Immunohistochemical findings in epiretinal membrane after long-term silicone oil tamponade: case report

Clinical Features and Possible Origin of Preretinal Deposits in Different Ocular Diseases and Events: A Narrative Review

Preretinal deposits (PDs) are a rare condition among fundus diseases. We found that preretinal deposits have some features in common that can provide clinical information. This review affords an overview of PDs in different but related ocular diseases and events, and summarizes the clinical features and possible origin of PDs in related conditions, providing diagnostic clues for ophthalmologists when facing PDs. A literature search was performed using three major electronic databases (PubMed, EMBASE, and Google Scholar) to identify potentially relevant articles published on or before June 4, 2022. Most of the cases in the enrolled articles had optical coherence tomography (OCT) images to confirm the preretinal location of the deposits. Thirty-two publications reported PD-related conditions, including ocular toxoplasmosis (OT), syphilitic uveitis, vitreoretinal lymphoma, human T-cell lymphotropic virus type 1 (HTLV-I) associated uveitis or HTLV-I carriers, acute retinal necrosis, endogenous fungal endophthalmitis, idiopathic uveitis, and exogenous materials. Based on our review, OT is the most frequent infectious disease to exhibit PDs, and silicone oil tamponade is the most common exogenous cause of preretinal deposits. PDs in inflammatory diseases are highly suggestive of active infectious disease and are preferentially accompanied by a retinitis area. However, PDs will largely resolve after etiological treatment in either inflammatory or exogenous conditions.

OPTICAL COHERENCE TOMOGRAPHIC PATTERNS OF POSTERIOR SEGMENT STICKY HEAVY SILICONE OIL

PURPOSE

To describe unique optical coherence tomography observations of adherent preretinal heavy silicone oil after removal.

METHODS

Retrospective observational review of files and optical coherence tomography scans of patients who had pars plana vitrectomy with heavy silicone oil. We investigated the possible precipitating preoperative and intraoperative factors and the association with postoperative epiretinal membrane and cystoid macular edema.

RESULTS

Forty-one eyes from 39 patients were involved. Two characteristic sticky silicone oil structures were identified in 33 patients (80%): variably reflective macrodroplets (bubbles) and hyperreflective microdroplets (dots). The main contributing variable was the tamponade duration. Other notable associations included postoperative epiretinal membrane and cystoid macular edema formation. Surgical interventions including heavy liquid did not show a strong predilection to their development. We reported two novel findings of sticky prefoveal macrodroplets in five patients and intravitreal macrodroplets and microdroplets casting shadows on the underlying retina in four patients.

CONCLUSION

This study confirms previously reported optical coherence tomography observations of sticky emulsified silicone oil remnants after removal. This is the first report of two distinctly different optical coherence tomography appearances after heavy silicone oil removal. The variability in size and reflectivity may be attributed to the amount and nature of the induced inflammatory reaction.

Analysis of the time and location of the silicone oil emulsification by spectral-domain optical coherence tomography after silicone oil tamponade

Purpose. To estimate localization and the period up to the appearance of small hyperreflective round-shaped droplets using spectral-domain optical coherence tomography (SD-OCT) after pars plana vitrectomy with silicone oil tamponade. Methods. A retrospective observational study included 24 patients who had undergone pars plana vitrectomy with silicone oil tamponade for proliferative vitreoretinopathy (PVR) retinal detachment. SD-OCT analysis was performed 1, 3, and 6 months after surgery. We characterized the emulsified silicone oil in the SD-OCT as the small hyperreflective round-shaped droplets. Results. In SD-OCT examination, none of the patients had hyperreflective round-shaped droplets visible one month after vitrectomy with silicone oil tamponade. The hyperreflective droplets were found three months after surgery—in one patient above the optic nerve and in five patients intraretinally (in the cystoid spaces). Six months after vitrectomy, the hyperreflective round-shaped droplets were still present in the aforementioned patients' eyes and additionally in 3 eyes above the optic disc. Conclusions. Hyperreflective round-shaped droplets were found in a SD-OCT examination 3 months after silicone oil tamponade. The authors suggest that they are most likely the emulsified silicone oil droplets. The authors hypothesize that emulsification and migration of silicone oil begin within 3 months after surgery.

Retrospective review of 50 eyes with long-term silicone oil tamponade for more than 12 months

BACKGROUND

Silicone oil (SO) is an established tamponade in treating complex vitreoretinal diseases. Although SO is intended to be removed after several weeks to months, permanent SO might be unavoidable in a small subgroup of patients with an extremely complicated clinical course. The aim of this study is to describe the long-term effects of intraocular SO tamponade.

METHODS

This retrospective study included 50 patients with intraocular SO (Oxane 5700 Bausch & Lomb, Kingston-upon-Thames, UK) for at least 12 months. The most common reasons for long-term SO tamponade were: retinal re-detachment (re-RD), proliferative diabetic retinopathy (PDR), ocular trauma, and persistent hypotony.

RESULTS

Mean age was 59.2 ± 18.4 years, and mean duration of silicone oil in the eye was 54.5 ± 58.6 months (median, 30 months). The average number of previous surgeries were 2.2 ± 1.5. Anatomic success was achieved in 37/50 (74%) of patients. Visual acuities (logMAR) were 1.8 ± 0.6, 1.6 ± 0.6, 2 ± 0.7 and intraocular pressures (mmHg) were 15.6 ± 7, 15.7 ± 5.5, 16.5 ± 7.1 at 3 months, 1 year and at last follow-up respectively. The main long-term silicone-oil-related complications observed were: band keratopathy (8%), corneal decompensation (12%), iris rubeosis (14%), and optic neuropathy (28%). Forty percent of patients achieved ambulatory vision in the SO-filled eye at final follow-up.

CONCLUSION

Long-term silicone oil can be a last-resort option in selected patients with severe vitreoretinal disease. Anterior and posterior segment complications did occur at significant rates. Forty percent of our patients maintained ambulatory vision. The actual number of patients that achieved satisfactory stereopsis and benefited functionally from long-term SO was much less [7/50 (14%)].

[Active drainage combined with air-fluid exchange for silicone oil removal: advantages and long-term follow-up]

INTRODUCTION

A number of silicone oil removal procedures are in use today. The purpose of this study was to evaluate the advantages of active drainage with air-fluid exchange for silicone oil removal.

PATIENTS AND METHODS

We conducted a prospective study on patients operated on for retinal detachment with vitrectomy with silicone oil intraocular tamponade between January 2005 and January 2006. The surgical procedures were three-port vitrectomy with silicone tamponade. Silicone oil was removed with active drainage and air-fluid exchanges. Visual acuity, floaters, intraocular pressure, emulsion, and silicone oil complications were evaluated at 3, 6, 12, and 18 months.

RESULTS

Fifty patients (50 eyes) underwent vitrectomy with silicone oil intraocular tamponade for RD with proliferative vitreoretinopathy. The mean duration of intraocular silicone oil tamponade was 4.5 months (1-15 months). Seventeen patients had complementary procedures such as phacoemulsification, epimacular membrane peeling, complementary retinopexy or intravitreal triamcinolone. At 1 year, the mean visual acuity was 3.2/10. One patient reported floaters. One patient had recurrent retinal detachment, one patient had intraocular hypertony, and significant emulsion was found in one patient. Microscopic emulsion was found in 20 patients.

DISCUSSION

This surgical technique is longer and more invasive than simple passive ablation. However, complementary procedures could decrease the risk of recurrent retinal detachment and provide better visual rehabilitation. Better silicone oil removal seems to limit residual emulsion.

CONCLUSION

Active drainage with air-fluid exchange for silicone oil removal is an interesting procedure. It could reduce short- and medium-term silicone oil complications in vitreoretinal surgery and increase the final visual outcome. However, a prospective comparative and randomized study is necessary to confirm our results.