Abstract
Purpose: :
To determine if the use of viscoelastic to fill the anterior chamber (AC) during silicone oil injection is safe, with ability to manage intraocular pressure (IOP), to achieve near total silicone oil fill, and to attain improvement in visual outcome.
Methods: :
Retrospective review of consecutive series of silicone oil injection technique from 1990 to 2006 by a single surgeon with at least 1 year follow up.
Results: :
Two hundred forty-three eyes met inclusion criteria. The most common operative diagnosis was retinal detachment / proliferative vitreoretinopathy (61%), followed by proliferative diabetic retinopathy (10%), macular degeneration (10%), trauma (9%), miscellaneous peripheral non-perfusion (5%), infectious retinitis (3%), and other (2%).Balanced salt solution (BSS) was used to reform the AC in 42 eyes (17%), while sodium hyaluronate 1% (SH) was used to reform the AC in 201 eyes (83%). In the BSS group, the majority (81%) had no use of intraoperative (intra-op) IOP lowering agents. In the SH group, no intra-op IOP lowering agents were used in 65 (33%), three topical IOP lowering agents in 92 (46%), and other combination in 44 (21%) eyes.The mean pre-op day 1 IOP and post-op day 1 (POD1) IOP in the BSS group without use of intra-op IOP lowering agents was 14.6 mmHg and 21.7 mmHg. In the SH group without IOP lowering agents, the pressures were 11.6 mmHg and 26.6 mmHg, respectively. In the SH group with 3 topical IOP lowering agents, the pressures were 11.6 mmHg and 19.7 mmHg, respectively. Although all groups showed higher mean pressures on POD1, the SH filled eyes did not show a statistically higher rise at POD1 (p=0.058), post-op month 1 (p=0.704), and post-op month 12 (p=0.074). POD 1 IOP was > 40mmHg in 20 (10%) of eyes in the SH group only, the majority of which were in the group without IOP lowering agents (75%). AC paracentesis was required in 5 (25%) of eyes in the subgroup, all of which did not receive intra-op IOP lowering agents.In all patients, a greater than 95% silicone oil fill was obtained in 91% of eyes. The mean pre-op VA in the BSS group was 1.89 (logMAR), which improved to 1.39 at post-op month 12 visit (p<0.009). In the SH group, mean VA improved from 2.15 to 1.68, respectively (p<0.0001).
Conclusions: :
The use of viscoelastic to reform the AC during silicone injection does not disadvantage the eye. The use of three topical intra-op IOP lowering agents help obtain a manageable IOP at POD 1. A near total silicone oil fill and improvement in VA can be achieved in a high percentage of cases using this technique.
Keywords: vitreoretinal surgery • retinal detachment • retina