Efficacy and safety of active silicone oil removal through a 23-gauge transconjunctival cannula using an external vacuum pump

Complications of Silicone Oil as Vitreous Tamponade in Pars Plana Vitrectomy: A Mini Review

PURPOSE

Silicone oil (SO) has been used as a vitreous tamponade for decades. Surgical complications such as glaucoma, cataract, or emulsification are well known. Despite that, increasing case reports of unexplained visual loss after SO removal is concerning because there is no treatment available. This article describes practical complications related to SO use and advantages/disadvantages for consideration regarding the choice of a vitreous substitute in practice.

METHODS

A literature review was conducted for publications related to silicone oil, heavy silicone oil, and vitreous substitutes.

RESULTS

This article summarizes the SO chemical and physical properties including both SO and heavy SO and postoperative complications such as corneal decompensation, glaucoma, hypotony, cataract, optic neuropathy. Surgical complications such as over/underfilling, SO migration/emulsification, sticky SO and proliferative vitreoretinopathy (PVR) simulating epiretinal membranes formation, recurrent retinal detachments, SO unexplained visual loss, and permanent SO, are described. A brief overview on potential vitreous substitutes is presented.

CONCLUSION

The decision to use SO as vitreous substitute in daily practice is based on the severity of retinal diseases and surgeon experience. SO potential complications must not be underestimated. The pursuit of novel safer vitreous substitutes is imperative.

Trocar opening: silicone oil removal with phacoemulsification and intraocular lens implantation

AIM

To evaluate the efficacy and safety of a modified technique [trocar opening (TO)] for silicone oil removal (SOR) in combination with phacoemulsification and intraocular lens (IOL) implantation.

METHODS

A total of 60 eyes of 60 patients with cataract and silicone oil-filled eyes were enrolled in this study. The patients were divided into two groups: the patients in the control group underwent 23-gauge pars plana active SOR surgery with phacoemulsification and IOL implantation, while the patients in the TO group underwent TO methods during surgery. Best corrected visual acuity (BCVA), surgery time, intraocular pressure, and operative complications were observed 6mo after surgery.

RESULTS

There was no significant difference between the two groups in terms of age, gender, preoperative, intraocular pressure, or time of silicone oil stay. Prior to surgery, the mean BCVA for the control and TO groups was 1.34±0.44 and 1.36±0.42. At 6mo following surgery, the mean BCVA improved to 0.74±0.36 and 0.77±0.32, respectively (P<0.001). There was no significant difference between the two groups. The mean SOR time was 6.9±2.3min and 4.8±1.2min in the control and TO groups (P=0.008). The total operation time was 28.2±8.5min and 24.6±6.4min, respectively (P=0.035). Posterior capsule rupture occurred in four eyes of control and none of TO group (P<0.01). Late recurrent retinal detachment occurred in one eye in the control group (2mo after surgery) and in one eye in the TO group (4mo after surgery).

CONCLUSION

TO is a simple, effective, time-saving, and safe method for SOR combined with phacoemulsification and IOL implantation.

Comparison of 2 modified methods for the active removal of silicone oil with a 23-gauge transconjunctival vitrectomy system

To report and compare 2 modified approaches for the active removal of silicone oil (ROSO) with a 23-gauge transconjunctival vitrectomy system.This prospective single blinded study was conducted from January 2015 to December 2016. Eighty-nine eyes of 86 patients who underwent silicone oil removal were enrolled. Patients were randomly divided into either group A or B. In group A, the fluid-air exchange tube was connected to a 1 mL syringe with the plunger removed and the tip was dilated with a hemostat so that it fit into the cap of the 23-gauge cannula to form a seal for oil drainage. In group B, the tip of the syringe was closely attached to the cap of the 23-gauge cannula by a tube adaptor, which was salvaged from a used silicone oil inject and aspirate pack and sterilized. Main outcome measures were time required for silicone oil removal, silicone oil residual, intraoperative and postoperative complications including hypotony, bleeding, and retinal redetachment.The mean time required was 6.08 ± 0.31 minutes and 6.11 ± 0.31 minutes for groups A and B, respectively. No silicone oil residual, severe hypotony, recurrence of retinal detachment, or impairment of visual acuity were observed in either group. Conjunctival injection and hyperemia were slightly more severe in group A, but spontaneously resolved in 2 to 3 days.Both methods described in this paper were demonstrated to be safe, effective, and cost-effective for the ROSO. The syringe dilation method caused more severe conjuntival irritation, thus we suggest using the tube adaptor method for hospitals equipped with cold sterilization equipment.

A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula

AIM

To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana.

METHODS

Forty-eight eyes of 48 patients underwent silicone oil (5700 centistokes) removal (SOR) were enrolled. A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine. Silicone oil was removed with suction of 500-mm Hg vacuum through the cannula. Main outcome measures were SOR duration, number of sutured sites, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications.

RESULTS

Silicone oil was successfully removed in all cases. The mean SOR time was 5.70±0.85min. Nine eyes (18.75%) needed suture partial sclerotomies. No intraoperative complications were noted. Transient hypotony (≤8 mm Hg) was seen in 3 eyes (6.25%) on postoperative day 1, but all resolved within 1wk. Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up. BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level.

CONCLUSION

Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.