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Januschowski K, Rickmann A, Smith J, Pastor-Idoate S, Pastor JC. Vision loss associated with silicone oil endotamponade in vitreoretinal surgery - a review. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06520-y. [PMID: 38888804 DOI: 10.1007/s00417-024-06520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE To clarify the definition, prevalence and classification of different types of unexplained vision loss associated with silicone oil (SO) endotamponades (SO in situ (SOIS) or after removal of SO (ROSO)) in vitreoretinal surgery and identifying the most specific clinical findings and suggesting possible causes. METHODS Review of the literature regarding randomized clinical trials (RCTs), retrospective case-control, cohort studies and case series evaluating the risk of using SO, published in English between 1994 and 2023, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus and Embase. The search was supplemented using the Medline option 'Related Articles' and consulting review articles on the topic. RESULTS Findings from reported clinical examinations in SOIS and ROSO are analyzed and finally different theories regarding the underlying pathophysiology are described. From the clinical point of view, findings have been found in OCT, OCTA, microperimetry and electrophysiological studies. Other clearly identifiable causes of vision loss related to the use of SO are listed and commented as differential diagnosis. Finally, the different physiopathological theories of the two types of causes of unexplained vision have been analyzed. CONCLUSION Unexpected vision loss under or after SO tamponade (SOIS and ROSO) is a significant concern which is probably underestimated because it is not a clearly defined and known entity. The most frequently described changes were in the ganglion cell complex but this unexpected vision loss remains a serious and unexplained concern for vitreoretinal surgeons and should be identified by clinicians, addressed by manufacturers and reported to Health Authorities as a serious incident according to the new regulation.
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Affiliation(s)
- Kai Januschowski
- Mount St. Peter Eye Clinic, Max-Planck-Str. 14-16, 54296, Trier, Germany
- Medical Department, University of Tuebingen, Tuebingen, Germany
| | - Annekatrin Rickmann
- Medical Department, University of Tuebingen, Tuebingen, Germany.
- Ophthalmology Department, Knappschaft Hospital Sulzbach, Sulzbach/Saar, Germany.
| | - Jonathan Smith
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
| | - Salvador Pastor-Idoate
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Ophthalmology Department, Hospital Clinico Universitario, Valladolid, Spain
| | - Jose Carlos Pastor
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
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Ushida H, Suzumura A, Yamada K, Shimizu H, Suzuki A, Ishikawa Y, Kikuchi R, Nishiguchi KM, Kaneko H. Decrease in electrolyte after vitrectomy surgery may affect the results of forensic investigations using vitreous humor. BMC Ophthalmol 2024; 24:219. [PMID: 38783230 PMCID: PMC11118106 DOI: 10.1186/s12886-024-03445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Vitreous humor (VH) is used for postmortem biochemical studies because it is well protected in an uncontaminated state even after death. The goal of this research was to investigate electrolyte concentrations in the VH from human eyes with and without a history of vitrectomy surgery. METHODS We analyzed the sodium (Na), potassium (K), chloride (Cl) and magnesium (Mg) concentrations from 34 VH samples from 34 patients. Eleven samples were from eyes with a history of vitrectomy, and the remaining 23 eyes had no history of vitrectomy. The correlations of Na, K, Cl and Mg concentrations with patient age, interval between first and second vitrectomy, and lens status (history of cataract surgery) were also evaluated. RESULTS The Na, K, Cl and Mg concentrations in VH from vitrectomized eyes were 134.1 ± 7.9 mmol/L, 3.7 ± 0.2 mmol/L, 99.7 ± 6.7 mmol/L and 0.59 ± 0.09 mmol/L, respectively; all were significantly lower than the corresponding concentrations in VH from control eyes (lower by 5.0%, 11.0%, 11.7%, and 22.6%, respectively). Na, K, Cl and Mg concentrations in VH from vitrectomized eyes did not show significant correlations with patient ages or the interval between their first and second vitrectomies. There were no significant differences in Na, K, Cl and Mg concentrations in VH between phakic eyes and intraocular lens-implanted eyes. CONCLUSIONS With the increasing number of vitrectomies being performed, it is necessary to consider the history of vitrectomy when using a subject's VH in forensic examination.
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Affiliation(s)
- Hiroaki Ushida
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Kazuhisa Yamada
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hideyuki Shimizu
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Atsuo Suzuki
- Department of Clinical Laboratory, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Yusuke Ishikawa
- Department of Clinical Laboratory, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Ryosuke Kikuchi
- Division of Clinical Laboratory, Gifu University Hospital, 1-1 Yanagido, 501-1194, Gifu City, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.
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Kontou EP, Karakosta C, Kounas K, Iatropoulos I, Tsinopoulos I, Kozobolis V, Stavrakas P. Macular Edema Following Silicone Oil Tamponade for Retinal Detachment: A Literature Review. Cureus 2023; 15:e51233. [PMID: 38283484 PMCID: PMC10821764 DOI: 10.7759/cureus.51233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Macular edema (ME) is a major cause of reduced vision following intraocular surgery. Although the pathophysiology of ME is not completely understood, inflammatory mediators play a key role. The incidence of ME following pars plana vitrectomy with silicone oil tamponade varies between 13% and 27%. ME usually resolves spontaneously following silicone oil removal, but treatment may be required for resistant cases. In this review, the mechanisms of ME formation after pars plana vitrectomy, its incidence, and its possible therapeutic approaches are discussed.
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Affiliation(s)
- Evgenia P Kontou
- Department of Ophthalmology, General Hospital of Athens "Korgialeneio-Benakio" Hellenic Red Cross, Athens, GRC
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Christina Karakosta
- Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Konstantinos Kounas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Ioannis Iatropoulos
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Ioannis Tsinopoulos
- Second Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vassilios Kozobolis
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
| | - Panagiotis Stavrakas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, GRC
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Patheja RS. A reminder about silicone oil toxicity: three cases over five years in a tertiary hospital. Int Ophthalmol 2022; 43:1477-1486. [PMID: 36227403 DOI: 10.1007/s10792-022-02544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Presumed silicone oil-related retinal toxicity causes central vision loss with a reported incidence of 1-33% in the first month after oil removal and 10% in the first six months of having silicone oil in-situ. This report examines local rates in a tertiary hospital that manages many geographically distanced patients. A miniature literature review, audit and case series are presented. METHODS A retrospective audit of all patients who underwent a 'removal of silicone oil' surgery at the Royal Brisbane and Women's Hospital between 2016 and 2021. Inclusion criteria were that the oil was inserted for primary or recurrent rhegmatogenous retinal detachment. Visual acuity was analysed at presentation, at 1 and 3 months of oil in-situ, preoperatively to removal of oil and up to 6 months after oil removal. Ocular coherence tomographic parameters were examined at each time interval, including nerve fibre layer (NFL) and ganglion cell layer and inner plexiform layer (GCL + IPL) thicknesses in the 3 mm parafoveal zone, presence of inner retinal microcystic changes or intraretinal silicone oil globules. Patients were identified who had unexplained vision loss of two or more Snellen lines. Further analysis and case review were performed. RESULTS AND CONCLUSIONS Between January 2016 and May 2021, 101 patients met the inclusion criteria. Three patients had significant and unexplained visual loss. They are presented in this paper. Presumed silicone oil toxicity is an increasingly recognised and potentially devastating phenomenon that vitreo-retinal surgeons should be wary of. Patients should be specifically consented for it and hospitals should perform local auditing to determine their own rates and inform this discussion.
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Affiliation(s)
- Rajan Singh Patheja
- Royal Brisbane and Women's Hospital Ophthalmology Department, Level 8, Ned Hanlon Building, Brisbane, QLD, 4029, Australia. .,FRANZCO, Brisbane, Australia.
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Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade. J Clin Med 2022; 11:jcm11175234. [PMID: 36079165 PMCID: PMC9457190 DOI: 10.3390/jcm11175234] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 12/22/2022] Open
Abstract
Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade.
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Liu Y, Lei B, Jiang R, Huang X, Zhou M, Xu G. Changes of macular vessel density and thickness in gas and silicone oil tamponades after vitrectomy for macula-on rhegmatogenous retinal detachment. BMC Ophthalmol 2021; 21:392. [PMID: 34781932 PMCID: PMC8591799 DOI: 10.1186/s12886-021-02160-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/30/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the macular vessel density and thickness in macular-on rhegmatogenous retinal detachment (RRD) after vitrectomy with gas and silicone oil (SO) tamponade. Methods Patients with macular-on RRD eyes, treated with a single successful vitrectomy with gas or SO tamponade and a minimum 30 months follow-up, were reviewed. Best-corrected visual acuity (BCVA), macular vessel density and retinal thickness by using optical coherence tomography angiography, were compared to the contralateral eyes. Results Sixteen eyes with gas tamponade and 17 eyes with SO tamponade were included in the study. LogMAR best-corrected visual acuity (BCVA) slightly improved from 0.25 ± 0.18 (Snellen 20/36) to 0.17 ± 0.23 (Snellen 20/30) in eyes with gas tamponade, and decreased from 0.30 ± 0.22 (Snellen 20/40) to 0.49 ± 0.28 (Snellen 20/62) in eyes with SO tamponade. The parafoveal vessel densities in superficial vascular complex (SVC) and the corresponding inner retinal thickness (IRT) were similar between the affected eyes and the contralateral eyes in gas tamponade group (P = 0.578, P = 0.943), while significantly reduced in the affected eyes, compared to the contralateral eyes in SO tamponade group (P < 0.001, P < 0.001). Conclusion Eyes in SO tamponade group had worse BCVA, lower SVC vessel densities and thinner corresponding IRT after vitrectomy for macular-on RRD, than those in gas tamponade group.
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Affiliation(s)
- Yang Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.83, Fen Yang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai, China
| | - Boya Lei
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.83, Fen Yang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.83, Fen Yang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai, China
| | - Xin Huang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.83, Fen Yang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.83, Fen Yang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.83, Fen Yang Road, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China. .,Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai, China.
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Lee JH, Park YG. Microvascular changes on optical coherence tomography angiography after rhegmatogenous retinal detachment vitrectomy with silicone tamponade. PLoS One 2021; 16:e0248433. [PMID: 33711059 PMCID: PMC7954302 DOI: 10.1371/journal.pone.0248433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose We aimed to evaluate microvascular changes on optical coherence tomography angiography (OCTA) in patients with rhegmatogenous retinal detachment (RRD) who underwent silicone oil (SO) tamponade and compare changes according to macular involvement. Methods This retrospective study included 48 patients with unilateral RRD who underwent vitrectomy and SO tamponade and were stable after SO removal. Control data were obtained from the fellow healthy eye. Ophthalmic examinations, including best corrective visual acuity (BCVA) and OCTA, were conducted. Differences in vascular density (VD) in different sections of the macula and differences in the foveal avascular zone (FAZ) were analyzed between the affected eyes and control eyes. Subgroup analyses according to macular involvement were performed. Results Baseline BCVA and duration of SO tamponade were associated with postoperative BCVA (p<0.001, p = 0.03, respectively). The average VD in the deep capillary plexus (DCP) and the VD of the nasal parafoveal area in both the superficial capillary plexus (SCP) and the DCP decreased relative to those in the control eyes (p = 0.026, p = 0.028, and p = 0.031, respectively). The FAZ area in the DCP and in the SCP also increased when compared with that in the controls (p = 0.043, p = 0.002, respectively). In addition, the macular-off RRD group had lower VD in the nasal parafoveal area of the DCP than the macular-on RRD group. Conclusion SO tamponade could cause microvascular changes, especially in the nasal parafoveal area. The macular-off RRD group were affected more than the macular-on RRD group.
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Affiliation(s)
- Ji Hye Lee
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Gun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Pichi F, Hay S, Abboud EB. Inner retinal toxicity due to silicone oil: a case series and review of the literature. Int Ophthalmol 2020; 40:2413-2422. [DOI: 10.1007/s10792-020-01418-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
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