Adequate Silicone Oil Tamponade by Utilizing the Space of Anterior Segment for Complicated Retinal Detachment: Technique, Efficacy, and Safety

Abstract

Purpose: To evaluate the efficacy and safety of adequate silicone oil (SO) tamponade procedure in patients with complicated retinal detachment. Methods: Thirty-one eyes in 31 patients were enrolled in this prospective case series. Adequate SO tamponade was performed by injecting the SO into the vitreous cavity and the entire anterior chamber, followed by posterior capsulotomy and inferior peripheral iridotomy. Preoperative and follow-up data including retinal anatomic reattachment and SO status, best-corrected visual acuity, intraocular pressure, surgical complications and management were collected and analyzed. Results: Twenty-nine eyes presented with complete retinal reattachment after subsequent SO removal with a primary success rate of 93.5%. Seventeen patients (54.8%) had complete anterior chamber SO migration to the vitreous cavity within the first postoperative day. The average time for anterior chamber SO migration was 2.3 ± 1.8 days. No oil-fluid interface in the vitreous cavity was observed in all the eyes, indicating a relatively adequate SO tamponade. Acute intraocular pressure elevation occurred in 16 (51.6%) eyes and was controllable under medication (n = 16) and anterior chamber paracentesis (n = 1). Two patients developed recurrent retinal detachment and received SO removal and a secondary adequate SO tamponade. At final follow-up, all the eyes had SO removal for at least 3 months and retinas maintained completely attached. Conclusions: The adequate SO tamponade procedure offers a simple, safe, and efficacious treatment alternative for complicated retinal detachment.

Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT

“…A possible reason is that the cerebrospinal fluid pathway is obstructed by the SiO globules and temporarily increases intracranial pressure [23] . The third or fourth ventricle is most likely to be this symptomatic compared to the lateral ventricles [4,[24][25] . Shields [26] proposed in 1989 that high IOP indirectly affected SiO migration.…”

“…The annual incidence rate of extensive population-based retinal detachment studies is about 1/10.000 [2] . Due to its high surface tension, silicone oil (SiO) has been used as a filler to treat complex retinal detachments [3][4] . Cibis et al [5] first introduced intravitreal SiO injection as an implant in 1962.…”

Comments on “Adequate Silicone Oil Tamponade by Utilizing the Space of Anterior Segment for Complicated Retinal Detachment: Technique, Efficacy, and Safety”

“…We thank the authors for sharing their adequate silicone oil tamponade (ASOT) in dealing with complicated retinal detachment 1 . However, considering the clinical application and promotion of ASOT, we propose the following problems worthy of discussion. If the standard eye has a vitreous cavity (VC) volume of 4.5 mL, a lens volume of 200 µL, and an anterior chamber (AC) volume of 260 µL, ASOT only increases the amount of silicone oil (SO) in the AC.…”

Response to the Letter to the Editor: Comments on “Adequate Silicone Oil Tamponade by Utilizing the Space of Anterior Segment for Complicated Retinal Detachment: Technique, Efficacy, and Safety”

“…We thank the authors for sharing their adequate silicone oil tamponade (ASOT) in dealing with complicated retinal detachment. 1 However, considering the clinical application and promotion of ASOT, we propose the following problems worthy of discussion.…”

“…In view of the above reasons, we suggest that ASOT should not be considered a mature and T hank you for the critical comments on our study. 1 We would like to clarified that adequate silicone oil tamponade (ASOT) is proposed for complex retinal detachment (RD), especially those with inferior retinal breaks, and it may serve as a complement to, rather than a substitute for, current surgical techniques.…”