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Szabó Á, Árpádffy-Lovas T, Hagyó K, Cseke I, Vámosi P, Tóth-Molnár E. The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study. BMC Ophthalmol 2024; 24:233. [PMID: 38831268 PMCID: PMC11145849 DOI: 10.1186/s12886-024-03505-7] [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: 09/11/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The long-term safety and efficacy of repeated applications of subliminal transscleral cyclophotocoagulation (SL-TSCPC) with a focus on cumulative energy was evaluated in glaucoma patients. METHODS In this retrospective, multicentric study the data of a total of 82 eyes with various causes of glaucoma that were treated with a single or multiple applications of SL-TSCPC were collected. Treatments were performed under general or local anesthesia with an 810 nm diode laser. Power was 2000 mW; duty cycle, 31.3%; total treatment duration, 80-320 s; equaling a total energy of 50-200 J per treatment session. Fifty-five eyes (55 patients) presented for all follow-ups, and these eyes were selected for further statistical analysis. The mean age was 60.0 ± 17.1 years, and 22 (40%) of the patients were female. Intraocular pressure (IOP) and dependence on further glaucoma medication were evaluated at 12 months following the initial treatment. RESULTS Eyes underwent 1 or 2 consecutive SL-TSCPC treatments. Median (min-max) baseline IOP of 34 (13-69) decreased to 21.5 (7-61), 22 (8-68), 20 (9-68), and 19.5 (3-60) mmHg at the 1, 3, 6, and 12-month postoperative timepoints respectively. The mean (± SD) IOP decrease at 12 months was 26 ± 27%, 39 ± 32%, and 49 ± 33% in the low (below 120 J, n = 18), medium (120-200 J, n = 24), and high (above 200 J, n = 13) cumulative energy groups respectively. At the 12-month timepoint, oral carbonic anhydrase use was discontinued in ¾ of the cases. CONCLUSIONS It was found that the repeated application of SL-TSCPC safely and efficiently decreases IOP in a Caucasian population with heterogenous causes of glaucoma, eyes with silicone oil responded to a greater extent. Inclusion of cumulative energy scales may contribute to better addressing repeated procedures in a standardized fashion.
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Affiliation(s)
- Áron Szabó
- Department of Ophthalmology, University of Szeged, Szeged, Hungary.
| | | | - Krisztina Hagyó
- Department of Ophthalmology, Péterfy Hospital, Budapest, Hungary
| | - István Cseke
- Department of Ophthalmology, Erzsébet Teaching Hospital, Sopron, Hungary
| | - Péter Vámosi
- Department of Ophthalmology, Péterfy Hospital, Budapest, Hungary
| | - Edit Tóth-Molnár
- Department of Ophthalmology, University of Szeged, Szeged, Hungary
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Huang RS, Mihalache A, Lau THA, Popovic MM, Kertes PJ, Muni RH. Pars Plana Vitrectomy With Silicone Oil or Gas Tamponade for Uncomplicated Retinal Detachment: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2024; 266:144-155. [PMID: 38815844 DOI: 10.1016/j.ajo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To compare the efficacy and safety of pars plana vitrectomy (PPV) with silicone oil compared to gas tamponade for uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN Systematic review and meta-analysis. METHODS A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to September 2023 for comparative studies evaluating the efficacy and safety of PPV with either silicone oil or gas tamponade in the setting of uncomplicated RRD. Our primary outcome was best-corrected visual acuity at the last study observation. Secondary outcomes included the rates of retinal reattachment, retinal thickness, and the incidence of adverse events. We performed a meta-analysis using a random-effects model. RESULTS Nine observational studies reporting on 491 RRD eyes were included. The mean best-corrected visual acuity at the last study observation was significantly better in the gas tamponade group than in the silicone oil group (weighted mean difference [WMD] = 0.17 logMAR, 95% confidence interval [CI] = [0.06, 0.27], P = .002). Rates of primary retinal reattachment were similar between the silicone oil and gas tamponade groups (P = .89). The ganglion cell layer was significantly thinner in the silicone oil group compared to the gas tamponade group (WMD =-3.70 µm, 95% CI = [-5.87, -1.53, P = .0008), as was the inner plexiform layer (WMD = -2.45, 95% CI = [-4.50, -0.40], P = .02) and outer nuclear layer (WMD = -11.74 µm, 95% CI = [-18.39, -5.10], P = .0005). CONCLUSIONS PPV with gas tamponade was associated with better functional outcomes compared to PPV with silicone oil, although both tamponades yielded comparable primary reattachment rates. The absence of randomized trials and the potential for selection bias underscore the importance of further investigation in diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto (RSH, AM), Toronto, Ontario, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto (RSH, AM), Toronto, Ontario, Canada
| | - Tsz Hin Alexander Lau
- Department of Ophthalmology and Visual Sciences, McGill University (THAL), Montreal, Quebec, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto (MMP, PJK, RHM), Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto (MMP, PJK, RHM), Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre (PJK), Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto (MMP, PJK, RHM), Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto (RHM), Toronto, Ontario, Canada.
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Łątkowska M, Gajdzis M, Kaczmarek R. Emulsification of Silicone Oils: Altering Factors and Possible Complications-A Narrative Review. J Clin Med 2024; 13:2407. [PMID: 38673681 PMCID: PMC11051299 DOI: 10.3390/jcm13082407] [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: 03/11/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Endotamponade of the vitreous body with silicone oil is a common procedure, being the basis of many vitreoretinal surgeries. However, emulsification may happen, which is a clinically relevant adverse event of silicone oil use. Methods: This review provides a thorough analysis of the emulsification process. It focuses on describing factors affecting this event as well as its possible subsequent complications. Results: The viscosity of silicone oil, the duration of emulsification, the status of the lens and many other factors have an influence on the onset and intensity of emulsification. This phenomenon carries several risks for operated eyes such as increased intraocular pressure, keratopathy or structural changes to the retina. Conclusions: The use of modern imaging techniques, especially optical coherence tomography, enables faster detection of the emulsification process. This allows for an adequate clinical response and more accurate follow-up of the patient.
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Coviltir V, Marinescu MC, Burcel MG, Cerghedean-Florea ME, Hașegan A, Tănăsescu C, Vică ML, Dura H. Challenges of Secondary Glaucoma Management Following Congenital Cataract Surgery, Penetrating Keratoplasty and Vitreoretinal Surgery. Diagnostics (Basel) 2024; 14:837. [PMID: 38667482 PMCID: PMC11049643 DOI: 10.3390/diagnostics14080837] [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: 01/23/2024] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Glaucoma is one of the world's leading causes of irreversible vision loss. It is often asymptomatic until it reaches an advanced stage, which can have a significant impact on patients' daily lives. This paper describes the case of a 50-year-old female patient who presented with acute onset of ocular pain, photophobia, and loss of visual acuity in her right eye (RE). The patient's medical history includes congenital cataracts, surgical aphakia, nystagmus, strabismus, amblyopia, and secondary glaucoma. Ophthalmological examination showed BCVA RE-hand movement, left eye (LE)-0.08 with an intraocular pressure (IOP) of 30 mmHg in RE and 16 mmHg in LE. Biomicroscopic examination of RE showed corneal graft, epithelial and endothelial edema, endothelial precipitates, corneal neovascularization, aphakia, and Ahmed valve superotemporally. Despite maximal topical and systemic treatment, Ahmed valve, and trabeculectomy, secondary glaucoma in the right eye remained refractory. Reimplantation of an Ahmed valve was performed. This resulted in a favorable outcome with increased visual acuity and controlled intraocular pressure. The combination of aphakia, penetrating keratoplasty, and secondary glaucoma is a challenge for any surgeon. It is important that both the perioperative risks and the possible complications are carefully assessed in each patient, especially if associated pathology is present.
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Affiliation(s)
- Valeria Coviltir
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Hospital of Ophthalmologic Emergencies, 010464 Bucharest, Romania
| | - Maria Cristina Marinescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Hospital of Ophthalmologic Emergencies, 010464 Bucharest, Romania
| | | | | | - Adrian Hașegan
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | - Ciprian Tănăsescu
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | - Mihaela Laura Vică
- Department of Cellular and Molecular Biology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania
| | - Horațiu Dura
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
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Li S, Wang X, Dou Z, Zhang J, Jia J. Study on maintenance of eyeball morphology by foldable capsular vitreous body in severe ocular trauma. BMC Ophthalmol 2023; 23:463. [PMID: 37974090 PMCID: PMC10655399 DOI: 10.1186/s12886-023-03209-4] [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: 03/15/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES To explore the feasibility and safety of using a foldable capsular vitreous body (FCVB) in managing severe ocular trauma and silicone oil-dependent eyes. METHODOLOGY This is a retrospective study of 61 ocular trauma patients (61 eyes) who presented to the Department of Eye Emergency, Hebei Eye Hospital from May 1, 2018, to May 31, 2019, including 51 male patients (51 eyes) and 10 female patients (10 eyes) with an average age of 44.98 ± 14.60 years old. The oldest patient was 75 years old, and the youngest was 8 years old. These cases represented 51 eyes with severe eyeball rupture and 10 eyes with severe, complicated ocular trauma, which became silicone oil-dependent after the operation. These patients received FCVB implants, and data regarding their visual acuity, intraocular pressure, changes in eye axis, cornea, retina, and FCVB state were recorded after the operation. RESULTS In all patients, the FCVB was properly positioned and well supported with the retina. All 61 patients cleared a follow-up window of 1-36 months with no reports of important changes in their visual acuity. Among the patients, 91.8% reported normal intraocular pressure, the retinal reattachment rate reached 100%, and the eyeball atrophy control rate reached 100%. There was no report of rupture of the FCVB, allergies to silicone, intraocular infection, intraocular hemorrhage, silicone oil emulsification, or sympathetic ophthalmia. CONCLUSIONS Foldable capsular vitreous bodies (FCVBs) designed to mimic natural vitreous bodies are suitable as long-term ocular implants that can provide sustained support for the retina without the need for any special postoperative postures. Their barrier function may effectively prolong the retention time of the tamponade and prevent various complications caused by direct contact of the eye tissues with the tamponade.
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Affiliation(s)
- Shanyu Li
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, 054000, Xingtai, Hebei, China
| | - Xiaoxuan Wang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, 054000, Xingtai, Hebei, China.
| | - Zhixia Dou
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, 054000, Xingtai, Hebei, China
| | - Jie Zhang
- Xingtai Third Hospital, 054000, Xingtai, Hebei, China
| | - Jinchen Jia
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, 054000, Xingtai, Hebei, China
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Du S, Yang X, Zha Y, Kuhn F, Ren H, Zhang J. Successive trabecular meshwork photocoagulation in the treatment and prevention of refractory hypotony. Med Eng Phys 2022; 110:103827. [PMID: 35690569 DOI: 10.1016/j.medengphy.2022.103827] [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: 03/16/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the effect of successive trabecular meshwork photocoagulation (sTMP) on the elevation of intraocular pressure (IOP) to treat or prevent refractory hypotony. METHODS The IOP changes of 15 refractory hypotonic eyes (or estimated to be hypotonic after silicon oil removal) in 15 consecutive patients were retrospectively analysed after sTMP. Fourteen eyes had intraocular silicone oil that was to be removed. Different lasers were used to destroy the trabecular meshwork 1-5 times (2.00±1.20 times on average) via the gonioscope or endoscope. Twelve eyes had a large area of exposed retinal pigment epithelium due to a large area of retinecotomy, one eye had a severe cyclitic scar, and two eyes had both a scar and a retinal defect. RESULTS After sTMP (1 to 125 months of follow-up, 22.87 ± 38.88 months), the average IOP in the 15 eyes was 11.70 ± 3.19mmHg (n = 15), significantly higher than the value before sTMP (8.26 ± 1.93 mmHg, P < 0.05). The IOP of the 15 eyes increased by 3.44 ± 2.61 mmHg, Eight eyes with an IOP of less than 10 mmHg before sTMP showed an IOP ≥10 mmHg after sTMP. Following sTMP, the silicone oil was removed from six eyes, and one of these eyes suffered a retinal detachment. CONCLUSION sTMP can significantly increase the IOP with a long-lasting effect and provide an opportunity for the removal of silicone oil despite large-area retinal defects or cyclitic scars in selected eyes.
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Affiliation(s)
- Shu Du
- Medical College of Soochow University, China; Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, China
| | - Xun Yang
- Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, China.
| | - Youyou Zha
- Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, China
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, AL, United States of America; Department of Ophthalmology, University of Pécs Medical School, Hungary
| | - Hui Ren
- Department of Fundus Diseases and Ocular Trauma, Chengdu Aier Eye Hospital, China
| | - Jing Zhang
- Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, China
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Luo L, Wei Q, Liu Q, Wang L, Jiang Y. Evaluation of Foldable Capsular Vitreous Body Implantation Surgery. Int J Gen Med 2022; 15:7077-7087. [PMID: 36097567 PMCID: PMC9464037 DOI: 10.2147/ijgm.s380609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Foldable capsular vitreous body (FCVB), a novel artificial vitreous substitute product, has been used clinically in recent years. The aim of this study was to evaluate the outcomes and complications of FCVB implantation surgery during the postoperative period. Methods We performed a prospective, nonrandomized study from November 2021 to March 2022. Eight patients with severe retinal detachment that could not be easily reattached were included in this study. Before and after surgery, visual acuity (VA), intraocular pressure (IOP), slit-lamp microscopy, optical coherence tomography (OCT), B-scan and CT were performed. Results After the operation, the FCVB was well distributed in the vitreous cavity and supported the retina according to the B-scan and CT images. During the follow-up period, no vitreous hemorrhage or retinal detachment was found in any of the patients. On the first postoperative day, the average IOP increased from 9.6 ± 7.7 mmHg preoperatively to 13.8 ± 14.3 mmHg. Although the IOP of two patients fell outside the normal range, IOP was finally held steady after the fifth postoperative day in all cases. In addition, three patients (37.5%) experienced eye ache, and after taking a Saridon tablet, the pain was greatly alleviated. Moreover, no adverse events, such as silicone oil (SO) spillage and emulsification or serious complications, were observed. Conclusion The current vitreous substitute FCVB is effective and safe for treating complicated retinal detachments in ophthalmic applications. Further multiple-center clinical designs should focus on indications and complications of FCVB during long-term follow-up periods.
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Affiliation(s)
- Liying Luo
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qingquan Wei
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qing Liu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Li Wang
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yanyun Jiang
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Yanyun Jiang, Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, People’s Republic of China, Email
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Loukovaara S, Gucciardo E, Korhonen A, Virtanen A, Harju M, Haukka J. Risk of glaucoma after vitreoretinal surgery - Findings from a population-based cohort study. Acta Ophthalmol 2022; 100:665-672. [PMID: 35470970 DOI: 10.1111/aos.15161] [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: 02/08/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the association between different types of vitrectomy and risk of different types of glaucoma and to determine the effect of systemic medication and diabetes status on this risk. METHODS A population-based nested case-control study included individuals of age ≥ 18 years who had undergone single vitrectomy, vitrectomy with retinal procedure, or combined phaco-vitrectomy between 2001 and 2010. End of follow-up was 2017. Odds ratio (OR) for the development of glaucoma after different types of vitrectomy and 95% confidence interval (CI) were based on conditional logistic regression models. For every glaucoma case, five controls were matched by age, sex, start of follow-up year, and hospital district. RESULTS The cohort (n = 37 687), of which 52.8% was female, consisted of 6552 individuals diagnosed with glaucoma and 31 135 controls matched by age, sex, and hospital district. Vitrectomy was performed on 103 eyes in the glaucoma group and 158 eyes in the control group. As regards the risk of any glaucoma, the risk was lowest in eyes that underwent combined phaco-vitrectomy (OR: 2.7, 95% CI: 1.8-4.1), followed by single vitrectomy (OR: 3.15, 95% CI: 2.1-4.8), and highest in eyes that underwent vitrectomy with retinal procedure (OR: 4.5, 95% CI: 2.7-7.4). Diabetes had no effect (OR: 0.96, 95% CI: 0.92-1.01), but 5-year systemic statin use slightly decreased glaucoma risk (OR: 0.86, 95% CI: 0.77-0.97). CONCLUSIONS Vitreoretinal surgery was associated with an increased glaucoma risk; the risk being related to the complexity of vitrectomy. Long-term systemic statin therapy may decrease glaucoma risk, while diabetes had no association.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland
- Individualized Drug Therapy Research Program, Faculty of Medicine University of Helsinki Helsinki Finland
| | - Erika Gucciardo
- Individualized Drug Therapy Research Program, Faculty of Medicine University of Helsinki Helsinki Finland
| | - Ani Korhonen
- Individualized Drug Therapy Research Program, Faculty of Medicine University of Helsinki Helsinki Finland
| | - Aapo Virtanen
- Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Mika Harju
- Glaucoma Unit, Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jari Haukka
- Department of Public Health University of Helsinki Helsinki Finland
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Surgical Treatment in Silicone Oil-Associated Glaucoma. Diagnostics (Basel) 2022; 12:diagnostics12041005. [PMID: 35454053 PMCID: PMC9031548 DOI: 10.3390/diagnostics12041005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 01/27/2023] Open
Abstract
Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods.
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Zhang C, Xiao R, Wang A, Zhao Z. SILICONE OIL-FILLED FOLDABLE CAPSULAR VITREOUS BODY VERSUS SILICONE OIL ENDOTAMPONADE FOR TREATMENT OF NO LIGHT PERCEPTION AFTER SEVERE OCULAR TRAUMA. Retina 2022; 42:553-560. [PMID: 35188493 PMCID: PMC9561226 DOI: 10.1097/iae.0000000000003336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
PURPOSE To compare the anatomical and functional outcomes of silicone oil (SO)-filled foldable capsular vitreous body (FCVB) and SO endotamponade in vitrectomy for patients with no light perception after ocular trauma. METHODS A total of 64 patients (64 eyes) with no light perception caused by severe ocular trauma were divided into FCVB and SO groups based on the surgical treatment. The main outcome measurements were retinal reattachment rate, intraocular pressure, best-corrected visual acuity, and number of operations. RESULTS Both the FCVB group (29 eyes) and the SO group (35 eyes) showed significant improvement in postoperative best-corrected visual acuity and intraocular pressure. The two groups showed no significant differences in final intraocular pressure and the retinal reattachment rate. The postoperative vision (≥LP) in the FCVB group was significantly worse than in the SO group (FCVB [4/29] vs. SO [18/35], P = 0.003). However, the number of surgeries in the FCVB group was significantly lower than in the SO group (FCVB [1.10] vs. SO [2.23], P < 0.001). CONCLUSION Vitrectomy combined with SO endotamponade shows better short-term improvement in the treatment of no light perception caused by severe ocular trauma. However, SO-filled FCVB can effectively prevent many complications caused by direct SO endotamponade, such as secondary surgeries or SO dependence.
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Affiliation(s)
- Chun Zhang
- Department of Ophthalmology, Jiangxi Clinical Research Center for Ophthalmic Disease, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Ruihan Xiao
- Department of Ophthalmology, Jiangxi Clinical Research Center for Ophthalmic Disease, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Anan Wang
- Department of Ophthalmology, Jiangxi Clinical Research Center for Ophthalmic Disease, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Zhenquan Zhao
- Department of Ophthalmology, Eye Hospital of School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; and
- Department of Ophthalmology, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
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Outcomes of a Foldable Capsular Vitreous Body Implantation: A Retrospective Study. DISEASE MARKERS 2022; 2021:6575195. [PMID: 34987675 PMCID: PMC8720596 DOI: 10.1155/2021/6575195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022]
Abstract
Background The vitreous body is an important part of the ocular body fluid. A foldable capsular vitreous body (FCVB) is designed to treat chronic adverse complications in severe ocular trauma and silicone oil-dependent eyes. This study is aimed at investigating a method for implanting an FCVB, its postoperative efficacy, and clinical value. Methods A retrospective analysis was performed on data from 18 patients who underwent vitrectomy and FCVB implantation for severe ocular trauma and silicone oil-dependent eyes between March 2019 and May 2020. All treated eyes underwent clinical examinations involving the best-corrected visual acuity, intraocular pressure, FCVB position, anterior segment photography, and wide-angle fundus photography regularly after surgery. Results Eighteen eyes from 18 patients were enrolled in this study. A total of 2.00–4.20 (3.46 ± 0.78) ml of silicone oil were injected into the FCVB during surgery. The patients were followed up at 1, 2, and 4 weeks and 3, 6, and 12 months after surgery. Twelve months after surgery, visual acuity improved in 7 (38.89%) eyes. In contrast, 10 (55.56%) eyes showed no obvious improvement, and 1 (5.56%) eye had decreased vision. Intraocular pressure at 12 months was 10.13 ± 3.52 mmHg, which was comparable to that before the surgery (t = 0.38, P = 0.71). The anterior chamber depth examined by slit lamp was 2.00–3.00 cornea thickness (CT) in 7 eyes, 1.00–2.00 CT in 2 eyes, and <1.00 CT in one eye. The anterior chamber disappeared in eight eyes. There were eight eyes with clear cornea, four eyes with localized opacity, and two eyes with obvious gray-white opacity. There was no case of severe FCVB deflection, rupture, or exposure during the observation period. Conclusion FCVB implantation is an effective and safe treatment for eyes with severe ocular trauma and silicone oil-dependent eyes. It may support retinal reattachment, slow down eyeball atrophy, reduce the risk of chronic adverse complications such as corneal endothelial decompensation, and maintain intraocular pressure and preoperative visual function.
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12
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Silicone oil droplets in the vitreous after intravitreal injections: review of literature with clinical examples. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov59959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Currently, intravitreal injections are firmly in the lead as a drug delivery method for treatment of a wide range of eye diseases. With the accumulation of clinical material, knowledge about the complications and side effects of this technique is expanding. One of the undesirable phenomena that has been actively studied recently is the ingress of silicone oil droplets from single-use syringes and needles used to perform the procedure into the vitreous cavity of patients eyes. The analysis of the results of original studies on this issue is carried out, and the currently available practical recommendations aimed at reducing the risk of this complication are presented. The article is illustrated with original clinical examples. It can be concluded that the penetration of silicone oil into the eye cavity during intravitreal injections is an urgent problem of modern ophthalmology that requires further investigation and solution.
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Zeng B, Wang Q, Sui G, Wang M, Xie W, Fu J. Foldable capsular vitreous body implantation for treatment of traumatic retinal detachment: two case reports. J Int Med Res 2021; 49:300060521990257. [PMID: 33563057 PMCID: PMC7879493 DOI: 10.1177/0300060521990257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Retinal detachment caused by severe ocular trauma is a type of refractory vitreoretinal disease. Current treatment methods include vitrectomy combined with silicone oil tamponade. However, long-term use of silicone oil tamponade has various complications, including a risk of silicone oil dependence that eventually leads to eyeball atrophy and enucleation. Foldable capsular vitreous bodies (FCVBs) offer a good solution for these problems. However, FCVBs have not been used in large-scale clinical applications and few cases have been reported in the published literature. The main use of FCVBs, based on current evidence, is in the treatment of the relatively few (but important) patients whose eyes have no visual potential; the aim of treatment in these patients is globe preservation, rather than restoration of vision. Here, we describe two patients who underwent FCVB implantation. The findings in these patients indicated that FCVBs can effectively support the vitreous cavity and detached retina. FCVB implantation may thus offer a safe and effective method for treatment of severe retinal detachment, avoiding the inconvenience caused by silicone oil dependence and enucleation. To confirm its long-term usefulness in clinical applications, many additional case reports are needed.
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Affiliation(s)
- Baihui Zeng
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Qian Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Guiqin Sui
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Mingxuan Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Wei Xie
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Jinling Fu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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Thacker M, Tseng CL, Lin FH. Substitutes and Colloidal System for Vitreous Replacement and Drug Delivery: Recent Progress and Future Prospective. Polymers (Basel) 2020; 13:E121. [PMID: 33396863 PMCID: PMC7796247 DOI: 10.3390/polym13010121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 01/10/2023] Open
Abstract
Vitreoretinal surgeries for ocular diseases such as complicated retinal detachment, diabetic retinopathy, macular holes and ocular trauma has led to the development of various tamponades over the years in search for an ideal vitreous substitute. Current clinically used tamponade agents such as air, perfluorocarbons, silicone oil and expansile gases serve only as a short-term solution and harbors various disadvantages. However, an ideal long-term substitute is yet to be discovered and recent research emphasizes on the potential of polymeric hydrogels as an ideal vitreous substitute. This review highlights the recent progress in the field of vitreous substitution. Suitability and adverse effects of various tamponade agents in present day clinical use and biomaterials in the experimental phase have been outlined and discussed. In addition, we introduced the anatomy and functions of the native vitreous body and the pathological conditions which require vitreous replacement.
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Affiliation(s)
- Minal Thacker
- Graduate Institute of Biomedical Engineering, National Taiwan University, Daan District, Taipei 10051, Taiwan;
| | - Ching-Li Tseng
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Feng-Huei Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University, Daan District, Taipei 10051, Taiwan;
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County 35053, Taiwan
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