The Clinical Study On Heavy Silicone Oil In The Treatment Of Retinal Detachment

Background and ObjectiveRetinal detachment is a common clinical disease, seriously affect the visual acuity. Cibis intravitreal silicone oil as a filler for the clinical years for the first time since 1962, people have been looking for better vitreous substitute. Vitreous cavity filling the existing limitations, gas, silicone oil specific gravity is less than water, and the pressure on the bottom and top of the posterior pole hole are not satisfied, and after filling the patients need to be a special position, it is difficult to the patients who cannot reach to the position. The heavy silicone oil make up for the disadvantage of gas and silicone oil, for the lower and posterior pole retinal breaks and the patients who couldn't aft facing lower after the case, it is an ideal substitute. This study througe observe anatomical repositioning of the retina, and postoperative complicati-ons vitreous cavity after filled with heavy silicone oil(Densiron-68), discuss the treatment of retinal detachment of the effect and safety.MethodsChoose 20 patients who is in hospital from July 2009 to July 2010,our hospital 20 patients with retinal detachment in 20 eyes, every patient deal with Pars plana vitrectomy, in which 14 males and 6 females, aged from 4 to 76 years, mean (43.93±23.87)years.Selection criteria contain two kinds:one is patients can not be prone to lower position this kinds contain 8 patients,2 patients with hypertension and diabetes,2 cases younger (<4 years).4 cases old age (> 70 years). The other is a macular hole, the bottom or below the main square in patients with retinal detachment, a total of 12 cases. Including 5 cases of recurrent retinal detachment (4 cases of ordinary silicone oil); 3 cases of traumatic; high myopia in 3 cases, IOL eyes of 1 patient.All patients deal with PPV under local anesthesia, during the surgery removed the crystal, according to the joint disease, cut the proliferation, membrane peeling, intraocular laser photocoagulation and filled with heavy silicone oil (Densiron-68). Remove the heave silicone oil also under local anesthesia, the trocar into the pars plana incision suction out the heavy silicone oil, and examine the eyes detailed. All surgical operation is completed by the same surgeon. After all patients have a detailed eye examination during the operation, including uncorrected and best corrected distance visual acuity, intraocular pressure, slit lamp examination front, the front mirror and the three mirror contact lens fundus, some patients with B- ultrasound examination or OCT.1,2,3,7,14 postoperative day, followed up months 1,2,3,6, remove the silicone oil after 1,2,3,7,14day,1month,3 month follow up, were recorded at visual acuity, intraocular pressure and the anterior and posterior segment conditions, the eye B- ultrasound determined retinal reattachment. SPSS17.0 software used for statistical analysis.ResultsAll patients had no complications, have reached the anatomic reset. Heavy silicone oil was 44～182 days time, the average (87.21±34.07) days, mean follow-up (91±14.23) days, remove the silicone oil the followed up is(92±16.35)days.1. Vision:20 patients macular retinal detachment attach the Macula, including light perception 4 cases,5 cases of hand,cases from 0.02 to 0.04,17 cases after removed the heavy silicone oil. patients (85%) compared with preoperative there are different degrees of improvement,2 cases without visionimprove,5 patients up the 0.1, the best corrected visual acuity is 0.5.2. Retinal reattachment:When removed silicone oil,14 of the 20 patients (14 eyes) retinal is normal, after follow up always maintain anatomic reduction.3 patients happend anterior PVR, proliferative membrane formation in silicone oil appears at the top of recurrent retinal detachment, filled with ordinary silicone oil re-operation given to obtain anatomic reduction, to remove the silicone oil to maintain anatomic. Heavy silicone oil removal in 3 cases, see the local minor uplift of the retina,1 case given Scleral buckling cerclage cryotherapy, The other 2 patients were given inert gas (C3F8) filled with omentum after reset, no retinal detachment during follow-up; 1 patient lost to follow.3. Complication:(1) intraocular pressure:All patients'intraocular pressure are in normal or low levels,after filled with heavy silicone oil intraocular pressure was increased in 18 patients,2 cases punctured in the anterior chamber in 1 week after surgery,intraocular pressure decreased to normal in patients;Other topical ocular hypotensive medication in patients with symptomatic treatment, decreased to normal.Intraocular pressure reduction occurred in 2 patients. (2) lens opacities:5 cases of phakic patients with different degrees of lens opacity or increased turbidity, mainly show posterior subcapsular cortical cataract. (3) heavy silicone oil emulsion:9 patients with different degrees of emulsification, the shortest time 32 days, up to 6 months. Below the lens posterior capsule showed a small amount of silicone oil droplets floating,1 case of emulsified silicone oil into the anterior chamber, located in the bottom, showing pseudo-hypopyon. (4) corneal degeneration, corneal endothelial damage:2 cases with poor Cornea after traumatic corneal preoperative patients has increased corneal opacity, corneal endothelial damage was not found in patients.(5) PVR occurred in 3 eyes postoperative, the retina occured different degrees of the proliferation, the people who occurred traction retinal detachment,the surgery were given again. ConclusionHeavy silicone oil Densiron-68 have the good effect on the posterior pole retinal hole, while improving postoperative comfort.