Giora Treister

REMOVAL OF SILICONE OIL IN THE MANAGEMENT OF GLAUCOMA IN EYES WITH EMULSIFIED SILICONE

Glaucoma and emulsification are two complications of silicone oil injection that are often coexisting. This study was undertaken to determine whether removal of emulsified oil has any effect on the management of the glaucoma. A comparison of eyes with and without glaucoma with emulsified oil also was undertaken. Eighteen eyes that underwent removal of emulsified silicone oil more than 6 months after the injection of the oil were reviewed. All eyes were observed for at least 6 months after removal with attached retinas. Eleven eyes had glaucoma at the time of removal. The diagnosis of glaucoma preceded the identification of emulsification in 8 of 11 eyes (73%). Removal of the emulsified oil did not affect the intraocular pressure (IOP) in 10 of the 11 (91%) glaucomatous eyes. The IOP was reduced in one patient. In the glaucoma patients, the final visual acuity was significantly reduced compared with the best corrected visual acuity obtained during the follow-up period (P = 0.016). In the nonglaucoma eyes with emulsified oil, the visual acuity did not significantly deteriorate during follow-up. At the end of the follow-up period, optic atrophy was observed in 9 of 11 (82%) of the eyes with glaucoma compared with two of seven (28%) of eyes without glaucoma. The results suggest that removal of emulsified silicone oil failed to control the glaucoma, and could not change the aggressive nature of the glaucoma in these eyes.

Vitrectomy and silicone oil injection in pediatric patients.

Objective: To determine the functional and anatomic results of vitrectomy with silicone oil injection in complicated retinal detachments in children. Design: A retrospective review of all records of children aged 15 years or younger who underwent vitrectomy with silicone oil injection between 1985 and 1994 in the Goldschleger eye institute. Results: Twenty‐eight eyes of 27 patients were included in the series, with a mean follow‐up time of 24 months. The underlying pathologies included penetrating injury (11 eyes), high myopia (8 eyes), choroidal coloboma (2 eyes), retinopathy of prematurity (2 eyes), and various other pathologies (5 eyes). At the end of the follow‐up, complete or partial anatomic success was obtained in 9 eyes (32%) and 3 eyes (10%), respectively. The final visual acuity was 20/400 or better in 5 eyes (18%) and hand motions or less in 19 eyes (68%). The visual acuity could not be determined in 3 eyes due to the age of the patients, and in 1 eye due to mental retardation. The worst results occurred in the perforating injury group. The usual complications associated with silicone oil occurred frequently. Conclusions: Satisfactory anatomic and functional results were obtained in a minority of the eyes included in our series. The grave prognosis was determined by the devastating nature of the external injury in the trauma cases and the severe vitreoretinal pathology in the other eyes.

Acute glaucoma following vitrectomy and silicone oil injection.

Three cases are described of acute glaucoma following vitrectomy and silicone oil injection in proliferative vitreous retinopathy. The first case developed silicone-induced pupillary block in a phakic eye. Cases 2 and 3 developed elevated pressure in aphakic eyes with deep anterior chambers. Cases 1 and 3 were treated by laser iridectomy. Case 2 was treated by removal of silicone. The pathogenesis and treatment of these problems are discussed.

Reduced rate of retinal detachment following silicone oil removal.

Purpose: To investigate the rate of retinal redetachment and other complications after silicone oil removal over a 4‐year period. Methods: Retrospective analysis of charts of patients who underwent vitrectomy and silicone oil injection between January 1994 and June 1998 followed by oil removal. Results: Sixty‐eight eyes of 67 patients were included. The average follow‐up time after oil removal was 15 months. Significant retinal redetachment developed in 6 eyes (8.8%). The redetachment rate was slightly higher in the 32 eyes with proliferative vitreoretinopathy (9.3%) than in the 36 eyes with other pathologies (8.3%). The average time to redetach‐ment was 4.2 months. These eyes were reoperated and reattached, and at the end of the follow‐up, three retained silicone oil. Two other eyes without redetachment were hypotonus after oil removal. Cataract extraction and intraocular lens implantation were performed at the time of oil removal in 18 eyes; 2 (11%) developed redetachment. Visual acuity improved significantly after oil removal (P < 0.001). Conclusion: The rate of retinal redetachment after removal of silicone oil in recent years is low compared with previous series. The authors attribute this reduction to the improved surgical management of complicated retinal detachments; particularly, the introduction of perfluorocarbon liquids and wide‐field viewing systems and the widespread use of endolaser.

Long-term follow up of accidental parafoveal laser burns.

The findings after 12 years of follow-up evaluation of 2 patients who sustained accidental parafoveal and juxtafoveal Nd:YAG laser injuries are reported. In both cases, the fovea was not destroyed by the initial insult and early scar formation. Both cases demonstrated, after more than a decade, minimal visual deficit without significant late complications. In spite of early decrease in visual performance, the long-term prognosis for Q-switched Nd:YAG laser retinal lesions in which the fovea was not directly involved in the injury or its repair mechanisms is relatively benign.

A quantitative in vitro model for silicone oil emulsification. Role of blood constituents.

To understand why some patients seem to be protected from emulsification and others are not, the authors developed an in vitro model for quantitative analysis of silicone oil emulsification. The pro-emulsifying potential of substances and blood components that may have access to the vitreous cavity in a patients eye was analyzed. In this model, red blood cell ghosts had the highest emulsifying effect; plasma and lymphocytes also had a significant emulsifying effect. Phospholipids in membranes and other soluble blood components may play important roles in this process. These results suggest the importance of avoiding and removing hemorrhage and avoiding inflammation when silicone oil is used in vitreoretinal surgery.

Epidemiology of retinal detachment in childhood and adolescence

The prevalence of retinal detachment during childhood and adolescence was studied in 45,000 recruits aged 17 to 19 years. History of retinal detachment was found in 13 cases (0.028%); 61.5% of these had traumatic retinal detachment, and 23.1% had high myopia without history of trauma. The age-related annual incidence of retinal detachment in patients aged ten to 19 years was calculated to be 2.9 per 100,000. The prevalence among the males was 3.7 per 10,000 and among the females 1.6 per 10,000. The difference between the sexes was not statistically significant.

Retrospective Analysis of Vitrectomy With and Without Internal Limiting Membrane Peeling for Stage 3 and 4 Macular Hole

BACKGROUND AND OBJECTIVE To evaluate the efficacy and safety of pars plana vitrectomy with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling versus pars plana vitrectomy without ILM peeling for stage 3 and 4 primary idiopathic macular hole. PATIENTS AND METHODS Sixty-two eyes of 60 consecutive patients with idiopathic macular hole underwent vitrectomy with gas (C3F8) injection. The first 46 eyes underwent vitrectomy without ILM peeling; of these, 14 had epiretinal membrane peeling and were excluded, leaving 32 eyes (no ILM group). The remaining 16 eyes underwent vitrectomy with ICG-assisted ILM peeling (ICG-ILM group). Follow-up data at 6 to 48 months postoperatively were recorded and analyzed. RESULTS Macular hole closure was achieved in 13 (81%) of 16 patients in the ICG-ILM group and 16 (50%) of 32 patients in the no ILM group (P = .036). Analysis of the data from eyes with closed holes indicates that the ICG-ILM group achieved a better mean final visual acuity compared with the no ILM group (20/60 vs 20/100, respectively) (P = .017). No complications were attributed to the use of ICG. CONCLUSIONS ICG-assisted ILM peeling significantly increased the rate of hole closure in eyes with stage 3 or 4 idiopathic macular hole. The use of ICG did not adversely affect the visual acuity results, and it appears to be a safe adjunct to macular hole surgery.

Predicted and actual refraction after intraocular lens implantation in eyes with silicone oil

Objective: To determine the difference between the predicted and postoperative refraction in eyes with silicone oil that had extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation. Setting: Ophthalmology department providing primary, secondary, and tertiary care in central Israel. Methods: Eight patients with silicone‐oil‐filled eyes following vitreoretinal procedures had ECCE and IOL implantation. The IOL power calculation was performed with the modified SRK II, the SRK/T, and the Holladay emmetropia/ametropia formulas, using the axial length of the eye, measured prior to the silicone oil injection, and the keratometric readings. The predicted and postoperative refractions were compared. Results: The postoperative refraction was more hyperopic than predicted by an average of 4.08 diopters (D) for the SRK II formula, 3.91 D for the SRK/T formula, and 4.01 D for the Holladay emmetropia/ametropia formula. Removing the silicone oil from two eyes several months after cataract extraction reduced the deviation from the predicted refraction to 0.25 and 0.80 D. Conclusion: The presence of silicone oil in the vitreous space induces a hyperopic shift in eyes having ECCE and IOL implantation. This hyperopic shift should be considered when calculating the IOL power if a long‐term tamponade with the oil is planned. If the silicone oil is to be removed shortly after the cataract extraction, the IOL power should be calculated solely from the formula.

Pressure sore in a patient who underwent repair of a retinal tear with gas injection

Abstract• Purpose: To demonstrate a pressure sore following strict head positioning in a patient who underwent encircling band, vitrectomy and gas injection. • Methods: A male patient was admitted to the hospital with a large posterior horseshoe tear in the inferior temporal retina with severe vitreous traction and retinal detachment. Encircling band, vitrectomy cryotherapy and gas injection was performed. After surgery the patient was instructed to sit in a facedown position. • Results: A pressure sore resulted from prolonged immobility of the right elbow due to face-down positioning following encircling band, vitrectomy and gas injection. • Conclusion: A patient injection. • Conclusion: A patient may rarely have compulsive personality traits that result in extreme compliance to the physicians recommendations; therefore, general instructions given for head positioning should include permission for a change in position when required, at least for brief periods of time.