Friberg T R, Guibord N M
University of Pittsburgh, PA, USA.
Ophthalmic Surg Lasers. 1999 Jul-Aug;30(7):528-34.
Corneal decompensation and complications are a frequent cause of visual loss after vitreoretinal surgery. This paper presents data regarding endothelial cell loss in aphakic and pseudophakic silicone oil filled eyes when oil was retained for many months. This study updates our previous investigation on the subject.
The corneal endothelial cell count of 10 eyes of 10 consecutive patients who had undergone vitreoretinal surgery, including fluid-gas exchange and ultimately silicone oil placement, were obtained. The patients underwent an average of 2.7+/-0.9 vitreoretinal procedures before the final procedure which induced the placement of silicone oil in the vitreous cavity. All had inferior iridectomies. The endothelial cell density measurements were obtained an average of 1 year after silicone oil placement. In all eyes, the oil was felt necessary for long term tamponade and therefore was not removed. The cell density of the operated eye was compared to the fellow eye, none of which had undergone silicone oil placement.
Both gas and retained silicone oil contribute to the loss of corneal endothelial cell density. The average endothelial cell loss in the 10 eyes with oil retained for an average of 10+/-12 months was 68.8 +/-31.4%, as compared to the fellow eye. The average cell loss was higher in the three eyes with silicone oil in the anterior chamber (range 44 to >95%). Pseudophakic eyes fared better, on average, than aphakic eyes (51.66+/-28% vs. 66.63+/-26.3%) with respect to cell loss. Five aphakic eyes and 1 pseudophakic eye developed corneal edema.
Endothelial cell loss occurs after vitreoretinal surgery and is exacerbated by long term silicone oil retention. The corneal endothelial cell damage is probably cumulative from procedure to procedure. Endothelial cell loss may be pronounced in eyes without a physical barrier between the anterior segment and the vitreous cavity, and in eyes where oil migrates into anterior chamber.
角膜失代偿及并发症是玻璃体视网膜手术后视力丧失的常见原因。本文呈现了无晶状体眼和人工晶状体眼填充硅油且硅油留存数月时内皮细胞丢失的数据。本研究更新了我们之前关于该主题的调查。
获取了连续10例接受玻璃体视网膜手术患者的10只眼的角膜内皮细胞计数，手术包括液 - 气交换并最终植入硅油。患者在最终导致玻璃体腔植入硅油的手术前平均接受了2.7±0.9次玻璃体视网膜手术。所有患者均行下方虹膜切除术。内皮细胞密度测量在硅油植入后平均1年进行。在所有眼中，认为硅油对长期填塞是必要的，因此未取出。将手术眼的细胞密度与对侧未植入硅油的眼进行比较。
气体和留存的硅油均导致角膜内皮细胞密度降低。10只留存硅油平均10±12个月的眼中，与对侧眼相比，平均内皮细胞丢失率为68.8±31.4%。前房有硅油的3只眼中平均细胞丢失率更高（范围为44%至>95%）。就细胞丢失而言，人工晶状体眼平均比无晶状体眼情况更好（51.66±28%对66.63±26.3%）。5只无晶状体眼和1只人工晶状体眼发生了角膜水肿。
玻璃体视网膜手术后会发生内皮细胞丢失，长期留存硅油会使其加剧。角膜内皮细胞损伤可能在一次次手术中累积。在前房与玻璃体腔之间没有物理屏障的眼中以及硅油迁移至前房的眼中，内皮细胞丢失可能会很明显。
