channeled through the inferior iridectomy with sufficient force to sweep the endothelium anterior to the iridectomy clean of erythrocytes, thus visualizing the mechanism that prevents a pupillary block glaucoma.

An epidemic of sticky silicone oil at the Rotterdam Eye Hospital. Patient review and chemical analyses.

PURPOSE: To report and study the phenomenon of abnormal silicone oil adherent to the retina at the time of removal in a number of patients. MATERIALS AND METHODS: Chart review was performed to identify possible patient or procedural factors that could predispose to sticky silicone oil formation. Gas chromatography-mass spectroscopy and nuclear magnetic resonance spectroscopy analyses were performed on sticky silicone oil samples, on perfluorocarbon liquid and on silicone oil samples straight from the vial. RESULTS: Sticky silicone oil remnants were seen on the retina in 28 out of 234 silicone oil removal procedures between January 2001 and November 2002. Forceful removal was complicated in two patients by a choroidal hemorrhage and in one patient by a retinal tear. The use of perfluoro-octane (PFO; C(8)F(18)) rather than perfluorodecalin (C(10)F(18)) was related to the phenomenon (P < 0.001). Gas chromatography-mass spectroscopy analysis revealed a significant presence of PFO in samples of sticky silicone oil, and traces of partially fluorinated carbon liquid were found in the sticky oil as well as in the PFO samples. CONCLUSIONS: The use of PFO may have been a predisposing factor for the occurrence of sticky silicone oil. While the presence of silicone oil remnants on the retina did not cause lasting side effect, forceful attempts at removal can lead to complications.

An unexpected experimental pitfall in the molecular diagnosis of bacterial endophthalmitis.

General primer-mediated ribosomal DNA amplification during endophthalmitis may improve the quality of diagnostic microbiology. However, extreme care needs to be taken not to introduce contaminating bacterial DNA during surgery procedures. The use of decontaminating iodine solutions can lead to such contamination due to the presence of DNA from Pseudomonas-like organisms.