Glaucoma is a common condition, the population 2% over the age of 40 even without a history of. However, it has to be borne in mind that silicone oil tamponade is not. The inner retinal layers gradually regained a more physiologic configuration over the residual. Recent approval of jetrea ocriplasmin to treat symptomatic vma vitreo macular adhesion has opened up a new era in non surgical management of macular holes. Treatment of idiopathic macular hole with silicone oil tamponade. To investigate the anatomical and functional results of silicone oil so removal after an extended period of so tamponade in eyes having received. We report a case of macular hole mh formation and retinal detachment after intravitreal conbercept injection for the treatment of choroidal neovascularization cnv secondary to degenerative myopia. Twenty highly myopic patients with macular holes and localized posterior rd, treated initially with intravitreal injection of c 3 f.
In these cases usually some air, gas or silicone oil is being injected into the vitreous cavity so that retina could be pushed against the eyes wall in which manner in fact it is to be. Repeat surgery in failed primary vitrectomy for macular holes. The front of the eye contains a lens that focuses images on the inside of the back of the eye. With this third surgery, silicone oil was placed in my eye instead of a permeable gas. Apr 01, 2009 results of highdensity silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia. This study aimed to evaluate treatment effects of intravitreal gas for macular hole with localized retinal detachment rd in highly myopic eyes and to examine how the vitreomacular relationship and other factors may influence treatment outcomes. Postoperative positioning after vitrectomy surgery. Outcomes of macular hole surgery using silicone oil or. Macular hole silicone oil theodore leng, md, ms theodore leng, md, facs channels. As you can see from the list above, just by putting oil in the eye, the vision is reduced. Silicone oil is an alternative to gas tamponade for macular hole surgery in patients who are unable or unwilling to posture.
Droplets of silicone oil are seen superiorly in a full thickness macular hole c. Macular hole surgery using silicone oil tamponade british journal. The described technique is developed to treat very large macular holes 8001,300. Silicone oils are important tools in vitreoretinal surgery because they have the ability to displace aqueous humor from the retinal surface, maintaining the adhesion between retina and retinal pigment epithelium.
Silicone oil has been widely used as a surgical tool in retinal surgery for many years. Why do i need postoperative postop head positioning. Secondary fullthickness macular hole mh formation after vitrectomy is a rare surgical complication, with an incidence reportedly between 0. Surgery called vitrectomy is the best way to treat a macular hole. In one patient 10%, after removal of silicone oil, reopening of the macular hole was observed and a second surgical intervention was required, after which closure of the macular hole was achieved. This was a retrospective interventional study of 10 eyes in eight patients who underwent surgical treatment of idiopathic macular holes using pars plana vitrectomy, ilm peeling using brilliant blue dye, and silicone oil tamponade without postoperative posturing. Vitrectomy the american society of retina specialists. The front of the eye contains a lens that focuses images on the inside of the back.
This fact, coupled with the necessity for future surgery to remove the oil, prevents most of us from using oil during the initial surgery. New treatment for macular holes east carolina retina. Internal repair of very large, myopic and recurrent macular. Kumar v1, banerjee s, loo av, callear ab, benson mt. Retina posted 5102019 theodore leng, md, ms, shares a case of a closure of recurrent macular hole 1 month after a primary attempt using autologous free ilm flap, autologous serum, and silicone oil. Of course it is possible to have eye problems unrelated to the retinal detachment or silicone oil such as continued diabetic circulation problems in diabetics or age related changes. Jun 28, 2011 23 g vitrectomy with ilm peeling and heavi silicone oil injection in retinal detachment with mac hole and post staphyloma. Macular hole surgery using silicone oil tamponade british. Silicone oil tamponade to seal macular holes without position restrictions. Remove or not to remove silicone oil after surgery eye care. The up side of the oil placement was that i didnat have to remain face down. Lasik method, i made two injections of gas and last injection of oil silicone im 10 months in the right eye.
Silicone oil or gas tamponade to treat macular hole. Silicone oil is often used as a last resort to prevent further operations. This, however, requires a second surgery to remove the silicone oil. If you have a macular hole, that may be the limiting factor to visual recovery. Intravitreal injection ocriplasmin trade name jetrea is a drug used by some retinal specialists to treat vitrealmacular adhesions.
Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular. Comparison of silicone oil versus gas tamponade in the treatment of idiopathic fullthickness macular hole james c. Retina today facedown positioning is not necessary in. Large full thickness, 700 microns, extensive surrounding subretinal fluid, yellow deposits on rpe within hole, mild epiretinal membrane. Intravitreal gas injection for macular hole with localized. In general, there is no consensus about the best choice of tamponade agent. Both groups had pars plana vitrectomy with detachment of the posterior cortical vitreous and injection of silicone oil or gas tamponade. The down side is that i need to have another surgery to remove the oil. The patients were unable to posture due to chronic illness and had stage 2, 3, or 4 full thickness macular holes. We analyzed the anatomical and visual outcomes after surgical treatment of idiopathic macular holes with pars plana vitrectomy, internal limiting. This area, called the retina, is covered with special nerve cells that react to light, like film in a camera. Silicone oil tamponade to seal macular holes ophthalmology. Densiron68 endotamponade for persistent macular holes. A recently published retrospective consecutive case series of patients from our practice 68 eyes in 65 patients shows that macular hole surgery can be performed without facedown positioning with results equivalent to surgery in patients who practice facedown positioning.
Clinical characteristics, risk factors, and surgical outcomes. Outcomes of eyes with failed primary surgery for idiopathic. Aug 17, 2018 rizzo s, genovesiebert f, vento a, et al. Many retinal surgeons will consider removal of the silicone oil after approximately 3 months, since that time frame allows the laser to have its maximum effect. This bubble helps flatten the macular hole and hold it in place while your eye heals. Thank you for your comments regarding the early use of silicone oil to treat retinal detachments. Whenever it comes to the silicone oil use in retinal detachment conditions it almost always means that the patients condition has got somehow complicated. My question is would you recommend gas or silicone oil to treat the macular hole. A macular hole within the eyes retina occurs when the nerve cells of the macula become separated from each other and pull away from the back surface of the eye, affecting vision. Submitted by dr peter van houten on sun, 031720 15. In the patient with the silicone oil injection, spectral domain optical coherence tomography revealed that the macular hole was sealed with an inverted internal limiting membrane flap in the presence of subretinal fluid 1 day after surgery. The few reported results of macular hole surgery using silicone oil have been contradictory.
Macular hole treatment american academy of ophthalmology. Silicone oil reinjection is a simple technique and can be done by all vitreoretinal surgeons but it has the disadvantages of the possibility of recurrent rd after silicone oil removal especially in the presence of high myopia, posterior staphyloma, and open and large macular hole and complications may occur as emulsification of silicone oil. Silicone oil for retinal detachments retina specialist. Silicone oil emulsification in retina surgery retina today. Discussing gas versus silicone for macular hole surgery. Treatment of idiopathic macular hole with silicone oil. The presence of internal limiting membrane is not required to obtain anatomical repair. To repair a macular hole surgically, an outpatient procedure called a vitrectomy is performed. Yes, the silicone oil will have to be removed at a later time. Facedown positioning is not necessary in idiopathic macular hole repair.
To evaluate usefulness of posterior vitrectomy with silicone oil tamponade for primary and secondary macular hole closure. Alain gaudric, ramin tadayoni, in retina fifth edition, 20. Previously only a hospital based surgery was able to reverse the process of macular hole development but now a new drug can be injected into the eye painlessly in the office and within a few weeks the process reverses back to more normal vision levels. Silicone oil reinjection without macular buckling for. To understand this capability, it is important to know the silicone oil characteristics.
Longacting gas with face down positioning for up to three weeks was used earlier in the development of surgery for. Silicone oil reinjection without macular buckling for treatment of recurrent myopic macular hole retinal detachment after silicone oil removal. Macular hole closure with autologous ilm and autologous serum. Oct 04, 2009 there was a recent article weighing the pros and cons of silicone oil versus intraocular gas tamponade for repair of macular hole.
Other variables, such as surgical skill, size of the macular hole, age of the hole, and the presence of preexisting eye conditions are critically important to the outcome. The second detached retina happened approximately a month after the first one. However, with macular hole, you would more than likely still have to be positioned face down even if you had silicone oil. To compare anatomic and functional outcomes of macular hole surgery with either silicone oil or c 3f 8 gas tamponade. Facedown positioning is commonly used to facilitate macular hole tamponade and closure postoperatively. Dec 20, 2019 secondary fullthickness macular hole mh formation after vitrectomy is a rare surgical complication, with an incidence reportedly between 0. Comparison of silicone oil versus gas tamponade in the treatment of idiopathic fullthickness macular hole.
Silicone oil is an alternative to gas tamponade for macular hole. Hyperoleum outlined in yellow arrows is seen in the vitreous cavity b. Comparison of silicone oil versus gas tamponade in the. At 6 weeks following silicone oil injection the ftmh was closed in nine eyes and flat open in one eye fig 2. Repeat surgery in failed primary vitrectomy for macular. Gas vs oil in macular hole surgery eye care medhelp. The high rates of success in these nonrandomized studies compared with the 69 % seal rate reported by the vitrectomy for treatment of macular hole study group. Furthermore, the bubble of decaline prevents subretinal migration of dye through the macular hole. The procedure as originally described 1 consists of pars plana vitrectomy, the separation of the posterior hyaloid cortex from the retinal surface, and the filling of the vitreous cavity with a long acting gas. Macular hole was first described in 1869 by knapp, 3 of a traumatic case. Heavy silicone oil densiron68 for the treatment of persistent macular holes. Results of highdensity silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia.
To investigate the anatomical and functional results of silicone oil so removal after an extended period of so tamponade in eyes having received vitrectomy for proliferative diabetic retinopathy. Noyes 4 1871 gave a detailed ophthalmoscopic description of a traumatic case, and ogilvie 1900 was the first to use the term hole at the macula. The procedure as originally described1 consists of pars plana vitrectomy, the separation of the posterior hyaloid cortex from the retinal surface, and the filling of the vitreous cavity with a long acting gas. Three patients with macular hole retinal detachment in high myopia underwent pars plana vitrectomy using the inverted internal limiting membrane flap technique. Treatment of retinal detachment due to macular hole. Facedown positioning is not necessary in idiopathic macular. An inverse pseudohypopyon of silicone oil is seen in the anterior chamber a.
Macular hole retinal detachment after intravitreal. These nerve cells are very close together in the middle of the retina where the eye focuses the images that we see. You need to position your head so the bubble presses against the hole or tear so it can seal. During your surgery, we may use a gas bubble or silicone oil to help close a macular hole or seal a retinal tear from a retinal detachment. On one hand is the issue of intraocular gas tamponade, high success rate of hole closure, but the difficulty in maintaining face down positioning for 1 to 3 weeks.
The success rates of surgery for full thickness macular holes ftmh have been steadily improving. Silicone oil tamponade for macular holes ophthalmology. Macular hole closure with autologous ilm and autologous. At present, comparatively few data on the longterm anatomic and visual outcomes after failed macular hole surgery exist.
A 60yearold woman presented with blurred vision in her left eye was diagnosed as cnv secondary to degenerative myopia. Advances in macular hole treatment and recovery visionaware. Internal repair of very large, myopic and recurrent. Clinical characteristics, risk factors, and surgical. Management options for unclosed macular holes include observation, outpatient fluidgas exchange, and vitrectomy with a number of approaches to the internal limiting membrane ilm and postoperative tamponade choice. Glaucoma is a common condition, the population 2% over the age of 40 even without a history of retinal detachment or silicone oil injection. See important issues raised by macular hole patients for suggestions on advocating for a more timely surgical appointment. Vitrectomy is a surgical procedure undertaken by a specialist where the vitreous humor gel that fills the eye cavity is removed to provide better access to the retina. Silicone oil reinjection is a simple technique and can be done by all vitreoretinal surgeons but it has the disadvantages of the possibility of recurrent rd after silicone oil removal especially in the presence of high myopia, posterior staphyloma, and open and large macular hole and complications may occur as emulsification of silicone oil and increase of intraocular pressure. Vitrectomy medical clinical policy bulletins aetna. Your ophthalmologist removes the vitreous that is pulling on your macula. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade densiron. Retina today silicone oil emulsification in retina surgery.
Fortysix eyes of 44 patients underwent macular hole surgery involving injection of silicone oil 23 cases or gas tamponade 23 controls. Intravitreal injection ocriplasmin trade name jetrea is a drug used by some retinal specialists to treat vitreal macular adhesions. Advantages of silicone oil for retinal detachments. Hyperreflective dots on oct yellow arrows demonstrate silicone oil droplets within the macular hole d. Remove or not to remove silicone oil after surgery eye. Infusion of silicone oil or a gas bubble theoretically provides a scaffolding or template for fibroglial proliferation. Intravitreal injection of conbercept, an anti vascular endothelial. Jan 02, 2020 thus, unless limited by patient circumstances, gas tamponade for macular hole repair is preferable to silicone oil tamponade. My first detachments presented on july 3 holiday weekend and were treated with pneumatic retinopexy in the doctors office. The video presents air fluid exchange and the injection of the oil through 25g superior temporal cannula.
Why vision is poor with silicone oil retina specialist. Late reopening of macular holes after initially successful treatment with. The few reported results of macular hole surgery using silicone oil. In this retrospective case series, we studied the effect of heavy silicone oil on persisting macular holes. This allows for a variety of repairs, including the removal of scar tissue, laser repair of retinal detachments and treatment of macular holes.
Controversies surrounding the surgical repair of macular holes 20gauge versus 23gauge versus 25gauge vitrectomy systems. After internal limiting membrane removal, the retina is detached from the pigment epithelium in the posterior pole by injection of subretinal balanced salt solution through a 40 g needle. During the procedure, the vitreous gel within the eye and a layer of scar tissue on the macula is removed and a bubble of either gas or silicone oil is placed in the vitreous to float to the back of the eye and keep the hole closed until it can heal. Retina posted 5102019 theodore leng, md, ms, shares a case of a closure of recurrent macular hole 1 month after a primary attempt using autologous. Silicone oil may be used for patients who are unable to be facedown. So, too, is the necessity to remove the cataract, or your natural lens, during retinal detachment surgery.