Pavlovic S, Dick B, Schmidt K G, Tomic Z, Latinovic S
Universitäts-Augenklinik Giessen.
Ophthalmologe. 1995 Oct;92(5):672-6.
In order to reduce the incidence of postoperative complications in silicone-filled eyes, many authors recommend that silicone oil should be removed from the eye as soon as a stable retinal situation is achieved. Even in the eyes with completely attached retina and a clinically stable situation there is a risk of retinal redetachment and other complications after silicone oil removal. In a retrospective study we analyzed 324 cases after silicone oil removal regarding the postoperative redetachment rate and risk of complications from this procedure. The indication for primary surgery was retinal detachment with PVR in 167 (51.5%) cases, proliferative diabetic retinopathy in 87 cases (26.8%), complications of penetrating ocular injuries in 48 cases (14.8%), giant tear retinal detachment in 9 cases (2.7%) and retinal detachment with a central hole in 13 cases (4%). At the time of silicone oil removal retina was completely attached in 277 eyes. Local retinal redetachment central to the encircling band existed in 47 eyes at the time of silicone removal. Follow-up time ranged from 6-63 months. Silicone oil removal was combined with a cataract operation in 42 cases (12.9%), penetrating keratoplasty in 9 cases (2.8%) and membrane peeling in 54 eyes (16.7). In the postoperative period the retina detached in 39 (12%) eyes. In the eyes with preoperatively completely attached retinas, redetachment occurred in 23 eyes (8%), whereas in the group of eyes with an unstable preoperative retinal situation, the retina redetached in 16 eyes (34%). The duration of the silicone oil tamponade had no effect on the redetachment rate. In the group of eyes with an unstable preoperative retinal situation, preoperative laser photocoagulation at the cerelage buckle, as well as central to the local detachment, reduced the incidence of redetachment after silicone oil removal significantly (25% vs. 53%). In the group of eyes with a preoperatively stable retinal situation, this effect was not significant. Our results show that in eyes with completely attached retinas, the risk of complications and redetachment after silicone oil removal is relatively low. In selected cases, even in eyes with incompletely attached retinas, silicone oil could be removed. Nevertheless, a relatively high risk of postoperative complications has to be taken into consideration. In eyes with an incompletely attached retina, preoperative laser photocoagulation at the cerclage buckle, as well as central to the local redetachment significantly reduced the incidence of redetachment after silicone oil removal.
为降低硅油填充眼术后并发症的发生率，许多作者建议，一旦视网膜情况稳定，应尽快从眼内取出硅油。即使在视网膜完全复位且临床情况稳定的眼中，取出硅油后仍存在视网膜再次脱离及其他并发症的风险。在一项回顾性研究中，我们分析了324例硅油取出术后的病例，观察其术后视网膜再次脱离率及该手术相关并发症的风险。初次手术的适应证为：167例（51.5%）为视网膜脱离合并增殖性玻璃体视网膜病变（PVR），87例（26.8%）为增殖性糖尿病视网膜病变，48例（14.8%）为穿透性眼外伤并发症，9例（2.7%）为巨大裂孔性视网膜脱离，13例（4%）为伴有中心孔的视网膜脱离。在取出硅油时视网膜完全复位的有277只眼。取出硅油时，47只眼在环扎带中央存在局限性视网膜脱离。随访时间为6至63个月。42例（12.9%）硅油取出术联合了白内障手术，9例（2.8%）联合了穿透性角膜移植术，54只眼（16.7%）联合了膜剥除术。术后，39只眼（12%）视网膜发生脱离。术前视网膜完全复位的眼中，23只眼（8%）发生了再次脱离，而术前视网膜情况不稳定的组中，16只眼（34%）视网膜再次脱离。硅油填充的持续时间对再次脱离率没有影响。在术前视网膜情况不稳定的组中，术前在环扎扣处以及局限性脱离中央进行激光光凝，可显著降低硅油取出术后视网膜再次脱离的发生率（25%对53%）。在术前视网膜情况稳定的组中，这种效果不显著。我们的结果表明，视网膜完全复位的眼中，取出硅油后并发症及再次脱离的风险相对较低。在某些特定病例中，即使是视网膜未完全复位的眼，也可取出硅油。然而，必须考虑到术后并发症的风险相对较高。在视网膜未完全复位的眼中,术前在环扎扣处以及局限性视网膜脱离中央进行激光光凝，可显著降低硅油取出术后视网膜再次脱离的发生率。
