Clinical effect of peripheral capsule preservation in eyes with silicone oil tamponade

Abstract

Background: At present, silicone oil has been widely used in vitrectomy to deal with complex fundus diseases. Usually, cataract extraction is combined with vitrectomy. However, reducing the complications of silicone oil tamponade and facilitating the secondary implantation of intraocular lens (IOL) are still an urgent problem.

Aim: To evaluate the clinical effect of vitrectomy combined with peripheral capsule preservation (PCP) in eyes with silicone oil tamponade.

Methods: This single-center retrospective analysis included 70 patients (73 eyes) who underwent vitrectomy and silicone oil tamponade combined with cataract surgery (stage I) between January 2015 and July 2019. All patients underwent selective reoperation for silicone oil extraction and IOL implantation (stage II) more than 3 mo after stage I. These patients were divided into three groups according to the different lens capsule preservation methods: 28 patients (31 eyes) in a whole capsule preserved (WCP) group, 17 (17 eyes) in a capsule absent (CA) group, and 25 (25 eyes) in a peripheral capsule preserved (PCP) group. Intraocular pressure (IOP), best-corrected visual acuity, surgery time, and other complications were recorded at each time point (1 d, 1 wk, and 1 mo after stages I and II).

Results: The IOP values were 14.9 ± 8.2 mmHg in the WCP group, 20.3 ± 13.0 mmHg in the CA group, and 14.2 ± 9.7 mmHg in the PCP group (P < 0.05) at 1 mo after stage I operation. Five eyes had IOP higher than 30 mmHg, and one eye in the WCP group appeared to have silicone oil entering the anterior chamber. There was no significant difference in IOP among the three groups at any other time point (P > 0.05). With IOL implantation, visual acuity improved significantly compared to stage I. The incidence rate of posterior capsule opacity was higher in the WCP group than in the other groups (P < 0.001). In the CA group, IOL deviation due to suture relaxation occurred in one case. There was no significant difference in the surgery time among the three groups in stage I (P = 0.618). In stage II, the surgery time of the PCP group and WCP group was significantly shorter than that of the AC group (P = 0.031).

Conclusion: Preservation of the peripheral capsule in vitrectomy combined with lens removal is a better option. This method has significant advantages in reducing intraoperative and postoperative complications.

Keywords: Intraocular lens implantation; Peripheral capsule preservation; Silicone oil tamponade; Vitrectomy.

Figure 1

Comparison of intraocular pressure in three groups at diffferent time points after operation. PCP: Peripheral capsule preservation group; CA: Capsule absent group; WCP: Whole capsule preserved group; ^aP < 0.05.

Figure 2

Anterior segment photography of patients in whole capsule preserved group and peripheral capsule preservation group. A: After phacoemulsification, although the posterior capsule was polished during the operation, there was still limited capsule opacification (arrow); B: After phacoemulsification, the posterior capsule was directly cut during vitrectomy to avoid the occurrence of posterior capsular opacity.

Figure 3

Diagrammatic sketches of silicone oil-filled eyes in three different capsule retention states. A: Whole capsule preserved group; B: Capsule absent group; C: Peripheral capsule preserved group.