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. 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. Surgery called vitrectomy is the best way to treat a macular hole. Infusion of silicone oil or a gas bubble theoretically provides a scaffolding or template for fibroglial proliferation. Macular hole surgery using silicone oil tamponade british. 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.
Glaucoma is a common condition, the population 2% over the age of 40 even without a history of retinal detachment or silicone oil injection. Treatment of idiopathic macular hole with silicone oil. 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. Silicone oil is rarely used during primary retinal detachment surgery, meaning we usually dont use silicone oil unless the retina repeatedly detaches. Macular hole was first described in 1869 by knapp, 3 of a traumatic case. Comparison of silicone oil versus gas tamponade in the treatment of idiopathic fullthickness macular hole. A 55yearold african american gentleman underwent 25g vitrectomy surgery with centistokes silicone oil injection for the repair of a combined rhegmatogenous and tractional retinal detachment due to proliferative diabetic retinopathy. Jun 28, 2011 23 g vitrectomy with ilm peeling and heavi silicone oil injection in retinal detachment with mac hole and post staphyloma. However, it has to be borne in mind that silicone oil tamponade is not. At present, comparatively few data on the longterm anatomic and visual outcomes after failed macular hole surgery exist. Advantages of silicone oil for retinal detachments. Silicone oil reinjection without macular buckling for. The down side is that i need to have another surgery to remove the 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.
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 the american society of retina specialists. As you can see from the list above, just by putting oil in the eye, the vision is reduced. My first detachments presented on july 3 holiday weekend and were treated with pneumatic retinopexy in the doctors office. This allows for a variety of repairs, including the removal of scar tissue, laser repair of retinal detachments and treatment of macular holes. The inner retinal layers gradually regained a more physiologic configuration over the residual. 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. Densiron68 endotamponade for persistent macular holes. New treatment for macular holes east carolina retina.
Retina today silicone oil emulsification in retina surgery. In general, there is no consensus about the best choice of tamponade agent. Kumar v1, banerjee s, loo av, callear ab, benson mt. There was a recent article weighing the pros and cons of silicone oil versus intraocular gas tamponade for repair of macular hole. Facedown positioning is not necessary in idiopathic macular hole repair. The front of the eye contains a lens that focuses images on the inside of the back of the eye. Intravitreal injection ocriplasmin trade name jetrea is a drug used by some retinal specialists to treat vitreal macular adhesions. Furthermore, the bubble of decaline prevents subretinal migration of dye through the macular hole. Clinical characteristics, risk factors, and surgical outcomes. To compare anatomic and functional outcomes of macular hole surgery with either silicone oil or c 3f 8 gas tamponade.
So, too, is the necessity to remove the cataract, or your natural lens, during retinal detachment surgery. Results of highdensity silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia. With this third surgery, silicone oil was placed in my eye instead of a permeable gas. We searched for publications on the surgical treatment. Submitted by dr peter van houten on sun, 031720 15. Silicone oil is an alternative to gas tamponade for macular hole surgery in patients who are unable or unwilling to posture. Advances in macular hole treatment and recovery visionaware. Clinical characteristics, risk factors, and surgical. Macular hole treatment american academy of ophthalmology. Macular hole closure with autologous ilm and autologous. Droplets of silicone oil are seen superiorly in a full thickness macular hole c. Comparison of silicone oil versus gas tamponade in the. Silicone oil tamponade to seal macular holes without position restrictions.
One patient received a silicone oil injection, and the other two patients received a longacting gas injection at the end of the surgery. Thank you for your comments regarding the early use of silicone oil to treat retinal detachments. Remove or not to remove silicone oil after surgery eye care. Heavy silicone oil densiron68 for the treatment of persistent macular holes. We analyzed the anatomical and visual outcomes after surgical treatment of idiopathic macular holes with pars plana vitrectomy, internal limiting. An inverse pseudohypopyon of silicone oil is seen in the anterior chamber a. Positioning is really a necessity in macular hole patients.
Yes, the silicone oil will have to be removed at a later time. The few reported results of macular hole surgery using silicone oil have been contradictory. 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. Your ophthalmologist removes the vitreous that is pulling on your macula. Remove or not to remove silicone oil after surgery eye. The up side of the oil placement was that i didnat have to remain face down. These nerve cells are very close together in the middle of the retina where the eye focuses the images that we see. My question is would you recommend gas or silicone oil to treat the macular hole. 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. If you have a macular hole, that may be the limiting factor to visual recovery. 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. This, however, requires a second surgery to remove the silicone oil.
Silicone oil tamponade for macular holes ophthalmology. 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. Intravitreal injection ocriplasmin trade name jetrea is a drug used by some retinal specialists to treat vitrealmacular adhesions. 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. 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. 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. Macular hole retinal detachment after intravitreal. 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. Three patients with macular hole retinal detachment in high myopia underwent pars plana vitrectomy using the inverted internal limiting membrane flap technique. Comparison of silicone oil versus gas tamponade in the treatment of idiopathic fullthickness macular hole james c.
Apr 01, 2009 results of highdensity silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia. Some surgeons use silicone oil in those who cannot position, requiring an additional procedure to remove the oil, which carries its own risks. Intravitreal gas injection for macular hole with localized. A 60yearold woman presented with blurred vision in her left eye was diagnosed as cnv secondary to degenerative 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. 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. You need to position your head so the bubble presses against the hole or tear so it can seal. The front of the eye contains a lens that focuses images on the inside of the back. At 6 weeks following silicone oil injection the ftmh was closed in nine eyes and flat open in one eye fig 2.
Treatment of idiopathic macular hole with silicone oil tamponade. The few reported results of macular hole surgery using silicone oil. This bubble helps flatten the macular hole and hold it in place while your eye heals. Macular hole silicone oil theodore leng, md, ms theodore leng, md, facs channels. Silicone oil is an alternative to gas tamponade for macular hole. 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. However, with macular hole, you would more than likely still have to be positioned face down even if you had silicone oil. Outcomes of macular hole surgery using silicone oil or. Hyperreflective dots on oct yellow arrows demonstrate silicone oil droplets within the macular hole d. 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. Why vision is poor with silicone oil retina specialist.
Late reopening of macular holes after initially successful treatment with. Silicone oil has been widely used as a surgical tool in retinal surgery for many years. Discussing gas versus silicone for macular hole surgery. Silicone oil tamponade to seal macular holes ophthalmology. To evaluate usefulness of posterior vitrectomy with silicone oil tamponade for primary and secondary macular hole closure. This area, called the retina, is covered with special nerve cells that react to light, like film in a camera. Macular hole closure with autologous ilm and autologous serum. Twenty highly myopic patients with macular holes and localized posterior rd, treated initially with intravitreal injection of c 3 f. To repair a macular hole surgically, an outpatient procedure called a vitrectomy is performed.
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. Glaucoma is a common condition, the population 2% over the age of 40 even without a history of. Facedown positioning is commonly used to facilitate macular hole tamponade and closure postoperatively. In this retrospective case series, we studied the effect of heavy silicone oil on persisting macular holes. Silicone oil for retinal detachments retina specialist. Silicone oil is placed in the eye to prevent the fluid from within the eye from reentering the retinal tears and getting underneath the retina while the laser is taking effect. Aug 17, 2018 rizzo s, genovesiebert f, vento a, et al. The video presents air fluid exchange and the injection of the oil through 25g superior temporal cannula.
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. This fact, coupled with the necessity for future surgery to remove the oil, prevents most of us from using oil during the initial surgery. To understand this capability, it is important to know the silicone oil characteristics. Advances in macular hole treatment and recovery page 12345. Longacting gas with face down positioning for up to three weeks was used earlier in the development of surgery for. 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. Macular hole surgery using silicone oil tamponade british journal. Silicone oil may be used for patients who are unable to be facedown. Postoperative positioning after vitrectomy surgery. Silicone oil reinjection without macular buckling for treatment of recurrent myopic macular hole retinal detachment after silicone oil removal.
Both groups had pars plana vitrectomy with detachment of the posterior cortical vitreous and injection of silicone oil or gas tamponade. In these cases, silicone oil is often used, which does not require facedown positioning. Repeat surgery in failed primary vitrectomy for macular. Jan 02, 2020 thus, unless limited by patient circumstances, gas tamponade for macular hole repair is preferable to silicone oil tamponade. Repeat surgery in failed primary vitrectomy for macular holes. Maghrabi eye hospitaltanta branch, tanta 31517, egypt. Why do i need postoperative postop head positioning. Hyperoleum outlined in yellow arrows is seen in the vitreous cavity b. 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. 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. Fortysix eyes of 44 patients underwent macular hole surgery involving injection of silicone oil 23 cases or gas tamponade 23 controls.
Whenever it comes to the silicone oil use in retinal detachment conditions it almost always means that the patients condition has got somehow complicated. Controversies surrounding the surgical repair of macular holes 20gauge versus 23gauge versus 25gauge vitrectomy systems. 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. Gas vs oil in macular hole surgery eye care medhelp. Retina today facedown positioning is not necessary in. See important issues raised by macular hole patients for suggestions on advocating for a more timely surgical appointment. Silicone oil or gas tamponade to treat macular hole. The second detached retina happened approximately a month after the first one.
The presence of internal limiting membrane is not required to obtain anatomical repair. Internal repair of very large, myopic and recurrent. Treatment of retinal detachment due to macular hole. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade densiron.
Secondary fullthickness macular hole mh formation after vitrectomy is a rare surgical complication, with an incidence reportedly between 0. The success rates of surgery for full thickness macular holes ftmh have been steadily improving. Vitrectomy medical clinical policy bulletins aetna. Dec 20, 2019 secondary fullthickness macular hole mh formation after vitrectomy is a rare surgical complication, with an incidence reportedly between 0. 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 patients were unable to posture due to chronic illness and had stage 2, 3, or 4 full thickness macular holes. Silicone oil emulsification in retina surgery retina today. Silicone oil is often used as a last resort to prevent further operations. Facedown positioning is not necessary in idiopathic macular.
Internal repair of very large, myopic and recurrent macular. Lasik method, i made two injections of gas and last injection of oil silicone im 10 months in the right eye. Outcomes of eyes with failed primary surgery for idiopathic. To investigate the anatomical and functional results of silicone oil so removal after an extended period of so tamponade in eyes having received. 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.