The use of continuous silicone oil infusion as a peroperative tool to facilitate break localisation, vitreous base dissection and drainage of subretinal fluid

Abstract

Introduction: We introduce the use of low-molecular-weight silicone oil as an infusion and as a peroperative tool to facilitate three specific surgical steps, namely internal search for retinal breaks, vitreous base shaving and drainage of subretinal fluid.

Method and patients: Ethics committee approval was obtained to test this novel agent in a small number of cases as a pilot study. Following vitrectomy the posterior retina was reattached and stabilised using perfluorocarbon liquid (PFCL). The infusion of balanced salt solution was then stopped and replaced with 5 mPas silicone oil. Subsequent surgery was assessed as to whether the infusion was helpful in the three surgical steps. Five cases were selected for this pilot study. Three presented with long-standing rhegmatogenous retinal detachment (RRD) of 2 or more months: 1 had dense vitreous haemorrhage and no fundal view at presentation; 2 had proliferative vitreoretinopathy. Of the remaining 2 cases, 1 had a giant retinal break and the other case had a combined diabetic tractional retinal detachment and RRD.

Results: Additional retinal breaks were found in 2 patients. The silicone oil joined with the PFCL to form a single bubble. The vitreous base along with the operculum of any retinal break was reflected anteriorly. The infusion of oil stabilised the anterior retina, making it possible to shave the vitreous closely in all 5 patients. Visualisation of the vitreous gel was also improved. There was a clear interface between vitreous and oil because of the large difference between the refractive indices of vitreous and oil. Four of the 5 patients had a total reattachment with one procedure. In the 2 cases in which 5,000 mPas silicone oil was used for long-term postoperative tamponade, no emulsification was observed. Follow-up of patients ranged from 6 to 13 months. There were no additional serious adverse reactions recorded.

Conclusion: We found that the experience of using silicone oil was very highly positive.