Maier M M, Engelmann V, Pfrommer S, Perz C, Lohmann C
Augenklinik, Klinikum rechts der Isar, Technische Universität München.
Klin Monbl Augenheilkd. 2011 May;228(5):477-9. doi: 10.1055/s-0029-1245362. Epub 2010 Aug 24.
The highly purified polydimethylsiloxane (PDMS) with a viscosity of 5000 centistokes (cs) is the preferred silicone oil endotamponade in vitreoretinal surgery (20 gauge) and shows high stability. In contrast in transconjunctival minimally invasive surgery (23 gauge) the application of 5000 cs. silicone oil shows substantial disadvantages because of time-consuming and difficult application procedure due to the small lumen of the used surgical equipment. Consequently silicone oils with lower viscosity like the 2000 cs silicone oil are being increasingly used in transconjunctival surgery.
We present two cases of early emulsification of the 2000 cs silicone oil (Siluron 2000 ©, Fluoron, Neu-Ulm, Germany) consisting of highly purified PDMS in the course of minimally invasive transconjunctival vitreoretinal surgery. In both cases 23 gauge vitrectomy with application of 2000 cs silicone oil was performed without any complication. The first case is a 34-year-old female with proliferative diabetic retinopathy who had already experienced several vitreoretinal operations. The present indication for vitrectomy was a persistent macular hole and vitreous haemorrhage. The second case is a 55-year-old pseudophakic patient with a retinal detachment after vitrectomy with gas endotamponade following rhegmatogenous retinal detachment.
In the first case emulsification of silicone oil was seen on the second postoperative day. In the second case emulsification was discovered two weeks postoperatively. In both cases high intraocular pressure did not occur.
With emerging performance of minimally invasive vitrectomy techniques the use of silicone oil with low viscosity in patients with conceivable endurance of the endotamponade appears to be beneficial. Up to now 10 patients have undergone 23 gauge vitrectomy with application of 2000 cs silicone oil without any complications in our clinic. In contrast, two cases demonstrated early emulsification of the 2000 cs silicone oil. To the best of our knowledge this complication has not been described before.
粘度为5000厘沲（cs）的高纯度聚二甲基硅氧烷（PDMS）是玻璃体视网膜手术（20G）中首选的硅油填充剂，且具有高稳定性。相比之下，在经结膜微创玻璃体视网膜手术（23G）中，应用5000cs的硅油存在诸多缺点，因为所用手术器械管腔小，导致应用过程耗时且困难。因此，粘度较低的硅油，如2000cs的硅油，在经结膜手术中越来越常用。
我们报告两例在微创经结膜玻璃体视网膜手术过程中，2000cs硅油（Siluron 2000©，Fluoron，德国新乌尔姆）早期乳化的病例，该硅油由高纯度PDMS组成。两例均行23G玻璃体切除术并应用2000cs硅油，均无任何并发症。第一例为一名34岁患有增殖性糖尿病视网膜病变的女性，她已经接受过多次玻璃体视网膜手术。此次玻璃体切除术的指征为持续性黄斑裂孔和玻璃体积血。第二例为一名55岁的人工晶状体眼患者，在孔源性视网膜脱离后行玻璃体切除联合气体填充术后发生视网膜脱离。
第一例在术后第二天发现硅油乳化。第二例在术后两周发现乳化。两例均未出现高眼压。
随着微创玻璃体切除技术的不断发展，对于可能耐受填充剂的患者，使用低粘度硅油似乎是有益的。到目前为止，在我们诊所已有10例患者接受了23G玻璃体切除术并应用2000cs硅油，均无任何并发症。相比之下，有两例出现了2000cs硅油的早期乳化。据我们所知，此前尚未描述过这种并发症。
