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J. L. Ferreira, L. P. Chong, F. Rezende, A. Maia, L. F. Hagemann, H. Primiano, R. C. Siqueira; To Stitch or Not to Stitch Small-Gauge Sclerotomies When Using Silicone Oil?. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2216.
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To report the occurrence of silicone oil (SiO) leakage after transconjuntival 25 (tsv25) and 23-gauge (tsv23) vitrectomy by experienced surgeons.The superficial tension between SiO and BSS (balanced salt solution) is 33 erg/cm2 and comes down to 14 erg/cm2 under action of the lipoproteins (biologic surfactants)(1).
Retrospective, noncomparative, case series. Six male and one female patients, age 10 to 71, mean 50.3 years old, underwent surgery for the following diseases: vitreous hemorrhage 4 (57%), being one case of central retinal vein occlusion and three cases of proliferative diabetic retinopathy; macular hole 1(14%); retinal detachment 2 (29%) cases. One patient (case # 6) had a tsv23 surgery and the SiO was inserted through the 23-gauge trocater. The conjunctiva was submitted to bipolar cauterization when the patient was reoperated for subconjunctival SiO removal and no further leakage was observed. Another patient (case # 7) was submitted to bipolar cauterization at the conjunctiva over the 23-gauge tunnel fashion scleral wounds, but it did not prevent leakage of the silicone oil. The other patients (cases # 2 to 5) had a tsv25 surgery and the SiO inserted through a converted 20-gauge sclerotomy that was sutured afterwards. Only one patient (case # 1) was submitted to transconjunctival suture of the 25-gauge sclerotomies and presented leakage of SiO even though. Three patients (cases 5 to 7) were submitted to tunnel fashion sclerotomies, being two 23-gauge and one 25-gauge - that were not sutured. One of the patients (case # 2) was submitted to reoperation and removal of the tenon with SiO was submitted to pathology examination (light microscopy).
SiO leaked after the first surgery of four patients and after a reoperation in three patients. The subconjuntival SiO detection varied from the first day to two months (mean 19 days) after the operation. The aspect varied from one bubble in one quadrant to several diffuse bubbles in all quadrants. Anatomopathological sample showed macro and micro vacuoles with fine fibrous tissues and giant cells.
SiO leakage can happen in conventional or in tunnel fashion sclerotomies, even late after surgery. Transconjunctival sutured sclerotomies can leak if not properly tightened. We advise careful wound suturing of all 20, 23 or 25-gauge sclerotomies whenever SiO is used.
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