Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal

AIM: To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plena technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety. METHODS: This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group). RESULTS: There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP <= 6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group. CONCLUSION: This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.

Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation

AIM： To estimate the effectiveness of phacoemulsification and foldable intraocular lens（IOL） implantation combined with transpupillary silicone oil removal.METHODS： There were 168 eyes of 168 candidate patients with cataract and silicone oil-filled eyes recruited in our study. All of the patients received the intraocular silicone oil removal surgery by transpupillary drainage and cataract extraction by phacoemulsification. Then the IOL implantation were also performed through corneal incision. RESULTS： The surgery was successfully completed in all eyes. Best corrected visual acuity（BCVA） and postoperative complications were recorded in three months after surgery. There were 143 eyes with BCVA improved, otherwise 25 eyes remained stable at the last follow-up visit. The mean BCVA statistically improved from 20/400±0.02 to 20/100±0.15（P〈0.001） and mean postoperative IOP was 13.85±2.18 mm Hg（P=0.415）. No intra-operative complications were reported.CONCLUSION： Phacoemulsification combined with transpupillary removal of silicone oil is a safe and simple effective method. In general, it enables quick recovery of visual acuity with less complication rate.

New technique for removal of perfluorocarbon liquid related sticky silicone oil and literature review

AIM:To investigate the safety and efficacy of sticky silicone oil(SSO)removal using a 22-gauge vein detained needle and inner limiting membrane(ILM)wrap-and-peel technique.METHODS:This retrospective consecutive case series reviewed the records of patients with a history of retinal detachment who had received silicone oil and perfluorocarbon liquid(PFCL)as intraocular tamponades.Patients were included in the analysis if they exhibited SSO remnants during silicone oil removal.The aspiration of most of the SSO remnants was performed by a 22-gauge vein detained needle.The small amounts of droplets adhered to the macula and epi-macular membrane were subsequently removed by the ILM warp-and-peel technique.The anatomical and functional outcomes,and postoperative complications were recorded.In vitro experiments were performed to simulate the formation of SSO remnants in four groups.RESULTS:Of 711 patients who underwent silicone oil removal during the study period,9 patients exhibited SSO remnants and underwent follow-up for at least 3mo.Seven eyes(78%)underwent the ILM wrap-and-peel technique to completely remove small droplets of SSO that were glued to the macula and epi-macular membrane.No obvious complications occurred.Postoperative optical coherence tomography revealed normal retinal structure in all patients.In vitro analyses showed that balanced salt solution and prolonged vibration(for 1wk)had the strongest effects on silicone oil and PFCL compound opacities.CONCLUSION:SSO remnants could be removed in an intact manner and without complications,using a vein detained needle-assisted and ILM wrap-and-peel technique.The findings suggest that PFCL and infusion fluid should be completely removed before silicone oil injection to prevent SSO formation.

Visual outcome after removal of silicone oil in patients undergoing retinectomy for complex retinal detachment

AIM：To evaluate the functional outcome after removal of silicone oil（ROSO）in patients undergoing retinectomy for complex retinal detachment.·M ETHODS：We performed a retrospective case note review of patients who underwent ROSO after retinectomy for complex retinal detachment.Patients with less than 6mo follow up and recurrent retinal detachment following ROSO were excluded.·RESULTS：Thirty-six patients were included.The mean best corrected visual acuity（BCVA）pre-ROSO was1.13 log MAR（SD 0.5）.The mean BCVA 3mo following ROSO was 1.16 log MAR（SD 0.53）,6mo following ROSO1.13（SD 0.63）,and 12mo following ROSO 1.18（SD 0.69）.At 12mo after ROSO,the BCVA improved in 38.9%of patients,remained unchanged in 25%,and deteriorated in 36.1%,although there was no statistical significant difference in BCVA after ROSO at 3,6 and 12mo（=0.93）.The size of retinectomy ranged from 15°to 270°（SD 53）and did not influence the visual outcome（=0.11）.·C ONCLUSION：There was no statistically significant difference in BCVA between pre-and post-ROSO following retinectomy for complex retinal detachment.There was no statistical difference in visual outcome related to the size of the retinectomy.