Department of Ophthalmology, Liuzhou People's Hospital, Liuzhou 545006, China.
Department of Ophthalmology, Liuzhou Hospital of Traditional Chinese Medicine, Liuzhou 545006, China.
Ann Palliat Med. 2020 May;9(3):1013-1019. doi: 10.21037/apm-20-949. Epub 2020 May 8.
During the remove of oil from the silicone oil-filled eye after vitrectomy, perfusion fluid is often mistakenly aspirated when mechanical force is used to remove the oil. This leads to a sudden sharp drop in intraocular pressure and collapse of the eyeball, which may cause complications. The aspiration of perfusion fluid can be detected when the oil is removed manually, and the force of the hand and location of the aspiration can be adjusted to remove the silicone oil instead. In this study, we assessed the efficacy and safety of a manual 23-gauge (23G) silicone oil remove method and confirmed that this is a feasible, highly efficient, safe, simple and economical way to remove oil.
We recruited 130 patients (130 affected eyes) 3-6 months after they had undergone vitrectomy and light silicone oil tamponade at our hospital. The patients/eyes were randomly divided into two groups (manual or vitrectomy system), with 65 eyes in each group. All eyes in both groups underwent 23G oil remove by the same physician. The following aspects of the two groups were compared: 1. Oil remove duration; 2. Average intraocular pressure at 1 day, 1 week and 1 month after the procedure; and 3. Postoperative complications, such as retinal redetachment, silicone oil residue, massive suprachoroidal hemorrhage and choroid detachment.
The average oil remove durations of the manual group and the vitrectomy system group were 5.92±1.34 and 8.87±1.68 min, respectively (P<0.05); the duration for the manual group was significantly shorter than that for the vitrectomy system group (t=11.07, P=0). The average intraocular pressures at 1 day, 1 week and 1 month after operation of the manual group were 10.2±2.7, 15.2±3.5 and 17.2±3.1 mmHg, respectively, and those of the vitrectomy system group were 9.8±2.4, 15.5±3.1 and 16.8±3.4 mmHg, respectively; the differences between the two groups were not statistically significant at any time point (t=0.892, P=0.374 at 1 day; t=0.517, P=0.606 at 1 week; and t=0.701, P=0.485 at 1 month). The difference in the incidence of postoperative complications, including retinal redetachment, silicone oil residue, massive suprachoroidal hemorrhage and choroid detachment, between the two groups was statistically significant (χ 2 =4.2787, P=0.0386). None of the affected eyes were complicated with transient intraocular hypotension, vitreous hemorrhage or endophthalmitis.
The manual 23G silicone oil remove method is highly efficient, safe, simple and economical and can be used conveniently and clinically by the majority of medical institutions.
在玻璃体切除术后硅油填充眼的硅油取出过程中，由于使用机械力取出油，常常会错误地抽吸灌注液，导致眼内压突然急剧下降和眼球塌陷，从而可能引发并发症。手动取出硅油时可以检测到抽吸灌注液的情况，并可以调整手的力度和抽吸位置来取出硅油。在本研究中，我们评估了手动 23G 硅油取出方法的疗效和安全性，并证实这是一种可行、高效、安全、简便且经济的取油方法。
我们招募了在我院接受玻璃体切除术后 3-6 个月且行轻硅油眼内填充的 130 例患者（130 只患眼）。患者/眼随机分为两组（手动或玻璃体切除系统组），每组 65 只眼。两组患者均由同一名医生行 23G 硅油取出术。比较两组患者的以下方面：1. 取油时间；2. 术后 1 天、1 周和 1 个月的平均眼内压；3. 视网膜脱离、硅油残留、大量脉络膜上腔出血和脉络膜脱离等术后并发症。
手动组和玻璃体切除系统组的平均取油时间分别为 5.92±1.34 分钟和 8.87±1.68 分钟（P<0.05）；手动组的取油时间明显短于玻璃体切除系统组（t=11.07，P=0）。术后 1 天、1 周和 1 个月，手动组的平均眼内压分别为 10.2±2.7、15.2±3.5 和 17.2±3.1mmHg，玻璃体切除系统组分别为 9.8±2.4、15.5±3.1 和 16.8±3.4mmHg；两组在任何时间点的差异均无统计学意义（t=0.892，P=0.374 于术后 1 天；t=0.517，P=0.606 于术后 1 周；t=0.701，P=0.485 于术后 1 个月）。两组术后并发症发生率，包括视网膜脱离、硅油残留、大量脉络膜上腔出血和脉络膜脱离，差异有统计学意义（χ 2 =4.2787，P=0.0386）。无一例患眼出现短暂性眼压降低、玻璃体积血或眼内炎。
手动 23G 硅油取出方法高效、安全、简便、经济，大多数医疗机构都可以方便、临床应用。
