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      Comparison of Repeated Fluid-Air Exchange and Passive Drainage for Removing Residual Emulsified Silicone Oil Droplets

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          To compare the efficacy of passive drainage (PD) and repeated fluid-air (FA) exchange for removing emulsified silicone oil (SO) droplets.


          Twenty rhegmatogenous retinal detachment (RRD) patients who underwent primary pars plana vitrectomy (PPV) with SO tamponade were randomly and evenly divided into two groups for PD and FA exchange. Once the bulk of SO was removed, the first 2 mL of the washout fluid was collected, and then, another 2 mL of the washout fluid was collected after PD or FA exchange. The size and number of SO droplets in the washout fluid were measured using a Coulter counter (Multisizer 3, Beckman Coulter, Indianapolis, IN, USA). The efficiencies of FA exchange and PD for removing emulsified SO were compared.


          The number of SO droplets decreased significantly after FA exchange and PD. The decrease in the number of droplets was statistically significant for larger droplets (>4  µm) with PD and for all droplet sizes with FA exchange. The decrease in the number of SO droplets of <4  μm was significantly greater with FA exchange than with PD. However, at the end of the procedure, the overall number and size distribution of SO droplets were similar for both procedures.


          PD and FA exchange reduced the number of residual emulsified SO droplets after SO tamponade efficiently. FA exchange may have some advantages over PD in removing small droplets.

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          Most cited references 24

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          The use of liquid silicone in retinal detachment surgery.

           P CIBIS,  S Canaan,  E Okun (1962)
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            Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study.

            This study aimed to report anatomic and visual acuity outcomes and complications after 1000-centistoke silicone oil was used as a retinal tamponade for the treatment of complex retinal detachments. Prospective observational multicenter study conducted at community and university-based ophthalmology clinics. The study cohort consisted of 2439 patients (2573 eyes) treated for complex retinal detachments associated with cytomegalovirus (CMV) necrotizing retinitis or a non-CMV etiology, including proliferative diabetic retinopathy, giant retinal tears, proliferative vitreoretinopathy, or ocular trauma. Vitrectomy surgery was performed for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade. Anatomic outcomes were complete retinal attachment and macular attachment. Visual acuity outcomes were ambulatory vision (> or = 4/200) and preservation of preoperative visual acuity. Complications were rates of secondary intraocular pressure elevation (> or = 30 mmHg), hypotony (< or = 5 mmHg), corneal opacification (including band keratopathy, corneal edema, and corneal abrasions), oil emulsification, and cataract. Outcomes were assessed 6, 12, and 24 months after surgery. At the 6-month examination, the retina was completely attached in 178 (78%) of 228 CMV eyes and in 855 (70%) of 1219 non-CMV eyes. The macula was attached in 216 (95%) of 228 and 1062 (89%) of 1189 CMV and non-CMV eyes, respectively. Ambulatory vision was noted in 151 (65%) of 234 CMV eyes and in 480 (38%) of 1251 non-CMV eyes. Visual acuity was preserved in 106 (46%) of 230 and 1035 (84%) of 1229 CMV and non-CMV eyes, respectively. The corresponding rates of complications for CMV and non-CMV eyes were: elevated intraocular pressure, 0 (0%) of 196 and 35 (3%) of 1196; hypotony, 11 (6%) of 196 and 228 (19%) of 1196; corneal opacity, 13 (6%) of 229 and 326 (26%) of 1248; emulsification, 3 (1%) of 211 and 29 (3%) of 959; and cataract in phakic eyes, 118 (64%) of 185 and 50 (63%) of 80. Retinal reattachment was achieved in the majority of eyes using vitrectomy and silicone oil retinal tamponade. Complication rates generally were less frequent in CMV eyes, but follow-up was shorter in this group of patients, largely because of reduced life expectancy. Cataract frequently developed in phakic eyes of study patients. Use of 1000-centistoke silicone oil can be considered in the management of complex retinal detachments associated with multiple etiologies.
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              Effect of silicone oil viscosity on emulsification.

              Emulsification of intravitreal silicone oil has been observed as a late complication after its use as a retinal tamponade. We compared the emulsification potential of silicone oil of different viscosities (100 centistokes [cs], 1000 cs, and 12,500 cs) and molecular composition in an in vitro model using a commercial detergent (benzalkonium chloride) and physiologic surface-active agents (human serum and lysed red blood cells). We found that silicone oils that have low-molecular-weight contents emulsify more readily than those that do not. Moreover, the extent and susceptibility to emulsification increases with decreasing viscosity or with an increase in the proportion of low-molecular-weight constituents. Hence, higher-molecular-weight (viscosity) oils or removal of low-molecular-weight components from medical grade fluid may lessen the emulsification observed clinically.

                Author and article information

                J Ophthalmol
                J Ophthalmol
                Journal of Ophthalmology
                4 July 2020
                : 2020
                1Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
                2Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
                3NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
                4Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
                Author notes

                Academic Editor: Elad Moisseiev

                Copyright © 2020 Jian Yu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funded by: National Key Research & Development Plan
                Award ID: 2017YFC0108200
                Funded by: Science and Technology Commission of Shanghai Municipality
                Award ID: 19441900900
                Research Article

                Ophthalmology & Optometry


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