Combined removal of silicone oil plus internal search (ROSO-plus) following retinal detachment surgery

Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment

We report a novel surgical sandwich technique using a combination of intraocular perfluoropropane (C₃F₈) and silicone oil for inferior retinal detachment (RD). After conventional pars plana vitrectomy and posterior vitreous detachment induction, fluid-gas exchange using 14% C₃F₈was done. This was followed by silicone oil injection using automated infusion pump to 50% fill of the vitreous cavity under direct visualization to achieve formation of two bubbles - gas bubble superiorly and silicone oil inferiorly. The patient was subsequently asked to maintain upright position. The two immiscible bubbles of C₃F₈and silicone oil provide tamponade to superior and inferior retina, respectively. With time, gas bubble reduces in size with a gradual superior shift of silicone oil. This novel sandwich technique achieves complete attachment of retina and reduces the risk of retinal redetachment in inferior RDs by adequately tamponading the inferior retina.

Key Factors to Improve the Outcome of Retinal Reattachment Surgery in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy

INTRODUCTION

For management of complicated retinal detachments, a pars plana vitrectomy with temporary silicone oil (SO) fill is the method of choice. According to literature, the retinal redetachment rate varies between <10% and >70% with around 36% in our own group (retrospective data analysis, n = 119 eyes).

METHODS

The main goal was to reduce the retinal redetachment rate. Standard operating procedures (SOPs) and evaluation protocols (EVALPs) were developed to prospectively analyse risk factors. Lab analysis of SO was performed, and the role of surgical experience was evaluated and investigated with Eyesi®.

RESULTS

We achieved a significant reduction of the retinal redetachment rate (to 6.80%, n = 101, p = 0.002). After surgery with SO injection, neither further membrane peeling (in 16.5%) nor retinal laser coagulation (in 100%) during revision surgery had a significant effect on the reattachment rate (p = 0.167, p = 0.23), while extensive additional laser coagulation reduced visual acuity (p = 0.01). A 3-port approach had to be set up to complete SO removal. A difference in success rate depending on surgical experience was confirmed, and the performance in Eyesi correlated with that in the patients' eye.

CONCLUSIONS

A SOP- and EVALP-based management and new strategies to secure the surgical performance seem to be essential for successful surgery.

STAINING-ASSISTED REMOVAL OF SILICONE OIL FOR THE IDENTIFICATION OF SUBCLINICAL PROLIFERATIVE VITREORETINOPATHY

PURPOSE

Retinal detachment is a frequent complication after removal of silicone oil (ROSO). A retrospective study was conducted to determine whether staining-assisted removal of silicone oil (st-ROSO) allowed better identification and removal of proliferative vitreoretinopathy (PVR) processes compared with a conventional removal of silicone oil technique.

METHODS

All individuals underwent pars plana vitrectomy (PPV) and silicone oil fill-in for complicated retinal detachments. In conventional removal of silicone oil (Group 1), no staining was used. In staining-assisted removal of silicone oil (Group 2), a mixture of trypan blue and brilliant blue G dyes was used to identify proliferative vitreoretinopathy and subclinical epiretinal membrane.

RESULTS

After the first 3-month follow-up, 15.9% of patients (N = 608) developed a retinal detachment. Retinal detachment occurred in 22.8% of patients in Group 1 (n = 284) and 9.8% of patients in Group 2 (n = 324; P < 0.001). In Group 2, proliferative vitreoretinopathy removal was performed in 153 eyes (47.2%).

CONCLUSION

The incidence of retinal redetachment was significantly lower after staining-assisted removal of silicone oil compared with a conventional technique. Staining-assisted removal of silicone oil allowed better identification and removal of proliferative vitreoretinopathy processes.

Combined phacoemulsification and transpupillary removal of heavy silicone oil

We describe a technique for heavy silicone oil removal combined with phacoemulsification and intraocular lens insertion without scleral incisions or sutures using a modified 16-gauge cannula. The technique is less invasive than other techniques for removing silicone oil and does not interfere with the uveal tract or the peripheral retina.