Pars plana subcapsulotomy to remove condense subcapsular opacification in combined surgery of silicone oil removal and phacoemulsification.

PURPOSE: Because of the direct contact of intravitreal silicone oil (SO) with the subcapsular membrane, cataract is one of the main SO-related complications. In a group of patients, condense subcapsular opacification occurs, which adds difficulty and risk when having sequential treatment of it. The aim of the current study is to assess the long-term outcomes of pars plana subcapsulotomy to remove condense subcapsular opacification in combined surgery of SO removal and phacoemulsification. METHODS: Retrospective cohort study. Consecutive patients who were scheduled to have combined surgery of SO removal and phacoemulsification, and with condense subcapsular opacification were included. After phacoemulsification and SO removal, circular subcapsulotomy (diameter = 3-5 mm) was performed with a 23-/25-gauge vitrectomy probe on each subject during the combined surgery. Main outcomes were pre- and postoperative best-corrected visual acuity (BCVA), intra- and postoperative complications. RESULTS: One hundred and twenty patients (120 eyes) were included. Postoperative logMAR BCVA at day 1, week 1, month 1, and final follow-up examinations was 1.0 ± 0.5, 0.7 ± 0.4, 0.6 ± 0.4, and 0.6 ± 0.3, respectively. Statistically significant median differences of logMAR BCVA occurred between the preoperative examination and each postoperative follow-up examination (all p < 0.001). The sharpest median increase in logMAR BCVA occurred between the day 1 and week 1 postoperative examinations (p < 0.001). CONCLUSIONS: For condense subcapsular opacification caused by SO tamponade, pars plana subcapsulotomy with a 23-/25-gauge vitrectomy probe during combined surgery of SO removal and phacoemulsification is effective and safe to have surgical management of it. The systemic approach enables patients to experience rapid and long-lasting vision rehabilitation in a single procedure.

Novel and easy techniques for 27-gauge silicone oil infusion and removal.

PURPOSE: To introduce novel and easy techniques for 27-gauge silicone oil (SO) infusion and removal. METHODS: Consecutive patients treated with 27-gauge pars plana vitrectomy (PPV) plus SO infusion (Infusion Group) and scheduled to have SO removal (Removal Group) were prospectively included, respectively. Patients in Infusion Group underwent 27-gauge PPV plus SO infusion. SO infusion was performed with a 24-gauge intravenous catheter connected with the SO syringe. Patients in Removal Group underwent machine-independent SO removal using a short section of infusion tube connected with a 10-mL syringe. Main outcomes were best-corrected visual acuity, intraocular pressure, surgical time and intra- and postoperative complications. RESULTS: There were thirty-five eyes (35 patients) and forty eyes (40 patients) included in Infusion and Removal Groups, respectively. Mean surgical time of complete SO infusion and removal was 5.5 ± 0.9 and 9.6 ± 2.1 min, respectively. In both groups, no patient experienced postoperative vision deterioration or hypotony. No obvious intra- and postoperative complications were observed. CONCLUSIONS: We recommend the use of the 24-gauge catheter method for 27-gauge silicone oil infusion when commercial infusion cannula is unavailable. The machine-independent method using easily available plastic infusion tube and syringe would be an ideal option when 27-gauge surgery is anticipated.

A SURGICAL APPROACH TO LARGE SUBRETINAL HEMORRHAGE USING PARS PLANA VITRECTOMY AND 360° RETINOTOMY.

PURPOSE: To evaluate the surgical approach of pars plana vitrectomy combined with 360° retinotomy and silicon oil tamponade in the treatment of patients with large subretinal hemorrhage. METHODS: Prospective, nonrandomized, and noncomparative case series study. Consecutive patients with breakthrough vitreous hemorrhage and massive subretinal hemorrahge were recruited to have combined surgery of pars plana vitrectomy with 360° retinotomy and silicone oil temponade. The main outcomes were best-corrected visual acuity, retina status, and postoperative complications. RESULTS: Twenty-one patients (21 eyes) were included. The mean follow-up was 19.9 ± 7.4 months. The mean preoperative thickness of subretinal hemorrhage was 4.25 ± 0.69 mm. All the patients were observed to have choroidal neovascularization during the surgical procedure. The mean logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) significantly improved from preoperatively 2.64 (hand movement) to 1.73 (7/400), 1.50 (6/200), 1.51 (6/200), and 1.45 (7/200) at 1 month, 3 months, 6 months after the initial surgery, and final follow-up. Postoperative complications included temporary higher intraocular pressure, silicone oil emulsification, lens opacification, epimacular membrane, retinal pigment epithelium loss, and subretinal fibrosis. At the end of the follow-up, retinas were all reattached without any recurrence of choroidal neovascularization. CONCLUSION: Pars plana vitrectomy combined with retinotomy and silicone oil tamponade is effective for eyes with breakthrough vitreous hemorrhage and massive subretinal hemorrahge.

A machine-independent method to have active removal of 5,000 centistokes silicone oil using plastic infusion tube and 23-gauge microcannulas.

BACKGROUND: To describe one modified method of having machine-independent removal of 5,000 centistokes silicone oil through 23-gauge trocar-cannulas. METHODS: Consecutive patients with silicone oil tamponade for more than four months and with complete retinal reattachment were included. Two 23-gauge trocars were used to make sclerotomies while the microcannulas remained in situ for intravitreous infusion and silicone oil drainage. A short section of infusion tube was connected with a 10 ml syringe's needle adapter. The other side was attached to the conjunctiva surface and covered the cannula's cap inside to form a closed space for silicone oil drainage. The main outcomes were duration for complete removal of silicone oil and intra- and postoperative complications. RESULT: There were totally twenty cases (20 eyes) included. The mean time for draining out the silicone oil was 4.54 ± 0.78 minutes. Intraoperatively, flute needle was introduced additionally in seven cases to achieve complete removal. No cases experienced postoperative visual acuity deterioration or refractory hypotony. No significant residual oil bubbles were observed. No retinal redetachment occurred throughout the follow-ups. CONCLUSION: The modified method of using an infusion tube and 23-gauge trocar-cannulas can achieve quick and complete removal of high viscosity silicone oil.

Accuracy of new-generation intraocular lens calculation formulas in eyes undergoing combined silicone oil removal and cataract surgery.

PURPOSE: To compare the performance of new-generation and traditional intraocular lens (IOL) calculation formulas in eyes undergoing combined silicone oil (SO) removal and cataract surgery and to evaluate the prediction accuracy of Wang-Koch (WK) adjustment in SO-filled long eyes. SETTING: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN: Retrospective consecutive case-series study. METHODS: New-generation formulas (Barrett Universal II, Emmetropia Verifying Optical, Kane, and Ladas Super formulas) and traditional formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T formulas) were compared. The performance of WK adjustment was assessed in eyes with axial length more than 26 mm. The median absolute error (MedAE) was the main parameter to evaluate the accuracy of formulas. RESULTS: A total of 211 participants (211 eyes) who underwent combined SO removal and phacoemulsification with IOL implantation were included. Four new-generation formulas displayed statistically significant lower MedAE (0.32 to 0.35 diopter [D]) and higher percentage of eyes within ±1.00 D of prediction error (85.31% to 87.20%) compared with those of the traditional formulas (MedAE: 0.39 to 0.50 D; ±1.00 D: 81.04% to 81.99%, P < .05). For SO-filled long eyes, all traditional formulas showed hyperopic bias (0.36 to 0.65 D, P < .05), except for Haigis formula (0.28 D, P = .083), and this bias could be corrected by WK adjustment (P > .05). EVO formula displayed the lowest MedAE both in total (0.32 D) and in long eyes (0.33 D). CONCLUSIONS: New-generation formulas and traditional formulas with WK adjustment showed satisfactory prediction accuracy in eyes undergoing combined SO removal and cataract surgery. EVO formula displayed the highest accuracy.

Long-term outcomes of Oxane Hd as intraocular tamponade in the treatment of complicated retinal detachment.

BACKGROUND: To evaluate the efficacy and safety of heavy silicone oil Oxane Hd as intraocular tamponade in the treatment of complicated retinal detachment (RD). METHODS: Forty eyes of 40 patients with complicated RD were recruited for this prospective study. Inclusion criteria were proliferative vitreoretinopathy grade > or = CP2, mainly inferior and posterior retinal breaks, or superior retinal breaks with patient's inability to posture. Oxane Hd was used as intraocular tamponade. The retinal status, the best-corrected visual acuity (BCVA) results, and any complications were observed. RESULTS: The mean duration of Oxane Hd endotamponade was 87.9 +/- 10.4 days, and the mean follow-up time after Oxane Hd removal was 438.1 +/- 153.7 days. The primary anatomical success rate after Oxane Hd removal was 87.5%, and with further intervention 97.5%. The BCVA significantly improved, from mean logMAR 2.12 +/- 0.60 to 1.38 +/- 0.59 (P < 0.001). The postoperative complications included temporary inflammatory reaction, moderately high intraocular pressure, heavy silicone oil emulsification, lens opacity and retinal proliferative membranes. CONCLUSIONS: Without a requirement for postoperative prone position, heavy silicone oil Oxane Hd is effective and safe for the treatment of complicated RD with inferior and posterior breaks. Larger groups and a longer follow-up period will be included to further evaluate the efficacy with Oxane Hd in superior retinal breaks.