|Year : 1983 | Volume
| Issue : 7 | Page : 990-991
Rational of injection of silicone oil in massive vitreous retraction
TN Ursekar, YR Dastur, RP Jehangir
Krishna Nivas,Jn. of Queens Road & Charni Road Mumbai, India
T N Ursekar
Krishna Nivas, Jn of Karve Road & RR Roy Road, Mumbai-400 004
|How to cite this article:|
Ursekar T N, Dastur Y R, Jehangir R P. Rational of injection of silicone oil in massive vitreous retraction. Indian J Ophthalmol 1983;31:990-1
|How to cite this URL:|
Ursekar T N, Dastur Y R, Jehangir R P. Rational of injection of silicone oil in massive vitreous retraction. Indian J Ophthalmol [serial online] 1983 [cited 2013 May 26];31:990-1. Available from: http://www.ijo.in/text.asp?1983/31/7/990/29725
The history of the treatment of retinal detachment shows the evolution of various methods. Begining with simple diathermy, scleral resection and then followed by scleral buckles, surgeons faced many patients, who fared badly despite meticulous localization of tears and correct placement of buckles. Attention was then drawn to the changes in the membranes. Thus the treatment of masive vitreous retraction (MVR) remained an engima for most eye surgeons.
Paul Cibis reported successful method for treatment of massive vitreous retraction (MVR) using liquid silicone. Unfortunately he died too young and his work remained in oblivion.
However, John Scott from Cambridge took up this project further and published his first result in 1973. Since then he has treated more than\2000 cases successfully. R.K Leaver, 4 et al showed further successful results with liquid silicone.
30 cases of detachment complicated by massive vitreous retraction were treated by using liquid silicone.
Vitreo-retinal retraction occurs as a complication of retinal detachment. A dynamic vitreous traction occurs following a retinal tear, leading to retinal detachment and formation of vitreous membranes. Various stages of vitreous traction have been described. Two distinct stages are seen. In early stage vitreous becomes cloudy and strewn with fine pigment detposits and the retina show traction folds.
In the later stage there is marked immobilization of retinal folds and distortion of retinal tears.
In the early stage when the vitreous membranes are not rigid injection of saline or air in the vitreous is sometimes successful. However, it is in the later stage such measures do not help. Cibis noted that as the membranes contracted there is localised region. He then conceived the idea of injection of liquid silicone to force the membranes away from the retina. Scott further elaborated this concept and advocated that these vitreous membrances must be separated early from the retina before their adhesions become firm to the retina. It is therefore necessary to treat such eyes urgently.
The technique involves the ingection of silicone oil (1:1000 centistok) in the vitreous cavity by a special syringe. As one injects the oil there must be a simulaneous release of subretinal fluid. It is necessary to see the retina flattening as one injects the oil in the vitreous cavity.
We have successfully treated more than 30 cases with this technique. The results may not be impressive. However I think it is very significant for a one eyed blind patient to have a navigational vision so as to feel independant.
As in any surgery problems and com-: plications do occur at times. It is necessary to visualize the entire process while injecting the oil. Multiple bubbles can hinder the procedure. A proper technique must be mastered to avoid this problem.
Secondly, if the subretinal fluid drains off excessively it becomes difficult to introduce the needle in the centre of the vitreous cavity. Here again adequate quantity of oil must be injected to gain a clear picture of the retina. It is necessary to inject on an a average of 3 ml. or more of the oil.
We have followed our cases from 6 months to 3 years.
We have come across following complications :
1. Sillicone oil bubble in A.C. 2. Cataract formation
3. Silicone liquid passing behind the retina through an open retinal tear.
4. Secondary glaucoma.
Silicone oil bubbles in A.C. did not pose any problem. It did not damage the corneal endothelium. The bubble disappeared in course of time.
Lens changes in the form of catract formation occured in 2 cases. Scott 3 described these changes as metaplasia of the capsular epithelium. An extracapsular cataract operation is advocated in such cases.
We lost one case, where the oil tracted behind the retina through the retinal hole.
Secondary glaucoma was treated in two cases. We could control it with Timolol.
We have not come across any toxic effect of the liquid silicone in our cases. Scott and Leaver have also not reported any such cases.
17 to 25 cases in our series showed reasonably good success with anatomical flattening of the retina and adequate improvement in vision. Failure to reattach the retina was due to poor case selection or inadequate surgical technique. In some cases retinal shortening was so severe that the silicone oil failed to flatten the retina completely resulting in redetachment. In other cases, we failed to evacuate the subretinal fluid completely. I would certainlay maintain that injection of liquid silicone is an acceptable method of treatment of retinal detachment complicated by massive vitreous retraction.
| References|| |
|1.||Cibis P.A., Becker B., Okun E and Canaan, 1962, Arch. Ophthalmol. 68,590. |
|2.||Scott J.D., 1973, Trans. Ophthalmol. Soc. U.K 93, 417. |
|3.||Scott J.D., 1977, Trans. Ophthalmol. Soc. U.K 97, 235. |
|4.||Leaver P.K, Grey R.H.B. and Garner A., 1979, Brit, J. Ophthalmol. 63, 361. |
|5.||Machemer Roert, 1978, Brit. J. Ophthalmol. 62, 737. |