Department of Ophthalmology, Medical University of Graz, Graz, Austria.
Acta Ophthalmol. 2011 Aug;89(5):e417-22. doi: 10.1111/j.1755-3768.2011.02131.x. Epub 2011 May 19.
To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium.
Sixteen aphakic patients with silicone oil endotamponade requiring SOR were recruited for this prospective study and randomly scheduled for limbal or pars plana SOR. The central corneal thickness (CCT), visual acuity (VA) and intraocular pressure were measured preoperatively, on the first postoperative day and 4 months after surgery. Endothelial cell density (ECD) was measured preoperatively and at the end of follow-up. The in vitro study was performed on ten enucleated porcine eyes. Corneoscleral discs were prepared and fixed on artificial anterior chamber followed by 2.5-mm limbal incision and 5-ml silicone oil injection in six cases and 5 ml balanced salt solution (BSS) in four cases.
The ECD decreased by 239.2 ± 86.7 (13.9%) and 86.7 ± 22.4 cells/mm(2) (5%) after limbal (n = 8) and pars plana SOR (n = 8), respectively (p < 0.001 for both). The difference between the groups was significant (p < 0.001). A significant increase in CCT and corresponding decrease in VA was noted on the first postoperative day using both procedures. At the end of follow-up, the CCT and VA were comparable to initial values. Postoperative hypotony (≤6 mmHg) was observed more frequently after limbal SOR. In the experiment, lamellar abrasions of corneal endothelium were observed after silicone oil injection, whereas no changes were observed after BSS injection.
Limbal SOR causes more considerable damage to the corneal endothelium than the pars plana approach because of mechanical abrasion.
比较无晶状体眼的角巩膜缘和扁平部硅油取出术（SOR），并评估硅油对角膜内皮的急性影响。
本前瞻性研究招募了 16 例需要 SOR 的硅油眼内填塞的无晶状体患者，并随机分为角巩膜缘或扁平部 SOR 组。术前、术后第 1 天和术后 4 个月测量中央角膜厚度（CCT）、视力（VA）和眼压。术前和随访结束时测量内皮细胞密度（ECD）。在 10 例猪眼进行体外研究。制备角巩膜瓣并固定在人工前房，然后在 6 例中进行 2.5mm 角巩膜缘切口和 5ml 硅油注射，在 4 例中进行 5ml 平衡盐溶液（BSS）注射。
角巩膜缘 SOR（n=8）和扁平部 SOR（n=8）后 ECD 分别下降 239.2±86.7（13.9%）和 86.7±22.4 个细胞/mm2（5%）（两者均 p<0.001）。两组间差异有统计学意义（p<0.001）。两种手术均在术后第 1 天引起 CCT 显著增加和 VA 相应下降。随访结束时，CCT 和 VA 与初始值相当。角巩膜缘 SOR 后更常发生术后低眼压（≤6mmHg）。在实验中，硅油注射后观察到角膜内皮板层磨损，而 BSS 注射后无变化。
由于机械性磨损，角巩膜缘 SOR 对角膜内皮的损伤比扁平部方法更严重。
