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Purpose: The aim of this paper was to report the outcomes of prophylactic chorioretinectomy in open-globe injuries where a foreign body penetrated the choroid or perforated the globe., Methods: We conducted a retrospective, consecutive, noncomparative, and descriptive study of patients registered in the ocular trauma database between January 2006 and December 2014, who underwent vitrectomy with chorioretinectomy., Results: Thirty-six patients (33 male, 3 female) with a mean age of 40 years and a median of follow-up of 13 months were included. Twenty-one cases had penetrating globe injuries with an intraocular foreign body and 15 cases had perforating globe injuries. A concomitant chorioretinectomy was performed in all eyes, although it was only partial in 8 eyes. At the end of follow-up, proliferative vitreoretinopathy (PVR) rates were 6.5%, anatomical success was 80.6%, and the globe survival rate was 96.8%., Conclusion: Prophylactic chorioretinectomy is a surgical procedure that may decrease posttraumatic PVR, thus improving final visual acuity and increasing globe survival rates., (© 2018 S. Karger AG, Basel.)

Purpose: To evaluate the effects of intravitreal silicone oil (SO) on subfoveal choroidal thickness (SFCT)., Methods: A total of 60 patients with unilateral pseudophakic macula-off rhegmatogenous retinal detachment were treated with a three-port pars plana vitrectomy and a 5,700-cSt SO endo-tamponade and subsequent SO removal. SFCT was measured before and 3 months after SO removal. The main outcome measure was the difference between the SFCT of operated eyes and the fellow eyes., Results: Before SO removal, the mean SFCT differences in group 1 (3-6 months' duration of SO), group 2 (6-9 months' duration of SO), and group 3 (9-18 months' duration of SO) were -14.8, -25.5, and -62.1 µm, respectively (p = 0.002, r = 0.398). Three months after SO removal, the mean SFCT differences in group 1, group 2, and group 3 were -13.4, -23.3, and -59.0 µm, respectively (p = 0.002, r = 0.393)., Conclusion: SFCT decreased significantly in eyes with long-term (≥6 months) intravitreal SO tamponade. Choroidal thinning did not improve after SO removal., (© 2018 S. Karger AG, Basel.)

Purpose: To evaluate retinal layer thickness with optical coherence tomography (OCT) in eyes with macula-off retinal detachment after silicone oil (SiO) or gas endotamponade., Procedures: Cross-sectional study of 40 eyes with macula-off rhegmatogenous retinal detachment that underwent vitrectomy. 20 eyes received SiO tamponade and 20 matched eyes received gas. 33 healthy fellow eyes served as controls. Macular spectral domain OCT was performed with automated layer detection in the 5 inner subfields of the Early Treatment Diabetic Retinopathy Study (ETDRS) map., Results: Comparing the SiO group with the gas group, the ganglion cell layer showed a significant thinning in all fields of the inner ring of the ETDRS map, the inner plexiform layer in the nasal, superior and temporal quadrants, and the outer plexiform layer in the nasal quadrant., Conclusions: Inner retinal layers in the fovea/parafovea were significantly thinner in the SiO group. Prospective studies are warranted to further elucidate possible retinal adverse effects of SiO tamponade., (© 2017 S. Karger AG, Basel.)

Background: The aim of this study was to examine the change in retinal thickness after vitrectomy with internal limiting membrane (ILM) peeling and/or silicone oil (SO) endotamponade in proliferative diabetic retinopathy (PDR)., Methods: The actual amount and ratio of changes in the retinal thickness were calculated., Results: Compared to control eyes in the ILM peeling (-)/SO (-) group, the central, superior inner, and temporal inner retina in the ILM peeling (+)/SO (-) group, the central and superior inner retina in the ILM peeling (-)/SO (+) group, and the central, inferior inner, temporal inner, and nasal inner retina in the ILM peeling (+)/SO (+) group showed a significant reduction of the retinal thickness. The central, superior inner, and temporal inner retina in the ILM peeling (+)/SO (-) group, the central and superior inner retina in the ILM peeling (-)/SO (+) group, and the central, superior inner, inferior inner, and temporal inner retina in the ILM peeling (+)/SO (+) group showed a significantly increased reduction rate of the retinal thickness compared to the control group., Conclusions: Macular retinal thinning in PDR was observed after ILM peeling and SO endotamponade, and it was increased by the combination of these 2 factors., (© 2017 S. Karger AG, Basel.)

Purpose: The aim is to describe tools and techniques that can be used to deal with total retinal detachment (open funnel) and associated proliferative vitreoretinopathy due to a 360-degree giant retinal break following ocular trauma. Setting/Venue: The video (available at www. karger.com/doi/10.1159/000444811) was created at the Ophthalmology Department, Faculty of Medicine Kasr Al Ainy, Cairo University Hospital, Cairo, Egypt., Methods: A 16-year-old female patient presented to the Cairo University Hospital after blunt ocular trauma. She had traumatic cataract, and ultrasound examination showed total retinal detachment. She was scheduled for surgery at the Cairo University Hospital. Phacoemulsification of traumatic cataract was done after insertion of the 3-port 23-gauge trocar system. The 25-gauge chandelier illumination system was used to assist the peeling of adherent posterior hyaloid and epiretinal membranes, allowing bimanual work using an end-gripping forceps and a diamond-dusted retinal scrapper. Removal of the vitreous surrounding the retinal funnel was performed, and a small perfluorocarbon (PFC) bubble was used to support the posterior pole. This was followed by refreshing the rolled edges of the retinal break and shaving the vitreous base and anterior leaflet of the giant break by surgeon-assisted scleral indentation. The eye was completely filled with PFC, and Argon laser retinopexy was performed. Direct PFC-silicone oil exchange was done to avoid retinal slippage (silicone oil 5,000 cSt was used)., Results: Retinal attachment was successfully achieved at the end of the surgery. The silicone oil was removed 5 months after the initial surgery. The patient's uncorrected visual acuity 1 month after removal of the silicone was 0.4., Conclusions: The chandelier-assisted bimanual technique is an effective method for dealing with adherent posterior hyaloid and epiretinal membranes in a detached retina, particularly in cases of complex open-funnel retinal detachment. Proper shaving of the anterior leaflet and refreshing the edges of the retinal break helps decrease postoperative PVR formation. Direct PFC-silicone oil exchange in giant retinal breaks helps minimize the risk of retinal slippage occurrence., (© 2016 S. Karger AG, Basel.)

Purpose: To study the safety of 20-gauge transconjunctival sutureless vitrectomy., Methods: Clinical data of patients who underwent 20-gauge transconjunctival sutureless vitrectomy for the first time, for various disorders, were reviewed retrospectively. The main outcome measures were the number of sclerotomies requiring suturing as well as the intra- and postoperative complications., Results: A total of 179 operations were performed. Indications for vitrectomy included 68 idiopathic epiretinal membranes, 26 macular holes, 23 phakic and 16 pseudophakic retinal detachments, and 46 various other, less common etiologies. Of these 179 operations, 166 (93%) were sutureless. Of the 537 sclerotomies created, 25 (5%) received a single transconjunctival-scleral suture. Intraoperative complications included premature dislodging of the cannulas in 2 sclerotomies and an iatrogenic horseshoe tear at 1 sclerotomy site. Postoperative complications comprised transient hypotony in 14 cases, subconjunctival gas in 2 cases, and choroidal effusion in 1 case. No serious complications (such as endophthalmitis) were observed., Conclusion: 20-gauge transconjunctival sutureless vitrectomy can be considered safe, as the intra- and postoperative complications observed are neither numerous nor significant. Sclerotomies appear to be safe and relatively easy to perform, without compromising the advantages of sutureless surgery., (Copyright © 2013 S. Karger AG, Basel.)

Purpose: To assess the outcome of scleral buckling surgery using a non-contact wide-angle viewing system for fundus visualization in patients with rhegmatogenous retinal detachment without proliferative vitreoretinopathy., Patients and Methods: Sixteen eyes of 16 patients underwent scleral buckling using a non-contact wide-angle viewing system combined with a 25-gauge illumination fibre inserted into the sclera at the pars plana., Results: The mean age of the patients was 53.6 ± 13.7 years and the mean follow-up time was 13.4 ± 2.8 months. Retinal reattachment was achieved in 13 of the 16 eyes (81%). Three eyes underwent vitrectomy with silicone oil injection because of development of proliferative vitreoretinopathy in 2 eyes and scleral perforation due to excessive indentation during cryoretinopexy in 1 eye. Two eyes developed limited subretinal haemorrhage during subretinal fluid drainage., Conclusion: Simultaneous use of a non-contact wide-angle viewing system combined with a 25-gauge light fibre illumination for fundus visualization brings the advantages of microsurgery and indirect ophthalmoscopy into scleral buckling surgery., (Copyright © 2011 S. Karger AG, Basel.)

Despite modern and sophisticated vitreoretinal techniques, the authors are convinced that an underreported patient group exists, for whom long-term silicone oil tamponade is unavoidable. We conducted a literature review of the current evidence base in order to provide guidance on the ocular tolerance and side effects of long-term silicone oil, weighing up benefits against complications as well as providing an outlook on future silicone oils with improved physical properties. We advocate the removal of silicone oil in all cases; however, one has to recognise that long-term silicone oil tamponade may have to be considered as a measure of last resort for selected patients. There is a clinical need to develop novel, emulsification-resistant tamponades., (Copyright © 2011 S. Karger AG, Basel.)

Aims: Posttraumatic endophthalmitis (PTE) managed with pars plana vitrectomy (PPV) and a variety of other methods often resulted in retinal detachment (RD), which deteriorates postoperative visual acuity (VA). We investigated initial ocular conditions, surgical management and outcomes of PTE patients and analyzed their relationship in order to find the necessary management for different patients' conditions., Methods: Retrospective study. Medical records of 62 consecutive patients who were diagnosed with PTE and managed with PPV were retrospectively analyzed. The included patients were divided into two groups depending on their initial VA, with light perception (LP) as borderline: group A (12 cases; VA=LP) and group B (50 cases; VA>LP). Specific variables related to surgical outcomes were analyzed, including: initial VA; intraocular foreign body; location and length of the wound; microbiologic test; cataract extraction; scleral buckling; silicon oil tamponade; gas tamponade, and retinal restoration. Data were statistically analyzed by the χ2 test, by univariate analysis for predictors and by multivariate logistic regression analysis., Results: RD happened in 19 (30.6%) of the 62 cases included. There were 6 cases (50%) in group A and 13 cases (26%) in group B which resulted in RD. Statistical analysis demonstrated that none of the related factors were correlated to the occurrence of RD (all factors: p>0.05) in group A, but in group B, scleral buckling (with: 2/22, 9%; without: 11/28, 39%; p<0.05) and silicone oil tamponade (with: 0/6; without: 13/44, 30%; p<0.05) were statistically significantly correlated to the occurrence of RD., Conclusions: Preventive scleral buckling and silicone oil tamponade are important for patients with good initial VA (VA>LP) to be successfully managed by PPV., (Copyright © 2011 S. Karger AG, Basel.)

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., (Copyright © 2011 S. Karger AG, Basel.)

Background/aims: To assess the outcomes and complications of endotamponade with Oxane HD following retinal detachment repair., Methods: Retrospective consecutive case series of inferior retinal detachment with Oxane HD endotamponade within a 3-year period., Results: Case notes for 18 eyes of 18 patients were reviewed. Four (22.2%) were total retinal detachments and 13 (72.2%) had proliferative vitreoretinopathy. The mean Oxane HD endotamponade and follow-up durations were 27 ± 38 and 66 ± 39 weeks, respectively. The eventual anatomic success rate was 77.8%, but without any significant difference in vision. Postoperative complications occurred in 14 (77.8%), including emulsification (6 eyes; 33.3%), epiretinal membrane (5 eyes; 27.8%), and posterior capsular opacification (4 eyes; 22.2%). Of the 14 eyes requiring intraoperative perfluorodecalin, 12 (85.7%) developed complications; all 5 (100%) eyes with direct exchange of perfluorodecalin with Oxane HD developed complications., Conclusion: Although useful for inferior retinal detachments, Oxane HD was associated with a relatively high rate of emulsification when compared to other series. Our series also suggests that prior use of perfluorodecalin intraoperatively, and in particular direct exchange of perfluorodecalin with Oxane HD, may be associated with an increased risk of intraocular complications., (Copyright © 2010 S. Karger AG, Basel.)

Purpose: To assess the success rates and complications of Densiron 68 intraocular tamponade in the management of complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR)., Methods: Twenty-one eyes of 20 patients with complicated RD and PVR were included in this prospective study. Vitreoretinal surgery with Densiron 68 intraocular tamponade was performed in all patients., Results: The success rate with 1 operation using Densiron 68 was 85.7%, and with further surgery 90.5%. Visual acuity improved from a mean logMAR of 2.25 (SD 0.73) to 1.19 (SD 0.88), p = 0.0001. There was little evidence of dispersion and excessive inflammation., Conclusion: According to the results of this study, vitreoretinal surgery with temporary Densiron 68 intraocular tamponade appears to increase the anatomical success and improve visual acuity, while giving rise to minimal complications, in selected cases of complicated RD and PVR., (Copyright © 2010 S. Karger AG, Basel.)

Purpose: To evaluate the efficacy and complications of heavy silicone oil (Densiron 68) in primary inferiorly located retinal detachment., Methods: Sixty-seven eyes of patients aged 24-79 years with inferior primary rhegmatogenous retinal detachment with/without proliferative vitreoretinopathy grades C and lower were included in the study. The mean duration of the Densiron endotamponade was 87 days (range, 60-180 days), with a mean follow-up after removal of 110 +/- 41 days., Results: Anatomical success was achieved in 64 of 67 eyes with completed follow-up. The mean visual acuity was changed significantly (p < 0.05). Partial superior redetachment occurred in 3 cases during endotamponade. No redetachment occurred after removal of the silicone oil. Postoperative best corrected visual acuity was better than 20/40 in 43 of cases at the end of follow-up. The mean intraocular pressure was 19.2 mm Hg during endotamponade follow-up. Mild to moderate intraocular inflammation was detected in 7 eyes. In 6 cases, adherence of residual bubble or bubbles was present after removal of the heavy silicone oil. Other complications, like elevated intraocular pressure (n = 6), emulsification (n = 8), temporary lens opacities (n = 14) or early cataract (n = 9), were detected after the operation., Conclusion: Long-term endotamponade with Densiron in inferior retinal detachment appears to be a safe and useful option., ((c) 2009 S. Karger AG, Basel.)

In modern vitreoretinal surgery, a variety of long-lasting endotamponades is available. These endotamponades differ in physical and chemical properties and their usage is based on certain pathological and surgical considerations. With modern endotamponades the treatment and prognosis for some severe diseases of the posterior segment was improved. Besides these supportive features of new endotamponades, the surgeon has to keep in mind that certain steps, like a complete removal of the vitreous and of any traction, are crucial for the success of an operation and that the most supportive step for the retina is complete endotamponade. This review gives an overview of longlasting endotampoandes in vitreoretinal surgery and of the indications for their usage., (Copyright 2010 S. Karger AG, Basel.)

Aim: To report on the use of a combined intra-ocular tamponade with silicone oil and perfluorohexyloctane (F(6)H(8)) in the treatment of complex retinal detachment., Design: A prospective consecutive interventional case series from seven study centres., Participants: 69 patients presenting a retinal detachment with proliferative vitreoretinopathy (PVR) and retinal breaks of the inferior two quadrants of the fundus., Method: Patients were divided into two groups: (1) 28 eyes which had not been operated on before; (2) 41 eyes affected by recurrent retinal detachment that had had unsuccessful previous surgery with silicone oil or gas tamponade. A pars plana vitrectomy, membrane peeling and -- when necessary -- a retinotomy were performed; the vitreous cavity was filled with two thirds of F(6)H(8) and one third of silicone oil 1,000 mPas (double filling, DF). The endotamponade was removed after 30-45 days (median 38) and replaced by balanced salt solution or silicone oil according to the condition of the retina., Results: Retinal reattachment was achieved in 52 out of 69 cases (75%) 6 months after removal of the DF without any endotamponade., Conclusion: The DF with F(6)H(8) and silicone oil allows a good endotamponading to the inferior retina and the posterior pole. The DF appeared to be well tolerated. Further studies are necessary to evaluate whether a DF is advantageous in respect to silicone oil filling alone in case of retinal breaks and PVR of the inferior retina.

Purpose: To report the anatomical and visual results of primary pars plana vitrectomy (PPV) without long-acting gas tamponade to repair primary rhegmatogenous retinal detachments (RRDs)., Methods: Twenty-seven consecutive patients (27 eyes) with peripheral retinal tears and new RRDs were treated according to the surgical protocol. Patients underwent PPV with fluid-air exchange and endolaser treatment to repair the RRD. Neither long-acting gas nor silicone oil tamponade was combined with PPV. All patients were followed from 6 to 26 months with an average follow-up of 11 months. Reattachment of the retina and visual outcome were compared to the results of previously published studies., Results: Reattachment was achieved in 24 of 27 eyes (89%) with a single operation, and in all 27 (100%) eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 0.4, and the median final visual acuity was 1.0., Conclusions: Primary PPV with fluid-air exchange alone and laser treatment is a safe, effective method for the repair of primary retinal detachments. The anatomical reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for primary PPV combined with long-acting gas tamponade., (Copyright 2004 S. Karger AG, Basel)

Introduction: In a few types of rhegmatogenous retinal detachment (RRD), scleral buckling (SB) has a lower success, and, here, pars plana vitrectomy (PPV) is a good alternative option. This survey reviews the indications and the surgical outcome of primary PPV with internal tamponade., Patients and Methods: We reviewed 205 eyes operated by primary PPV for RRD at the Department of Ophthalmology of the Philipps University Marburg between the years 1990 and 1997. The indications of PPV were: holes greater than 90 degrees; holes posterior to the equator; proliferative vitreoretinopathy grade C; pseudophakic status., Results: A complete reattachment of the retina after absorption of the gas or after silicone oil removal was achieved by 1 operation in 146 eyes (71.2%) and in 195 eyes (95.2%) by a second intervention., Conclusion: Although SB is the standard procedure for the treatment of RRD, complicated cases can be treated successfully with primary PPV., (Copyright 2003 S. Karger AG, Basel)

Of the 168 eyes undergoing silicone oil removal from 1993 to 2000, 34 developed retinal detachment after the removal of silicone oil. The management and the results of the 34 eyes were reviewed. Surgical procedures included pars plana vitrectomy, encircling band, cryocoagulation, endotamponade. Five of the 34 eyes had a second retinal detachment after these operations. One of these 5 eyes had a third retinal detachment. Final retinal reattachment was achieved in all eyes. Visual acuity decreased in 16 of the 34 eyes with retinal detachment, and 18 of the 34 eyes had a visual acuity of less than 0.02. These results show that surgery for retinal detachment after silicone oil removal yields a high rate of anatomic success, while the visual outcome is poor for a substantial number of patients., (Copyright 2002 S. Karger AG, Basel)

We evaluated the use of simultaneous double filling with polydimethylsiloxane (PDMS) and fluorosilicone (FSiO) in the repair of complicated retinal detachment in 12 selected cases. Initial retinal reattachment was achieved in all cases. Proliferative vitreoretinopathy (PVR) recurred in 10 patients (83%), 6 of which showed partial retinal detachment. Inferior and superior postoperative residual free spaces were abolished by this procedure, but a new residual fluid space was created, lying horizontally between the bubbles and expanding in a triangular shape nasally to the optic disk and temporally to the macula. Overall, 9 of 10 eyes with postoperative PVR had proliferation involving these areas. These findings support the concept that 'compartmentalization' is of major importance in determining postoperative cell proliferation.