After retinal detachment surgery. Complications with prolonged stay of silicone oil in the eye cavity (clinical and morphological study) Injection of silicone in case of retinal detachment

To replace the pathologically altered vitreous body (ST) (blood, exudate, moorings) extracted from the vitreous cavity, it is often limited to the introduction of isotonic sodium chloride solution, heated to body temperature. However, in cases of subtotal and even more so total vitrectomy, there is every reason to give preference to those substitutes that are closer in viscosity to natural ST. At present, gealon is more often used abroad, and in our country - luronite, honsurid, viton.

Expanding gases and air

Sterile air has been used as a temporary substitute for many years. Such pneumoretinopexy can be the basis for outpatient surgical treatment of fresh retinal detachment, especially in the case of breaks localized in the upper half of the fundus. More promising, however, is the use of expanding gases, in particular, from the group of sulfohexafluorides (SF6) or perfluoropropanes (C3F8), etc. (see table). Their widespread use in our country has long been held back by the lack of permission from the State Pharmaceutical Committee.

Here it is useful to cite excerpts from the ARCEOLE instructions for the use of ophthalmic gases SF6 (sulfur hexafluoride), C2F5 (hexafluorohexane), C3F8 (octafluoropropane).

The kit includes:

• a cylinder with one of the indicated gases with a volume of 30 ml;
• sterile graduated syringes with a volume of 50 ml with a sterilizing filter of 0.22 microns and a device for connecting the syringe to the balloon (adapter);
• a special tape for attaching to the patient's wrist, designed to identify him with gas endotamponade.

Each cylinder contains pure, non-sterile gas. The gas is non-toxic, inert, non-flammable, colorless, odorless. When injected into the eye, the gas is not metabolized, but is gradually eliminated through the bloodstream through the lungs. The instructions draw attention to the fact that the gas is not sterile and is subjected to sterilization when passing through the sterilizing filter included in the kit. Each syringe included in the kit must be used for sterilization and preparation of only one portion of the air-gas mixture.

Mixture preparation. A sterile 30 gauge needle in a protective cap is placed on the instrument table. A sterile syringe (volume 50 ml) with an adapter attached to it and a sterilizing filter is placed on the instrument table. Check the patency of the syringe by pulling the piston (after releasing the piston will return to its original position, removing residual air). Place the non-sterile bottle on a flat surface next to the operating table (during manipulations, non-sterile personnel support this bottle). The gas bottle can be pre-disinfected by immersion in a solution of chlorhexidine, then all manipulations with it are carried out by sterile personnel. The syringe, equipped with an adapter and a filter, is connected to the balloon by vigorously inserting the tip of the adapter into a special opening of the balloon with a protective stopper. The gas in the pressurized balloon will passively enter the sterile chamber of the syringe. The tip of the adapter inside the stopper is supported until at least 10 ml of sterile gas enters the syringe through the sterilizing filter. Disconnect the syringe with the adapter from the vial by gently pulling and shaking the syringe. The vial must be handled by non-sterile personnel. The adapter and filter remain connected to the syringe. It should be remembered that the adapter tip after these manipulations is not sterile. To prevent infection, do not manipulate the operating table. By pressing on the piston, excess gas is removed from the syringe, leaving the desired volume. Without putting the syringe on the operating table, the required volume of air is added to it, achieving the desired composition of the air-gas mixture. The air will be sterilized by passing through the filter. Remove the filter adapter from the syringe. Immediately put on a sterile 30 gauge injection needle with a protective cap. Place the syringe and needle on the operating table. The air-gas mixture is ready for injection. Enter the air-gas mixture as soon as possible. The cylinder should not be reused 15 or more days after the first gas intake.

The composition of the air-gas mixture

• SF6, 20% - in a 50 ml syringe - 10 ml of pure gas in 40 ml of air, is preferred for retinal detachments without PVR and diabetic retinopathy, also an option for giant tears and eye injuries
• C2F6, 16% - in 50 ml syringe - 8 ml of pure gas in 42 ml of air, preferred for retinal detachments and macular holes, also an option for giant tears and eye injuries
• C3F8, 12% - in 50 ml syringe - 6 ml of pure gas per 44 ml of air, preferred for PVR

Warning:

• anesthesia with inhaled nitrogen protoxide should be discontinued at least 15 minutes before the use of ophthalmic gas;
• gas endotamponade should be performed exclusively by vitreoretinal surgeons trained in this technique;
• before the introduction of gas and during the period of gas tamponade, it is necessary to control the patency of the central retinal artery;
• after the introduction of gas, daily monitoring of IOP and the use of ophthalmohypotensive therapy, if necessary, are necessary;
• in most cases, the patient is recommended the preferred position of the head during the period of gas tamponade;
• in patients with a gas bubble in the vitreal cavity, as well as within 3 months after the introduction of gas, anesthesia with the use of protoxide nitrogen is contraindicated due to a significant increase in the risk of intraocular hypertension

For relatively fresh detachments with upper breaks, sulfurhexafluoride is preferred. In more severe clinical cases, gases with a long period of effective tamponade are used. The longer the effective time of tamponade, the higher the risk of complications, including irreversible ones.

The effect of the gradual expansion of the volume of these poorly soluble gases after their introduction into the eye cavity is based on Fick's rule. According to this rule, a bubble of gas slowly dissolving in tissues gradually increases in volume if, on the other side of the membranes (vascular walls) limiting it, i.e. in the bloodstream, there is another more rapidly dissolving gas, in this case nitrogen, entering the blood through the lungs. To mitigate the action in question (to avoid ophthalmohypertension), polytetrafluoroethylene gases, as already noted above, are used not in pure form, but mixed with air.

Stages of the actual surgical intervention:

• using a three-way tip inserted through the sclerotoma in the flat part of the ciliary body into the vitreous cavity, they begin to fill the eye with air (through a filter) under a pressure of 30-40 mm Hg. Art.;
• for drainage of SRF (through the second channel), the cannula is brought closer to the optic disc (in the absence of high detachment blisters);
• when the eye is filled with air, one of the scleral openings is closed;
• a large 50 ml syringe is filled with a mixture of expanding gas with air;
• 35 ml of the indicated gas mixture is injected into the eye cavity from a syringe (15 ml is left in case of necessary elimination of hypotension that may occur due to depressurization of the system at the end of the operation);
• close the second sclerotomy hole.

A gas bubble that plugs the retina from the inside, usually for 5-7 days, firstly, prevents the penetration of newly formed chamber moisture through the gap from the vitreous cavity under the retina and, secondly, simply presses the latter to the underlying choroid. The presence of gas in the eye cavity creates restrictions for the patient for air travel, climbing mountains, and for anesthesia.

In the USA, a method has been patented for the polymerization of magnetic polymers in the form of liquids and scleral fillings directly during anti-detachment operations on the eye. Protection of the retina from siderosis has not been reported. In general, it is obvious that this problem cannot be solved without adequate vitrectomy.

silicone oils

Technically, a proposal by R. Cibis et al., published back in 1962, turned out to be much simpler and less dangerous than the methods listed above. liquid silicone with simultaneous drainage of subretinal fluid.

To inject silicone oil into the eye cavity, the usual system for supplying liquid to the vitreophage is not suitable. Given the high viscosity of silicone oil, it is necessary to take a needle with a wider lumen than usual and create additional “gates” for it in the sclera (in the projection of the flat part of the ciliary body). Through another wound channel, the pathologically altered fluid is expelled from the vitreous cavity or subretinal space. There are various methods of the so-called bimanual operating technique. S.N. Fedorov, V.D. Zakharov et al. (1988) believed that the introduction of liquid silicone into the eye to eliminate retinal detachment is indicated:

• with relapses of retinal detachment, if the introduction of gas was ineffective;
• with retinal dialysis with edge inversion;
• with retinal detachments with prolonged hypotension;
• with funnel-shaped retinal detachments, where the gap could not be detected.

The authors warn against the introduction of silicone in the presence of rough vitreoretinal tractions in the eye cavity, with subatrophy of the eyeball and the presence of a persistent inflammatory process. In recent years, the most important indication for the use of silicone oil in the surgical treatment of retinal detachment has been the presence of macular holes. However, it is really possible to use this method only on the condition that after the operation the patient will be able to lie face down for several (up to 10 or more) days. During the operation, either the eye is initially filled with air, and through another sclerotoma, the posterior part of the eye is filled with silicone oil, maintaining the IOP at 10 mm Hg. Art. and allowing air to escape through the first sclerotoma, or immediately inject silicone oil to drain the SRF that exits through the anterior retinal tear.

A longer silicone tamponade compared to air tamponade makes it possible to count on success even if light tractions are preserved, i.e., when PVR has begun, in particular after an injury. In macular surgery, relying on a higher functional effect, biological additives are used, introducing during the operation for up to 10 minutes directly into the spot area a material in the form of a drop (0.5 ml) of autologous serum, bovine blood, etc., which contain a transforming factor growth (TGF-2), autologous platelet concentrate, thrombin-fibrin mixture.

Initially, so-called lightweight silicones were available to ophthalmic surgeons. Yielding in density to the vitreous body (0.8-0.9 versus 1.1), silicones with a viscosity of about 400 cSt in the vitreous cavity float upwards and therefore are more suitable for blocking tears (tearings) located in the upper half of the eyeball. Silicone liquid is transparent, colorless, bactericidal. It has a very high viscosity and therefore cannot move freely through narrow gaps. For its introduction into the eye cavity, you need to take cannulas, needles with an internal diameter of more than 1 mm.

There are many proposals for the technique of gradually filling the preretinal space with silicone fluid with synchronous expulsion of the subretinal fluid from the eye. During the forced slow (due to high viscosity) injection of silicone, pauses should be avoided, since crushing the drug into small bubbles will adversely affect visual functions in the future, facilitate the penetration of silicone bubbles into the subretinal space and into the anterior chamber. In general, one of the main problems in the use of silicone oils in ophthalmic surgery is their instability, in particular, the tendency to so-called emulsification (crushing into small bubbles). It has been established that among the factors contributing to this is blood (bloodless execution of all manipulations is required). As more and more viscous light silicones (1000-4000 cSt), and then heavy silicones, such as Oxane, purified from low molecular weight components, but containing fluorinated olefin, came into practice, the emulsification problem was overcome, but the technology of their introduction into the eye cavity became more complicated. . Moreover, with all the acuteness, the problem of removing them from the eye also arose. The fact is that in the long term, at the sites of prolonged contact of intraocular structures with silicone fluid, dystrophic processes occur: the lens becomes cloudy, the corneal endothelium suffers, and preretinal fibrosis develops; as a result, ophthalmotonus increases. It is for these reasons that in any case, both with success and in the absence of it, it is advisable to remove the silicone from the eye cavity, replacing it with an isotonic solution of sodium chloride, luronite, honsuride, visitil or healon.

When using high-viscosity silicones (5000 cSt), there is a problem with choosing the caliber of the vitreophage tip. R. Gentile (2008) recommends making an incision in the upper temporal quadrant of the sclera for a 20 gauge tip, but you need to have a trocar with an adapter for it, which allows you to switch to a 25 gauge tip if necessary for fine intravitreal operations. According to V. Gabel (1987), severe silicones do not cause such a pronounced proliferative vitreoretinopathy as the lungs. In search of heavy silicone, ophthalmologists turned, in particular, to fluorosilicone oil, which turned out to be slightly heavier than water (commonly used polydimethylsiloxanes are lighter than water and therefore occupy the upper part of the vitreous cavity of the eye). It is also essential that the heavier silicones also turned out to be less viscous. At a viscosity of 300 cSt, the usual vitreophage system could be dispensed with for administration. Silicone, after the necessary purification from low molecular weight compounds, loses its toxicity and, according to numerous observations, can be left inside the eye for a long time.

heavy liquids

Back in 1987 St. Chang et al. found that heavy liquids, in particular perfluorotributylamine and other low-viscosity, but heavy fluorine compounds, first used by S. Haidt et al., have a more reliable plugging property than heavy silicones. (1982). These preparations, in particular Soviet perftoran (“blue blood”) and other high-purity liquid perfluoroorganic compounds (PFOS), such as perfluorodecalin from Opsea or Vitreon (perfluorophenantrene) from Richter, or DK-164 perfluoropolyether (vitreopress), finally high-purity perfluoropolyether 6MF-130 and perfluorooctalbromine have a high relative density (1.94-2.03) with a viscosity of only 8.03 cSt, and therefore can be extremely useful in removing dislocated lenses from the CT, not only natural, but also artificial.

When ST is replaced with perftoran, the lens floats from the fundus to the pupil area. But upon completion of the operation, perftoran must be removed from the eye. Vitreopress H.P. Takhchidi and V.N. Kazaikin (1999) was left in the eye for up to 3 weeks after surgery.

Combined use of silicone oils and heavy liquids.

In the treatment of retinal detachments with breaks localized in the lower part of the eyeball, F. Genovesi-Ebert et al. (2000) found it useful to use a combination of heavy silicone (at a viscosity of 1200 cSt) and low viscosity perfluorocarbon (FeHg). Both preparations were removed from the eye 1 month after administration. Full retinal reattachment was achieved in 83% of cases. True, in 33% of cases, emulsification was observed and in 8% - glaucoma uncontrolled by drugs.

With giant retinal tears exceeding 75 ° along the perimeter, V.N. Kazaikin (2000) recommends the following intraocular intervention technique. During the so-called three-port vitrectomy, small portions of vitreopress are introduced into the vitreous cavity. Settling on the bottom of the eye, it squeezes out the subretinal fluid in the zone of contact with the retina. The epiretinal membranes stretched at the same time, the surgeon can now dissect atraumatically. A prerequisite for success is the removal of not only these membranes, but also the basic vitreous body. After filling (stage by stage) of the entire vitreous cavity with vitreopress, endolaser coagulation of the retina is performed in 4-6 rows. Immediately after this proceed to the silicone tamponade.

The direct replacement of "heavy" PFOS with a "lighter" silicone oil creates conditions under which the "dead space" above the PFOS level is immediately eliminated, as it is occupied by the lighter silicone. As PFOS is sucked out of the posterior part of the eye and new portions of silicone oil are introduced, the interface between them drops lower and lower. Thus, while the last portions of PFOS still retain the full fit of the retina created already at the beginning of the operation, the last portions of silicone oil come into contact with the concave posterior surface of the fundus. PFOS should be removed from the eye at the end of the operation.

Thus, heavy liquids (PFOS, etc.) are shown primarily as a tool that stabilizes (presses) the retina during surgery, as a way to release (prevent) retinal infringement in the scleral or cannula openings, as a technique for changing the contour of the retina in search of a break ( with simultaneous compression of the sclera). The rule is to remove heavy fluids from the eye cavity immediately after the operation is completed. Small bubbles of heavy fluid that have fallen into the anterior chamber are removed with a thin needle using paracentesis. The remains of a heavy liquid in the vitreous cavity behind the air are not easy to detect. However, a temporary stop and a new cycle of its removal is not recommended.

Operating microscopes with coaxial illumination, operating contact lenses (concav -20, -40 diopters) or non-contact aspherical lenses (+60, +90 diopters) play a significant role in the safe conduct of intravitreal operations. In the presence of opacities in the cornea, a domestic ophthalmic endoscope or a temporary keratoprosthesis can be used. The success of surgical treatment of retinal detachment, achieved over the past 30-40 years, would be simply unthinkable without the use of polymers in the form of fillings, tapes, threads, tourniquets, balloons, liquid substitutes for the vitreous body.

A month ago, she underwent retinal detachment surgery. The retina was detached from 6 to 12, there were 3 breaks. A closed subtonal vitrectomy, endotamponade with light silicone, endolaser coagulation of the retina was performed. After the operation, it is recommended to lie face down and walk with your head down. Now I'm worried about small glows around the periphery of the eye (especially from the side and from above), the lateral field of view has slightly decreased. Doctors say: "everything is fine, the retina is attached." Q: Are these symptoms normal after surgery?

The listed symptoms in themselves do not speak about the pathological course of the postoperative period, although their significance can only be determined upon examination.

Silicone was removed 4 months after the operation. At discharge, the retina is attached, I don’t feel flashes of light, as before. Vision is normalized. One question. When I lie on my back, nothing bothers my eyes. When I move my eye, walk or bend down, small bubbles, dark dots and dust rise from below and begin to fly. When I raise my head up or lie down on my back, everything calms down. Everything seems to dissolve in the air and disappear. What is it - the remnants of silicone or the reaction of a weakened setchaka to the removal of silicone? How dangerous is it?

Yes, apparently, these are some kind of inhomogeneities in the vitreous cavity - residual turbidity, PFOS and / or silicone residues. This in itself is not dangerous.

Need help! A new problem arose: the cornea became cloudy. After the silicone removal operation, vision stabilized within a week, I saw 3-4 lines on the table. After that, a fog appeared before the eye. Cloudy glass effect. I don't see a single line.

After the operation there was a slight erosion of the cornea (almost cured). Eye pressure 19. Is it possible that silicone residues get on the cornea and irritate it? In the center where the operation was performed, they say that there is so little silicone that it cannot cause clouding of the cornea. They told me to keep my eye pressure checked. Tell me, what could cause clouding of the cornea and is it possible to insist that surgeons remove the remnants of silicone again? Thank you.

14 months ago, I underwent surgery for retinal detachment in my left eye (circlage, subretinal fluid release and retinal cryopexy), then I did laser coagulation 3 times. Now vision OD: 0.05 - 3.75 cyl -3.0 axis 3 deg. = 1.0, OS: 0.09 - 6.5 cyl -3.0 axis 175 deg = 0.3-0.4 Question: Now I was asked to remove the silicone, what is the possibility of re-peeling, and how difficult is this operation and rehab after?

The likelihood of recurrence without examination cannot be assessed. It ranges from 0 to 100%. If silicone removal is suggested, then the doctor sees no immediate threat of retinal detachment. The operation to remove silicone is technically quite simple for a specialist. In 1 month after the operation, in the normal course of the postoperative period, it will be possible to return to work.

Hello! I had a retinal detachment, they operated on, they injected silicone, then they pumped it out and then they replaced the lens! I am tormented by the remnants of silicone. Can I be operated on and remove the silicone? What consequences can there be?

You can try. Unfortunately, this doesn't always work out. The list of possible complications of interventions on the vitreous cavity is huge. I don't think you want to know all this. Fortunately, the chance of complications is low.

I want to ask if it is possible to go to the cinema after the retinal detachment operation. The operation was done 10 days ago

Can. You probably had dystrophy, not detachment. Otherwise, you would still be lying, maybe not in the hospital, but at home, for sure, and complaining about a sore and watery eye, not thinking about the fact that you can go to the movies.

Hello. Husband 16.11. I had surgery on my left eye for a retinal detachment. I don't know all the data. 17.11. they gave an injection under the eye, after which the eye swollen and a bruise came out, as after a blow. The eye was opened incompletely on 19.11. Today 21.11. while still in the hospital, he noticed that the eye being operated on was squinting, looking to the side, and not straight, as before. The doctor at first said that everything was fine and wanted to write it out, but after the husband pointed out such a defect, he replied that they put a seal there and left her husband in the hospital. What could have happened that led to the strabismus? Could it be a medical error?

In descending probability: either the filling interferes, or one of the muscles that move the eye is damaged during the operation, or the damage occurred during the injection. As a rule, such things pass with time. The term "error" is not appropriate here, since such problems occur even in the most experienced and attentive doctors. The last thing for the well-being of your family right now is to find the doctor at fault.

I had a retinal detachment surgery. The operation was done 18 days ago. You can ask when you can go to the sauna, pool and cinema. And when it will be possible to carry heavy.

Sauna is generally not recommended for 2-3 months after retinal detachment surgery. swimming pool - at least 3 months, cinema - for 1 month. Carrying loads of less than 5 kg is usually not prohibited. It is recommended that you discuss these matters with your surgeon, as he may have a different opinion from the above.

My mother underwent a retinal detachment surgery and was injected with silicone. It has been 12 days since the operation, and the eye still hurts and watery. Drinks painkillers. Can you tell me how long this condition will last and is it normal?

Of course, I cannot know how long this will continue. Your mother has had one of the most difficult operations in ophthalmic surgery, so the presence of pain is not something extraordinary. On the other hand, without an examination, I can not say that everything is fine with her.

In August of this year, silicone was pumped into me. They said that after 3 months it will be removed. But there was a relapse and I had the operation again. When the silicone will be removed now is unknown. Vision is currently 10% corrected. Tell me, can it stabilize at all? And also, can all these interventions affect my appearance, i.e. darkening of the operated eye, etc.? When can I start taking photos? (I work as a model)

stabilization is possible.

The palpebral fissure (degree of eye opening) after retinal detachment surgery remains narrowed for a long time (months), the eye itself is red. This is a completely natural situation. You can start shooting based on an assessment of your appearance - either your own or the photographer's.

On October 12, 2011, exactly one month after the detection of detachment 1 to 7 hours with the capture of the ocular zone, OS operation was performed: Posterior total vitrectomy, Retinotomy, Laser coagulation of the retina, Long-term tamponade of the vitreal cavity with silicone oil. Silicone removal surgery is recommended after 6 months, isn't that too long? Is it possible to restore vision after this operation? Now vision Vis OS=0.15 Tn.

Not too much. The terms are assigned by the attending doctor, weighing on the scales only his/her known information about the risk of recurrent detachment in your case and the risk of complications associated with a long stay of silicone oil in the eye. In addition, during these 6 months you need to periodically show your surgeon. Perhaps the initial decision will be changed in one direction or another, depending on the development of the situation.

At the risk of looking like a pessimist, I will say that the prognosis for the restoration of vision in such cases is very restrained.

A surgical operation was performed to fix the retina with silicone. Do I need an eye patch in the postoperative period.

A week ago, I had a sectorial filling with silicone on my right eye. The eye is clean, there is no pain, the air bubble disappeared three days ago. But: I see in the upper left corner of the right eye, albeit reduced in size, a movable translucent curtain that "leaves", whether to look to the left and up, and today a transparent wrinkle appeared in the inner corner of the right eye and it feels as if a contact lens has moved into the corner of the eye . Could the silicone seal come off and "go out" into the corner of the eye? There is no pain, only the sensations described above, although I constantly drip an antibiotic into the eye as prescribed by the doctor. Check-up next Tuesday. Thank you in advance for your response.

It is unlikely that this is a mixture of fillings, accumulation of mucus at the site of the conjunctival suture or its thickening is possible. Internal examination of the ophthalmologist will help you deal with your complaints.

I was operated on 6 months ago and now I'm worried about small glows around the periphery of the eye (especially from the side and from above), the lateral field of vision has slightly decreased, the lower and upper fields of vision have slightly decreased, it has become very bad to see.

Hello! She was admitted to the hospital with a diagnosis of retinal detachment with multiple breaks, including macular breaks, PVR B, destruction of the vitreous body, initial cataract in the right eye. 07/13/11 an operation was performed: Vitrectomy, removal of the internal limiting membrane, gas tamponade (20% C3F8), dynamic circling. 07.09.11 changed the lens. It has been 11 months since the operation, there is no clarity of vision, and everything is crooked. Please tell me, will my vision improve over time, or will it be so? Thanks in advance!

Most likely, there will be no high vision with such a diagnosis. Your complaints may persist despite the successful anatomical result of the surgical treatment, given that there are structural changes in the macula. It is necessary to constantly monitor the state of the retina of a healthy eye.

Hello. after an eye injury, rupture and detachment of the retina, they did a circlage, they injected gas, tell me when you can drive and play sports at least under your weight, and how to behave after the operation.

You can sit behind the wheel for driving on smooth roads as soon as you feel that the available visual functions are sufficient for safe driving.

Sports activities provoke relapses of retinal detachment. Most likely, they will have to be abandoned for 3-4 months. In general, it is a question for the doctor treating you.

Hello, 6 years ago, after detachment, silicone was pumped in, but they didn’t remove it, they said it’s dangerous and I don’t see anything, only a little light from this eye began to mow a little, I’m a young girl, it worries me a lot. Is it possible to get some vision back?

An eye examination is required. Silicone oil in the vitreous cavity, as a rule, leads over time to the development of complicated cataracts. removal of which may slightly improve vision. Contact our clinic for a consultation.

Hello, I had retinal detachment surgery 1 month and 20 days ago. Can I fly on airplanes, if so, after what period of time? Or right away?

Now air travel is not contraindicated in your case. As a rule, if silicone was introduced into the vitreous cavity during an operation for retinal detachment, then you can fly on an airplane after 3 days, if air - after 5-6 days, if gas - after 3 weeks.

Hello, I have this question. I have a retinal detachment, last year silicone was injected, after 6 months it emulsified and became cloudier than the lens. when replacing the lens, they replaced the silicone, because. there was a relapse of retinal detachment. at this time, silicone got into the anterior chamber. the doctor says to sleep on the operated side, but there are pains. on which side should I sleep and what is the danger of finding silicone? thanks in advance for your reply.

The presence of silicone oil in the cavity of the anterior chamber can be complicated by an increase in intraocular pressure, the development of uveitis. dystrophic processes from the cornea. What exactly is your pain syndrome connected with, I find it difficult to answer in person - you need to consult with your doctor.

Good day. On May 24, I underwent surgical treatment of my right eye: dynamic circling, episcleral filling, release of SRF, cryopexy of the sclera. Preventive laser coagulation of the second eye is scheduled for August. All restrictions in the postoperative period are clear; restriction of weights, no reading, no bending work, etc. I have a question: what are the restrictions in sex? Beloved man patiently waiting.

Before prophylactic laser photocoagulation, you can have sex, avoiding physical exertion on your part.

Hello! After a thorough examination, a diagnosis of OST was made. Manifestations - multiple black dots, lace. Vision is not impaired, but phenomena interfere. It's forever? And what can be done?

If no retinal pathology was detected during a thorough examination, then you will soon adapt to the manifestations of vitreous detachment. There is no effective method of conservative treatment of vitreous opacities.

Good day! And what restrictions and for how long will need to be observed after laser coagulation? I myself am not going to carry weights. But visual loads. I work 80% of the time at the computer.

Within 5 days after laser coagulation of the retina, it is recommended to reduce the amount of fluid consumed to 1-1.5 liters / day, give up strong coffee and alcoholic beverages, and wear contact lenses. Staying in a hot bath and lifting weights are excluded for a month. You can read and work at the computer the next day after the operation.

Hello. Diagnosis: OD-retinal detachment stale, subtotal, perforative traction, 2nd cat. gravity. Operation - Circular depression of the sclera with the release of subretinal fluid passed without complications. At discharge: Vis OS=1.0 There is not enough retina, there is a gap and the bottom of the retina should grow. The ophthalmologist said that the retina seems to be sticking already. Questions: 1. Vision for 2 months after the operation has not improved a bit, is it because of the tourniquets and the new shape of the eye? Can I hope for an improvement in vision. 2. Is it possible to sit at a computer in this state? How many hours a day or how many minutes? 3. And when specifically it will be possible to pull up on the bar at least 50 times a day, even exercises do not help to keep My strength in the body. Thanks for your reply in advance.

1. Curvature of the sclera induces the appearance of myopia of a small degree. It is possible that vision will improve somewhat with the selection of a contact lens, but much depends on the functional ability of the retina.

2. Working at a computer is not contraindicated for you.

3. It is better for you to discuss this question with your attending physician after examining the anatomical state of the retina.

Hello. Probably a stupid question, but still. There was a retinal detachment. Can onions be peeled after surgery?

Please tell me, how long after the retinal detachment operation (silicone is pumped) can I work on the computer and for how many hours?

In the first 7-10 days after the operation, work at the computer only when necessary. In the future, you can return to the usual mode of visual stress.

Hello. I have already had surgery twice for retinal detachment. The first in two stages in 2007 - circular indentation of the sclera, silicone, coagulation, then the removal of silicone. The second time in September 2011 the first stage with silicone. second for silicone removal and lens replacement in February 2012. Now I'm worried about blurred vision, as if the silicone has not been completely removed. Will it pass? What vitamins and products would you recommend for prevention. *For example, with lutein? Milgamma? And can you play table tennis? I play at a semi-amateur level, but quite seriously? Thanks))

1. Your complaints may be related to clouding of the posterior capsule. which is often observed after lens replacement.

2. There is no fundamental difference in vitamins, take any permitted by the Ministry of Health.

3. The possibility of playing sports depends on the anatomical state of the retina and is determined after an internal consultation with the attending physician.

Probably, the existing ptosis can be corrected with surgery. An eye examination is required.

Hello! very interested in the question. On July 4, they performed an operation on a sectoral detachment. vision is almost restored. (was -5). on the second eye the same detachment. only much less. it was noticed during the examination at first eye. In the same place. The operation will be August 17th. those. This Friday.

the question is this. Nothing worries me now. a month after the first operation has passed, before the second there is still time. Can I go to a beauty salon and get my eyelashes dyed? I really do not want to go pale after the second operation for another month.

If you are not sure about the absence of a possible allergic reaction to the coloring preparation, then it is better to wait a little with this cosmetic procedure. Otherwise, there are no contraindications.

Hello! I had a high degree of myopia, there was a retinal detachment, everything that could be done in ophthalmology to attach the retina, I went through all the stages, as a result, I downloaded silicone 5000, and a complicated cataract was removed a year later. the eye still does not see a single line, tk. the posterior capsule is very dense, the fundus is not visible, my question is whether it can be corrected with a laser and whether it is necessary to remove the silicone. Thank you.

An eye examination is required. If it is impossible to carry out laser discission, clouding of the posterior capsule. possibly surgery. Silicone oil does not need to be removed.

Good afternoon! Tell me please. I was diagnosed with a pre-ruptured retinal condition in my left eye and was offered a vitrectomy. I read that there are a lot of possible complications and plus the result is not guaranteed. What if I do not have this operation, what does it threaten me with? Thanks in advance!

Without surgery, this can lead to the formation of a macular hole and a significant decrease in vision.

Good afternoon! I have complicated high myopia in one eye since childhood - 12-15 diopters. In 1987, there was a keratotomy and LKS. Nonetheless. vision has not improved, with glasses - 9 on the OS I see only three lines. OD - myopia of a small degree. farsightedness. In August 2012, OCT of the left eye revealed a vitreous detachment. traction syndrome. macular prerupture. subretinal fibrosis. History of type 2 diabetes mellitus. Is it possible in such a situation to inject into the vitreous body of lucentis? In complications after its introduction, there is a detachment of the retina. Will this make the condition worse? And is it necessary to do lucentis in the eye with + 1.75D?

There is a list of indications for intravitreal administration of Lucentis. which does not include traction syndrome with macular prerupture. It makes sense to consult a surgeon about vitrectomy.

Hello, I am very scared for my vision, so I wanted to ask you. The surgery for retinal detachment on the left was performed on 08/24/20012, after the operation I saw blurry but better, now I see worse, stripes appeared in the middle of the eye. as if there were more hairs in the eye and clouding, the 3rd week went, and the eye did not fully open only half, into the area. for inspection and ultrasound go only in October. What's going on with my eye normally? I'm very worried. Lyudmila 37 years old

Probably, your complaints are connected with some heterogeneity in the vitreous cavity. The listed symptoms in themselves are not a pathological course of the postoperative period, but their significance can only be determined during examination and examination.

Good afternoon!

Tell me, if 2 months ago they had an operation for detachment, and then a "moth" appeared in the eyes again, what does this mean.

This means that there is clouding of the vitreous body. What effect this symptom can have on the state of the retina in your case will be determined by an internal examination.

Good afternoon! Had surgery to remove silicone after retinal detachment. Introduced gas. Before the operation, the eye with silicone saw, now it does not see anything. They say that after 2 weeks it will stabilize, but for 4 days nothing has happened. What could it mean, please tell me

Most likely, to determine the functional result of the operation, it is necessary to wait for the resorption of the gas introduced into the vitreal cavity (10-14 days).

Good day. I had an operation on my right eye, a retinal detachment, laser coagulation and uploaded something I didn’t remember, A week later they removed and uploaded silicone. The first operation was performed on July 3, the second on 10.07 a month later they came for an examination and the doctor said that the swelling of the retina did not sleep, he prescribed Retinalamin, Dexon and Emoxipin and said to come in a month. We'll go soon BUT my eye squints to the right and there is, as it were, a small cloud in the middle (hard to see) a little higher some kind of incomprehensible line like a spoon in a glass of water breaks (similar situation) Why didn’t I exfoliate again? they told me to lie on my back, but I turn around at night! Will the strabismus get better or will surgery be needed?

Strabismus. probably due to low vision in the affected eye. As a rule, such strabismus cannot be eliminated without surgery.

Visual symptoms can tell a lot: about silicone in the vitreous body, about the incomplete reattachment of the retina, about epiretinal membranes. about the recurrence of the detachment. Need to be examined.

Hello. Thanks for your help. Yesterday I went to the doctor about the outbreaks, everything is in order. The retina was operated on 1.5 years ago, throughout the postoperative follow-up, everything is normal. Tell me, with severe nasal congestion (a deviated septum), is it dangerous for the eye to blow my nose hard, while I feel strong pressure on the eye, although this sensation may be subjective, but still.

Hello. Two months ago, an operation was performed to glue the retina on the left eye. There was an almost complete detachment. I could look at the bright sun and see nothing. Now I see almost everything that falls into the field of view, but the image of the object seems to be watching under water. The edges of the item are slightly broken. And most importantly, the image from the operated eye is shifted in relation to the image of the healthy one. And pretty significant. It's good to count money. They become twice as many. Please tell me whether the images of the object will be combined in perspective and if so, after what period of time.

These questions are difficult to answer for many reasons. The first reason is that I don't know what causes the doubling. If this is due to the position of the operated eye, then it is probably possible to try to correct it. If double vision is due to changes in the retina. there are practically no opportunities for active improvement of the situation. Actually, this is the second reason.

6 months after the operation, silicone was pumped out of the retina, vision deteriorated, it became cloudy 7 days after the operation. Should it improve?

In general, if the retina has not detached again, vision should not deteriorate. One possible explanation is the correction of myopia with silicone in the eye. When it is removed, myopia "returns".

Good day! This is a worrying question. In June of this year, my sister underwent a detachment operation, they pumped gas. The retina was adjacent to the surgical band, and after 3 months there was a relapse. An operation was performed - heavy silicone was introduced, please tell me, is a relapse possible when there is silicone in the eye? There are complaints of clouding and narrowing of the field of vision

As long as the silicone is in the eye, there will be no relapse. But it must be removed, because then the eye with the adjacent retina will become blind due to atrophy of the optic nerve.

Hello. An operation was performed - CV + drain subretin. liquid + cryopexy, 4 months have passed, in the peripheral zone (just where the process of retinal detachment began) there is now an image jitter (3-4 times a day, or in the evening) sometimes flashes (one or two) Please answer what it is (not Is it a re-start of detachment, because it all started that way)? The silicone cord has not been removed. Thank you!

Without internal survey it is difficult to be defined or determined with value of your complaints. Consult with your surgeon.

Tell me, what is the maximum time period for retinal detachment surgery in order not to lose sight?

Retinal detachment is a very serious condition. After detachment, the retina can retain its function for up to 1 month, then irreversible changes occur. Therefore, the faster the retinal detachment is operated on, the more likely it is to save vision.

Hello, I had an operation due to detachment of the upper part of the eye, silicone was pumped in, after 3 months. removed the silicone, pumped gas. As the gas dissipates around the periphery of the eye, distortions appear in the form of dark waves, not always, only when the eye strains (focuses on the subject). There was also an operating lower detachment. Vision -5 slightly deteriorated after the 1st operation. The doctor said it was necessary to observe the condition, said nothing more, but shook his head. What are my chances of not going blind?

Of course, there are chances. Show up regularly and do everything that your surgeon will prescribe (who, believe me, wishes you recovery no less than you, despite his reticence).

Hello, I had retinal detachment surgery. I am a wood painter by profession, can I then work in my profession?

It is possible, if possible, to avoid heavy lifting and significant physical exertion.

Hello, I have retinal detachment from 11 am to 4 pm, two ruptures, two weeks ago I underwent CV + subretinal fluid drainage + creopexy. After the operation, the dark veil was replaced by a slightly yellowed spot and distortion of vision at the place of detachment, a sparkling spot and blinking circles appeared, vision from -8 became -13. The symptoms still do not go away, is this normal and when should there be improvements? The surgeon said to come only in a month. I should check earlier.

An increase in the degree of myopia is associated with a change, due to the operation, in the geometry of the eye - a circular impression leads to a dilation of the anterior-posterior axis of the eye. Other complaints described by you may be a normal manifestation of the postoperative period and do not indicate any serious pathology. In any case, their significance can only be determined during an internal examination.

Good afternoon, a month ago, a cystic small tumor was found in the left eye near the retina, they said that she had torn the retina a little, they made an incision in the eye and injected some medicine, after that she still underwent a course of treatment with injections. Can you tell me if I can do fitness now? I can’t ask the doctor because the operation was done in another city. Thank you.

My father underwent retinal detachment surgery on his left eye, he was treated with silicone, he stayed with him for 3 months, yesterday 30.01. 2013 the silicone was removed, I’m interested in such a question, the eye began to see badly than with silicone and a yellow tint (why is it yellow?) And I saw a black mountain at the top (the doctor said that this is air that it should be sucked out) and even for 3 months when it was silicone, when he looks at the letters with his healthy right eye, they double in him (he says that it’s up and to the right (or left I don’t remember exactly) we are very worried that they could violate a healthy eye, is this possible?

Surgery for retinal detachment does not affect the healthy eye. The feeling of double vision is most likely caused by a muscle imbalance, which often occurs after surgery. The air bubble will dissipate over time. Regarding your other complaints, it is better to consult with your doctor, who knows both the condition of the eye and the features of the operation.

Good afternoon! On December 1, 2012, my husband underwent surgery for a total retinal detachment with a valve rupture at 11 o'clock. Selikon was uploaded. He strictly followed all the recommendations of doctors during frequent examinations. Yesterday, 01/09/13, a second operation was scheduled and carried out to extract the silicone. Everything, it seems, went well, but during today's morning examination of the ophthalmologist, they did not let him go home from the hospital and said that there was a clouding of the lens. Why could this happen? Previously, this problem did not seem to exist, since it was never voiced. Thank you in advance for your response.

On April 14, 2011, my daughter entered the Moscow Eye Research Institute. Bol. them. Helmholtz with a diagnosis of OI Proliferative diabetic retinopathy, gliosis 3-4, traction retinal detachment. O.Z. Vis OD=0.01NK OS=0.05 sf-1.5D=0.1nk. Surgical treatment of OD was recognized as unpromising. 04/27/11 pre-op. preparation - anti-VEGF therapy; 04.05.11 OS operation - posterior closed subtotal vitrectomy, membrane peeling, end tamponade of PFOS; 05.11.11 OS operation Lensectomy with implantation of IOL + 20,OD, revision of the vitreal cavity, laxative retinotomy, endotamponade with silicone oil 1300 cSt . At the moment, the eye does not see. a film formed on the lens. Due to the tight fit of the laser, it does not break through. Silicone has been with us for 2 years. The surgeon told us: wait for new technologies. I can't help anymore. What should we do? Who can you turn to for qualified help? The right eye can go blind at any moment. And now no one is interested in the operated eye. Help. The girl is only 25 years old!

If it is not possible to do laser dissection of the opacities of the posterior capsule. then surgery may help. You can't promise anything in absentia, not knowing for what reason you are denied an operation, but you can try to consult with our parent organization in Moscow or come to us.

Hello! I was diagnosed with a retinal detachment of the eye. They said I would do an episcleral filling. Please explain the essence of this operation and how much vision will deteriorate?

The goal of any operation for retinal detachment is to bring the detached retina closer to the pigment epithelium. With extrascleral filling, this is achieved by creating a site of depression of the sclera. At the same time, due to the created shaft of depression, retinal breaks are blocked, and the fluid accumulated under the retina is gradually absorbed by the pigment epithelium and capillaries of the choroid.

Recovery of visual functions in the postoperative period occurs gradually, over several months. Postoperative visual acuity largely depends on the duration of the detachment and the involvement of the macular region in it. In addition, after extrascleral filling, the geometry of the eyeball changes somewhat - the anterior-posterior axis increases, which is accompanied by the appearance of a slight myopia or an increase in its degree.

I had surgery for retinal detachment six months ago when I can sleep on the operated side, when I can drink alcohol

Hello, in 2008, I had laser coagulation on two eyes, after what interval can it be repeated!

If necessary, laser coagulation can be repeated a day after the procedure, and after many years. In some cases, this is not required at all. Indications are determined by a laser surgeon after examining the fundus.

I had an operation for retinal detachment six months ago, is it possible to lift dumbbells for me and with what weight.

On this occasion, it is better for you to consult with your doctor: there are cases when power loading and weight lifting are contraindicated at all.

Six months ago, I underwent retinal detachment surgery, how much time I can watch TV, how much time I can work on a computer and whether I can swim.

Watching TV programs and working at a computer are limited to reasonable limits - neither will lead to a relapse of retinal detachment.

Hello! 11.02.13 in MNTK them. Fedorov, I underwent retinal detachment surgery with silicone tamponade. To this day, rare slow yellow and white flashes along the periphery do not stop, but several times from the periphery they reached almost to the center. Similar but more extensive outbreaks occurred during detachment. Corrected visual acuity is only 40% and there is no improvement. Maybe just a little time has passed?

This may be. Most likely, these are some inhomogeneities in the vitreous cavity.

You should know that the prognosis for the restoration of vision in such cases is very restrained. It all depends on the functional ability of the affected retina.

On March 4, 2013, I underwent laser coagulation, during which period I need to lie down, not leave the house and drink alcohol.

In many ways - it all depends on the cause that caused the redness of the eyes: conjunctivitis. blepharitis. iridocyclitis. dry eye syndrome. episcleritis. Redness of the eye is a rather non-specific symptom that occurs with various pathologies. Internal consultation of the oculist is necessary.

Hello, six months ago I had an operation for retinal detachment, is it possible to do fast dancing.

You can, only if these fast dances of yours are not associated with the risk of falling, hitting the head, shaking the body and sharp bends in different directions.

Hello, I had an inferior retinal detachment in almost the entire lower hemisphere with two breaks. A month ago I had Arrugo circlage, ESP, cryoretinopexy and scleral puncture. Now, after the edema has subsided, the retina in the center seems to fold when I blink and move my eye. The doctor says that the retina is attached, just its upper layers fold a little and this will pass. Can I believe it? And I also have a feeling that the heart is beating from below the eye, even the image twitches a little. The doctor says it's because I lie down a lot. What could it be?

1. This is possible. Folding of the retina of varying severity may be after surgery.

2. You may have a nervous tic. Surgery for retinal detachment is a big stress. Get plenty of rest, avoid conflicts. Frequent blinking helps a lot.

Hello. I had a vitrectomy a month and a half ago, and silicone was injected. Today they suggested removing the silicone. Is not it too early.

Don't know. The terms are appointed by the attending doctor, weighing on the scales only known to him information about the risk of relapse of detachment in your case.

And tell me, please, there was a small detachment of the mesh. left eye (from 2 to 11) - the operation was done quickly, 5 days after the start. After the operation (vitrectomy, silicone), the eye sees in the center, near the nose, below, it clearly sees where it was exfoliated (and before the operation there was a dark spot). The rest is somehow not very good. Moreover, the transition from I SEE to I NEVIZH is smooth. And the stealth zones are not black, but light gray or something. That is, I kind of see the light with them. Although I don't see it to the left corner. There are also many spots of inflammation after the operation. The reason is not clear. Tomography gives atrophy of the nerve. I wrote a lot, sorry. If you can outline some perspectives, write.

It looks like some kind of heterogeneity in the vitreous cavity. Let's hope that the situation will improve after the removal of silicone oil.

Atrophic changes in the optic nerve should be treated conservatively (drugs that improve the trophism and conductivity of the nervous tissue, magnetic and electrical stimulation).

Hello. I have a retinal detachment with multiple breaks. Silicone stood a little over a year. In January 2013 silicone rejection, secondary cataract and secondary glaucoma began. The eye is swollen and cloudy. Have made operation. Some of the silicone has been removed. But now the pain started again, very strong. The pressure was 27. Inflammation was determined. They put a blockade for the umpteenth time and an injection in the eye. Is treatment needed? The eye is already blind, I see only a bright light, I don’t count on vision anymore. But I'm tired of the pain. Still holding a temperature of 37.4 can it be from the eye? There is no cold.

In some cases, it is possible to carry out laser surgery that reduces intraocular pressure in order to relieve pain and preserve the eye as an organ. This is the so-called. LCPC - laser cyclophotocoagulation. You can contact our clinic. It is impossible to completely exclude the ocular cause of an increase in body temperature - it is possible.

Hello. Maybe off topic, sorry. My father was diagnosed with retinal detachment a month and a half ago. According to the quota, the operation is scheduled for next year. Will such a long wait affect the result of the operation? Maybe you need to sign up for an operation on a paid basis? The eye is almost invisible. Thank you.

Retinal detachment is a very serious pathology. The successful result of surgical treatment largely depends on the duration of the operation - the earlier, the more favorable the prognosis. After 1 month of the existence of a detachment, irreversible changes occur in the retina, nerve cells die, vision is irreversibly lost. Gradually, the retina is replaced by connective tissue that does not perform visual functions. By waiting so long for surgery, you run the risk of completely losing your sight.

Hello. On April 3, 2013, they underwent retinal detachment surgery, they injected silicone oil 1300, after a wound in the sclera of the right eye, please tell me how to behave in everyday life, what is possible and what is not. Thank you.

Such issues are usually discussed with the attending physician on the day of discharge or a special memo is given to the patient along with the discharge summary. As a rule, such recommendations are individual and depend on the state of the retina. volume of surgical treatment and further treatment tactics. Until the next doctor’s examination, where you can clarify the features of your rehabilitation period, I can advise the following: do not rub your eye and do not put pressure on it, do not lift weights, do not drive a car until the eye heals, take breaks more often when watching TV or reading, observe established regimen of instillation of eye drops.

Good afternoon! On October 2, 2012, laser coagulation was performed, as multiple retinal tears were found in both eyes. I have a myopia of an average degree -5. 0 in both eyes. The doctor recommended to limit physical. load and change jobs (I'm a seamstress). Now I am a housewife, but I am very called to work. Question: Will I have a relapse in detachment due to sewing? And what is the probability of loss of vision in general? Thank you in advance, Olga, 42 years old.

In fact, a well-performed laser retinal photocoagulation can allow you to return to your work. However, it is difficult for me to assess the situation in absentia and promise you the absence of complications when working with a sewing machine.

Please tell me I had an operation to restore the retina with the introduction of silicone a week ago, can I drive a car?

It is better to refrain from driving a car until the eye is completely healed (3-4 weeks). In addition, do not forget about the visual acuity necessary for driving: the best eye without glasses or with glasses or contact lenses on is not lower than 0.6, the visual acuity of the worst with glasses or contact lenses on is 0.2.

On February 2, 2012, a retinal detachment operation was performed. After surgery, vision in this eye was 0.02, with a correction of 0.1. Now the eye began to see worse, a cataract is developing. Is it possible to do an operation to remove the lens if there is still gas in the eye.

It is possible, but it seems that there is no more gas in the vitreal cavity: as a rule, it resolves within a few weeks.

Hello! In April, I underwent surgical treatment of retinal detachment in the upper outer quadrant. After victectomy, endolaser coagulation and injection of PFOS (April 16), the eye saw quite well for 2.5 days. After replacing PFOS with gas on April 19, intraocular pressure increased in the postoperative period, afterburner was carried out to reduce it. From the moment of discharge on April 26 to this day, there is a strong clouding in the eye, in the center of the field of vision there is an invisible rounded spot. On examination, doctors note the replacement of gas with intraocular fluid, the normal postoperative state of the retina, and slight clouding of the lens, which does not interfere with the examination of the retina. Could such significant blurring with loss of vision in the center be caused by an increase in intraocular pressure during gas tamponade?

It is hard to say. A sudden increase in intraocular pressure to high numbers, such as during an acute attack of glaucoma, can lead to reduced vision or even its complete loss. Perhaps your complaints are partly related to clouding of the lens and the functional state of the retina.

On May 6, 2013, an operation was performed Episcleral filling (2-4 hours) + closed subtotal vitrectomy with gas tamponade of the virtual cavity. diagnosis. Operation of the detachment of the retina of the left eye. Gas tamponade of the vitreal cavity of the left eye.

Question: how long should you be in a face down position? And what should you see?

Of course, these questions should be addressed to your attending physician, who should have informed you about the peculiarities of the postoperative period.

As the gas dissipates (up to 14 days), the upper part of the visual field begins to brighten, and you may notice a "level of media separation" that changes position depending on the movement of the head. In addition, 10-12 days after the operation, when the amount of gas in the eye remains less than a third of the volume of the vitreal cavity, one whole vesicle of the eye can break into several vesicles, which can lead to the appearance of "floats".

Usually, the "face down" position should be observed for the first few days - a week after the operation. Your surgeon may have a different opinion than mine on this matter.

Traumatic retinal detachment (TOS) is one of the frequent and severe complications of the traumatic process, the pathogenesis of which has many components (retinal tears, subretinal hemorrhages and exudates, traction component). Based on this, approaches to the treatment of TOS are being formed - extrascleral filling, laser coagulation, retinotomy with retinopexy, as well as tamponade of the detached retina by introducing various implants with a high specific gravity into the vitreous cavity.

Among the plugging agents, the researchers identified silicone oil (SM). A good effect of silicone tamponade (96% fit) was shown in severe forms of retinal detachment accompanied by PVR, giant retinal tear, retinal detachments after trauma, and macular holes. High-tech methods for synthesizing SM have been developed. There have been studies of SM of different gravity, the so-called heavy silicones, which is associated with the problem of treating retinal detachment in the lower part of the fundus. These studies showed good tissue tolerance, but a more pronounced inflammatory response compared to conventional SM. However, the big problem was the need to remove silicone, which is due to a number of complications. The most characteristic clinical complications are described: pupillary block with the development of secondary glaucoma, cataracts, and band-shaped keratopathy. However, the most severe complications were caused by changes in the retina, which was revealed by histological examination, both in the study of the enucleated eyes of patients and the eyes of experimental animals. With a long stay of SM in the eye, atrophy of the outer and inner segments in the layer of photoreceptors, as well as the layer of ganglion cells, was shown. The appearance of spherical formations in the form of vacuoles surrounded by macrophages was noted. Similar silicone "vacuoles" were found not only in the retina, but also in the optic nerve, choroid, retinal pigment epithelium, ciliary body, iris, and corneal endothelium. By 18 months, the silicone had penetrated the inner limiting membrane, infiltrating the entire retinal tissue. All these data justified the obligatory removal of the SM after 1 month. At the same time, the removal of the SM was accompanied by the risk of recurrent retinal detachment with a more severe course, which allowed surgeons not to rush to remove the SM or to remove it at a later date. The lack of a consensus on the tolerability of the tamponing drug makes it relevant to further study aimed at identifying the positive and negative properties of SM.

Target— study of morphological changes in the tissues of the eye during prolonged stay of SM in it, as a plugging material used in TOS surgery.

Material and methods. The study of morphological changes was carried out on 14 enucleated eyes of patients who developed traumatic retinal detachment after trauma, in connection with which several surgical interventions were performed. In all patients, SM was used as a tamponade. In one patient, the SM was removed two years after the operation; in the rest, the SM was not removed.

Loss of visual functions, sluggish uveitis and signs of subatrophy of the eyeball were the cause of enucleation.

Results and discussion. In all 14 patients, SM was introduced into the vitreous cavity as a plugging material, the stay of which was long: 6 months. - 3; 1.5 years - 3; 2 years - 3; 3 years - 2; 10 years - 2; 30 years - 1. Retinal detachment in 11 patients occurred after an accidental injury (8 - contusion and 3 - penetrating wound), in 3 retinal detachment was observed after a surgical injury - cataract extraction with the introduction of IOL. All patients clinically observed a picture of sluggish uveitis in the absence of visual functions. In 11 patients, a total retinal detachment was found, in three the retina was adjacent.

Morphological examination in 14 eyes of patients revealed changes caused by trauma, both accidental and surgical. However, the most pronounced changes were localized in the retina. It was natural to identify SM droplets on the inner surface of the retina, surrounded by inflammatory infiltration with a predominance of macrophages. Inflammatory infiltration was also localized in the choroid, which was diffusely infiltrated with lymphocytes, edematous.

It should be noted that the inflammatory reaction prevailed in the first two years after the introduction of SM, and later fibroblastic processes increased. In the long term (10-30 years) in 2 patients, bone formation was noted, which was located on the inner surface of the choroid, had a microscopic structure characteristic of a flat bone. Pronounced changes in the retinal tissue were noted during prolonged stay of the SM. The retina was infiltrated with SM droplets varying in size from large cystic cavities to small bizarre vacuoles. Some vacuoles contained contents resembling the remains of emulsified SM. The retinal tissue became atrophic, neuronal elements disappeared, and glial tissue grew. In some cases, as a result of atrophic changes, the retina turned into glial tissue. However, retinal detachment was absent in these patients. This situation may have explained the loss of functions in the "adjacent" retina during its prolonged tamponade with silicone.

conclusions. A morphological study showed that prolonged stay of the SM in the eye cavity in 14 patients caused specific complications: the development of an inflammatory process around the “fat” drops (SM), the formation of epiretinal and subretinal membranes as a result of fibroblastic processes with possible bone formation, the development of atrophic processes in retina with loss of neuronal structures. The results obtained suggest that SM has a destructive effect on the eye tissues during its prolonged stay in the eye cavity, and that it is expedient to remove the SM at an earlier time in order to prevent specific complications.

20-10-2012, 14:36

Description

Complications of vitreoretinal surgery may be related to technical errors, the general condition of patients and the severity of the eye disease. The quality of instruments and equipment, the qualifications and well-coordinated work of the staff, the experience of the surgeon and assistants most directly affect the number and severity of complications. The results of operations can be influenced by general severe diseases, in this regard, preoperative examination, preparation of patients for surgery and postoperative treatment are of great importance. The state of the eye itself, the severity of structural and functional changes determine both the extent of the surgical intervention and its outcome.

Bleeding

Bleeding often complicate the course of the postoperative period. Most often, hemorrhages occur in PDR, but they can occur in other diseases. The source of bleeding is surgical incisions, neovascular ERM, vessels of the iris and retina. The intensity of hemorrhage can be different: from a light suspension, which makes it difficult to examine the fundus, to a more pronounced one, when the reflex disappears. The degree of intensity of hemorrhages depends mainly on the state of ophthalmotonus immediately after surgery. Therefore, careful sealing of surgical incisions is very important. Significant hemorrhages usually do not occur when silicone or an air-gas mixture is introduced into the vitreal cavity. It is useful after vitrectomy to introduce a certain amount (1.0-1.5 ml) of sterile air for pneumovasopexy in the area of ​​sclerotomy. It is advisable to use this technique also when removing silicone and in some other situations (Fig. 20.1).

Rice. 20.1. Air injection after vitrectomy

In cases where there is a risk of bleeding, it is necessary to use hemostatic drugs prophylactically before surgery. A good effect is the use of hemostatic drugs during the operation, if bleeding occurs.

For the treatment of hemorrhages in the postoperative period, it is also necessary to prescribe, first of all, hemostatic agents (dicinone, contrical, vikasol, histochrome, etc.) and conduct active absorbable therapy (reopoliglyukin, hemodez, Perftoran emulsion in the form of intravenous drip injections).

Surgical interventions should be resorted to only if, according to ultrasound hemorrhage accompanied by retinal detachment. In such cases, in addition to vitrectomy, the introduction of PFOS, endolaser coagulation and the replacement of PFOS with gas or silicone are necessary.

A fairly rare complication that is associated with severe hypotopia of the eye is subchoroidal hemorrhage. Attempts to release blood from under the choroid in the first hours or days after hemorrhage are doomed to failure. It is possible to release blood through a sclerotomy or sclerectomy only after 10-15 days, when hemolysis occurs and the blood becomes liquid. This intervention should be resorted to as a last resort if the complication is accompanied by OS or if there is a large bubble of hemorrhagic OS in a single eye without a tendency to resolve. In most cases, subchoroidal hemorrhages resolve in 1-2 months. The appointment of hemostatic and absorbable therapy accelerates the healing process.

Recurrent hemophthalmos

A serious problem is recurrent hemophthalmos, which can occur in aphakic eyes after severe injuries, with PDR and uveitis. Quite effective in this complication is the method of pneumovasopexy. This procedure is performed behind a slit lamp.

Operation technique . After drip anesthesia and application of an eyelid expander under biomicroscopic control, paracentesis is performed for 6 hours in the limbus area with a thin (0.3 x 12 mm) disposable injection needle, dressed in a syringe with an air-gas mixture.

The surgeon, having inserted the end of the needle into the anterior chamber, holds the syringe in this position motionless, and the assistant, pressing the plunger of the syringe, injects a small amount of the mixture into the hook to obtain a slight increase in IOP (Fig. 20.2).

Rice. 20.2. Introduction of air-gas mixture

The needle is removed, under the influence of excess pressure, blood flows out through the paracentesis (Fig. 20.3).

Rice. 20.3. Displacement of blood by gas

The needle is re-introduced into the anterior chamber and a new portion of the mixture is added, after which the needle is again removed from the eye. This procedure must be repeated several times.

After the gas fills most of the cavity of the eye, including the entire anterior chamber, the patient is asked to remove his chin from the stand and, tilting his head forward, look down. In this position, the gas bubble goes up into the vitreal cavity, and the anterior chamber is filled with blood suspension, the liquid-gas replacement can be continued. By alternating the position of the head and the introduction of gas several times, it is possible to completely remove liquid blood from the eye. In this case, both the vitreal cavity and the anterior chamber will be filled with gas.

In those cases when it is necessary to preserve visual functions, you need to use a 20% mixture of fluorinated gas with air. In cases where the goal of treatment is to preserve the eye as a cosmetic organ, more concentrated mixtures (40-60%) can be used. When there is persistent hypotension and the threat of subatrophy, the use of 100% fluorine-containing gas (perfluorocyclobutane, perfluoromethane, sulfurhexafluoride) is justified.

Pneumovasopexy can be performed repeatedly, if necessary, against the background of hemostatic treatment. This technique is successfully used not only in the fight against recurrent hemophthalmos, but also in chronic choriociliary detachment.

Inflammation

Vitrectomy is a low-traumatic operation, and reactive inflammation after it is negligible. However, in debilitated patients, as well as in systemic diseases, the inflammatory reaction can be pronounced. The inflammatory process is significantly increased by incomplete removal of the lens masses, spontaneous or planned iridectomy with a vitreotomy. There is a direct dependence of the reaction of the eye on the operation on the volume of intervention.

Reactive inflammation aggravated by extensive coagulation. A protracted inflammatory process after vitreoretinal surgery can stimulate the development of PVR, which may result in OS relapses. Especially actively it is necessary to fight against the postoperative inflammatory reaction in the eyes, where even before the operation there was a pronounced neovascularization. In severe cases, in the absence of adequate anti-inflammatory treatment, progressive PVR can lead to subatrophy of the eyeball.

After completion of each vitreoretinal operation it is necessary, together with antibiotics, to be administered under the conjunctiva and corticosteroids. In the postoperative period, instillations of corticosteroids (dexamethasone, triamcinolone) in combination with non-steroidal anti-inflammatory drugs (naklof) and mydriatics (1% atropine solution) are sufficient in most cases. In severe cases, subconjunctival steroid injections should be used.

Corneal change

Most often, the cornea is affected in capsular aphakia, when the CT cavity is tamponade with silicone. Silicone oil often enters the anterior chamber, sometimes filling it (Fig. 20.4).

Rice. 20.4. Silicone in the anterior chamber contacts the cornea

The resulting prolonged permanent contact of silicone with the corneal endothelium leads to endothelial-epithelial dystrophy. The process of development of dystrophy in the early stages is reversible: if you eliminate the contact of silicone with the cornea, its transparency is restored. In cases where it is not possible to completely remove the silicone due to the risk of OS, an attempt should be made to refill the silicone into the CT cavity. This can be done by introducing sterile air into the anterior chamber with a fired needle.

To prevent the silicone from re-emerging into the anterior chamber, you need to do basal iridectomy(Fig. 20.5).

Rice. 20.5. Basal iridectomy at 6 o'clock reduces the risk of silicone escaping into the anterior chamber

When using "light" silicone, it is done in the meridian of 6 hours, with "heavy" silicone - at 12 hours. The migration of silicone into the anterior chamber is facilitated by the movement of the intraocular fluid. The idea behind the formation of basal colobomas is to create a bypass for the IVF, which reduces its pushing effect on the silicone. A more reliable barrier to silicone in noncapsular aphakia is a pupillary IOL, which can be implanted during the main operation or in the postoperative period, when there is a threat of silicone migration.

Certainly, all measures must be taken that silicone tamponade be a temporary measure. In cases where there is residual OS, either additional filling or transpupillary laser coagulation should be performed. If these measures do not lead to success, you need to do the transvitreal operation again. In this case, it is necessary to replace silicone with PFOS. When aspirating silicone, you must simultaneously inject PFOS under the silicone. After that, the ERM is removed, an ELC is performed, and PFOS is again replaced with silicone.

The silicone may come into contact with the cornea in the form of an emulsion. The low surface tension of silicone predisposes to emulsification in a mobile organ such as the eye. However, the pronounced accumulation of the emulsion is a manifestation of the inflammatory process, the exudate plays the role of an emulsifier. The same role can be played by the remains of ST, blood, and lens masses. The emulsion accumulates in the anterior chamber in the form of a white foamy mobile mass with a horizontal level. When using "heavy" silicone, the emulsion accumulates at the bottom of the anterior chamber, resembling a hypopyon. The emulsion of "light" silicone accumulates at the top (Fig. 20.6).

Rice. 20.6. Silicone oil emulsion in the anterior chamber

Emulsified silicone rarely causes corneal changes. Removing it is not difficult. The emulsion is easily washed out with a stream of saline through paracentesis (Fig. 20.7).

Rice. 20.7. Washing out the silicone emulsion

Iris change

With extensive coagulation, simultaneously capturing the nasal and temporal halves of the eyeball, for example, with circular external diathermocoagulation or with ELK, possible development of iris atrophy and the appearance of mydriasis. This complication is associated with damage as a result of coagulation of the posterior long ciliary arteries and pearls. To prevent the development of this complication, it is necessary to carry out only transscleral cryocoagulation in the horizontal meridians (at 3 and 9 o'clock), which damages large vessels and nerves less.

Neovascularization of the iris is most often observed after surgery for PDR; this process can proceed very quickly against the background of inflammation, especially if rubeosis phenomena were present before the operation, as well as in cases where the operation was not successful. The use of active anti-inflammatory therapy in many cases leads to the reverse development of newly formed vessels.

Glaucoma

An increase in ophthalmotonus in the postoperative period can be caused by various reasons: blockade of the outflow tract by erythrocytes (hemolytic glaucoma), pupillary blockage by gas or silicone, neovascular glaucoma, steroid glaucoma. Control of IOP should be carried out both in the early postoperative period and in the long-term, especially in cases where glaucoma can be expected.

Hemolytic glaucoma. If during the operation the blood is not completely removed or if bleeding occurs after the operation, it is possible to close the drainage zone of the anterior chamber angle with red blood cells and increase IOP. Washing during the operation of the vitreal cavity, coagulation of bleeding vessels, careful suturing of sclerotomies, the use of hemostatic agents significantly reduce the frequency of this complication. The rise in IOP is usually temporary, stopping after hemolysis ends and with the appointment of antiglaucoma drugs. Pilocarpine in these cases usually reduces IOP slightly, the use of xalatan is more effective, especially in combination with β-blockers (timolol, arutimol). In some cases, the appointment of carbanhydrase inhibitors (diacarb) is required.

Tampon-dependent glaucoma. Tamponade of the CT cavity with fluorine-containing expanding gases may be associated with an increase in IOP. It is necessary to use 20% mixtures of these gases with air. Such a mixture does not expand and does not usually cause hypertension. But the use of even such a mixture for aphakia and pseudophakia does not exclude the rise in IOP.

The mechanism of action in these cases is not associated with the expansion of the gas, but is due to the blockade of the pupil by a gas bubble if the patient does not comply with the “face down” position (Fig. 20.8).

Rice. 20.8. Grinding of the anterior chamber under the action of a gas bubble

A constant reminder to patients of the need to comply with the regime, control by the staff helps to avoid this complication. With a short violation of the regimen, the complication that has arisen is quickly stopped when the position changes. If, for any reason, the patient has been in the face-up position for several days, the adhesion between the iris and cornea may not restore the anterior chamber. In such cases, surgical intervention is required - deepening of the anterior chamber through the flat part of the ciliary body.

Pupil blockage can also occur when silicone oil is used for tamponade of the vitreal cavity, and in this case, the complication is also associated with a violation of the regimen.

Neovascular glaucoma. Neovascular glaucoma usually occurs after PDR surgery and is associated with vascular growth in the trabecular zone. This complication is characterized by a progressive and poorly controlled increase in IOP. The situation can be improved by panretinal laser coagulation. A decrease in the vasoproliferative factor can stop the growth of new vessels and even lead to their involution. It is advisable to perform anti-inflammatory therapy.

In the initial stages, you can get a decrease in IOP with the use of local antiglaucoma drugs (pilocarpine, timolol, xalatan, trusopt). Diacarb in diabetic patients should be used with caution and only in exceptional cases.

If medical treatment is ineffective, laser trabeculoplasty, non-penetrating deep sclerectomy, endocyclocoagulation, or cryocyclopexy should be used.

Steroid glaucoma. In some patients, corticosteroid drugs must be prescribed for a sufficiently long period. Long-term use of steroids often leads to an increase in IOP. Tonometric control in such patients should be systematic. The abolition of steroid therapy, as a rule, contributes to the normalization of IOP. In cases where it is impossible to cancel corticosteroids, antiglaucoma treatment should be carried out simultaneously with their use. Usually, instillations of ?-blockers are sufficient to control IOP, but sometimes the use of xalatan or a combination of xalatan with ?-blockers is required.

Cataract

The development of cataracts in the early postoperative period may be associated with damage to the posterior capsule during surgery. Injury to the lens can occur with the end of a sutured infusion cannula in case of accidental severe hypotension. When working at the extreme periphery, the instruments pass in close proximity to the posterior pole of the lens and can injure the posterior capsule. Small damage to the capsule may go unnoticed during surgery and lead to cataracts in the postoperative period.

The most common cause of cataract development is prolonged contact of the capsule with plugging agents(fluorine gases, PFOS, silicone). When using PFOS and gases, cataracts can occur if the patient did not follow the postoperative regimen. In cases where the patient observed the prescribed position and there was no prolonged contact with the posterior capsule, cataracts, as a rule, do not develop.

It is much more difficult to prevent contact if prolonged silicone tamponade is used. If the silicone is removed when slight opacities appear on the posterior capsule, they may gradually resolve. It is advisable for such patients to prescribe drops that prevent the development of cataracts (taufon, vitaiodurol, vitafakol, quinax, catalin, etc.).

In cases where the removal of silicone oil will inevitably lead to a recurrence of retinal detachment, lens opacity increases, it is necessary to plan cataract removal with IOL implantation. The limbal route should be used using small incision techniques and IOL implantation in the capsular bag.

Retinal complications

Retinal disinsertion. Retinal tears during vitrectomy occur mainly as a result of traction from the CT. Traction can already occur during the insertion of the instruments, so the movement of the instruments prior to the start of excision should be kept to a minimum. Increased tension on the CT can be caused by overactive, excessive aspiration, which is especially dangerous when working close to the retina. The cause of the rupture is the direct contact of the instrument with the retina. A sewn infusion cannula, when the eyeball is turned upwards, can bend under the action of the upper eyelid, and its end will injure the retina.

Tears and tears of the retina may not be noticed during the operation, especially if they are small and located on the periphery. OS associated with such ruptures occur in the early postoperative period. In later periods, ruptures occur as a result of the development of PVR. Proliferation in the postoperative period most often occurs along the surface of the retina, the resulting ERM can cause significant tangential traction, leading to retinal breaks. OS after vitrectomy develops very quickly, within a few days it can become total, vesicular and tends to take on a funnel-shaped configuration in a short time.

Treatment of such detachments requires removal of ERM, introduction of PFOS, ELS and replacement of PFOS with gas or silicone. The operation can be supplemented with local filling of the rupture zone and transscleral cryocoagulation.

macular edema. Edema of the macular zone of the retina can complicate the course of the postoperative period and cause a significant decrease in visual acuity. Quite quickly, if left untreated, edema can turn into a cystic form, and then into macular degeneration.

Timely administration of corticosteroids (dexamethasone) in the form of subconjunctival injections usually gives a positive effect. In some cases, transpupillary barrier laser coagulation of the macular zone is required.

Vascular occlusion. A significant prolonged rise in IOP during surgery or in the postoperative period can lead to occlusion of retinal vessels and complete loss of vision. This formidable complication is easier to prevent than to cure. Mandatory systematic monitoring of the state of ophthalmotonus should be carried out both during the operation and in the postoperative period. It is also necessary to constantly check visual functions. In all cases of increased IOP, the most decisive measures must be taken to reduce it, regardless of the time of day.

Conducting operations strictly according to indications and at optimal times, adequate preparation of patients, accurate surgical technique and constant monitoring of the condition of the operated eye can significantly reduce the number of complications. Timely detection of complications, active medical and surgical tactics for their treatment make it possible to minimize their negative impact and increase the effectiveness of vitreoretinal interventions.

Article from the book: .

The invention relates to medicine, namely to ophthalmology, and can be used to prevent the release of silicone into the anterior chamber of the eye when replacing liquid perfluoroorganic compound (PFOS) with light silicone in aphakia during surgical treatment of retinal detachment. Before the operation, the length of the eye is measured and the maximum allowable pupil diameter is calculated, at which the light silicone will not escape into the anterior chamber. During the operation, the pupil diameter is measured immediately before the replacement of PFOS with light silicone, and if the pupil diameter is found to exceed the calculated value, then the pupil is constricted with medication to a value not exceeding the calculated value. The method allows to create an effective way to prevent the release of silicone into the anterior chamber of the eye when replacing PFOS with light silicone in aphakia.

(56) (continued):

CLASS="b560m" of the vitreal cavity with silicone oil (preliminary communication). - Ophthalmosurgery, 2005, No. 4, pp. 28-32. M. L. Krasnov, B. C. Belyaev Guide to eye surgery. - M., 1988. pp. 416-419.

The invention relates to medicine, namely to ophthalmology, and can be used to prevent the release of silicone into the anterior chamber of the eye when replacing liquid perfluoroorganic compound (PFOS) with light silicone in aphakia during surgical treatment of retinal detachment.

The authors are not aware of a way to prevent the release of silicone into the anterior chamber of the eye when replacing PFOS with silicone in aphakia during surgery using tamponade of the vitreal cavity with light silicone (silicone oil, density less than 1 g/cm3).

The objective of the invention is to provide an effective method for preventing the release of silicone into the anterior chamber of the eye when replacing PFOS with light silicone in aphakia.

The technical result, according to the invention, is achieved by the fact that in the method of preventing the release of silicone into the anterior chamber of the eye when replacing PFOS with light silicone in aphakia, before surgery, the length of the eye is measured and the maximum allowable pupil diameter is calculated, at which there will be no exit of light silicone into the anterior chamber, according to the formula:

where:

L - eye length, mm;

Sil - viscosity of light silicone, cSt,

It is known that lightweight silicone is the most versatile and frequently used substance for long-term tamponade of the vitreal cavity in the treatment of retinal detachment by subtotal vitrectomy (Takhchidi Kh.P., Kazaikin V.N., Rappoport A.A. Completion of tamponade of the vitreal cavity with silicone oil in the treatment retinal detachment // Ophthalmosurgery. - 2005. - No. 4. - P. 28-32, Sell C.H., McCuen B.W., Landers M.B., Machemer R. Long-term results of successful vitrectomy with silicone oil for advanced proliferative vitreoretinopathy // Amer. J. of Ophthalmol.-1987.-Vol.103.-P.24-286).

It is known that when the vitreal cavity is tamponade with light silicone and concomitant aphakia, one of the main complications of the operation and the postoperative period is the migration of silicone into the anterior chamber of the eye. The release of silicone causes blockage of the anterior chamber angle and the development of secondary uncompensated glaucoma, the presence of silicone in the anterior chamber for more than one month leads to the development of band-shaped corneal dystrophy (Gao RL, Neubauer L, Tang S, Kampik A. Silicone oil in the anterior chamber // Graefes Arch Clin Exp Ophthalmol - 1989 - Vol.227(2) - P.106-9).

The absence of a lens diaphragm and the patient's face-up position create potential conditions for silicone migration into the anterior chamber: under the action of the Archimedes force, light silicone tends to reach the highest position and migrates into the anterior chamber through the pupil. The release of silicone can occur both during the operation and in the postoperative period. The release of silicone into the anterior chamber during the operation will require additional surgical intervention to remove it from the anterior chamber, which, consequently, will lead to an increase in the duration of the operation and may be the cause of more pronounced inflammation and transient ophthalmohypertension after the operation.

We operated on 17 patients (20 eyes) for retinal detachment in aphakic eyes using light silicone replacement for PFOS. In 13 patients, during the replacement of PFOS with lightweight silicone, no leakage of lightweight silicone into the anterior chamber was observed. 4 patients experienced partial release of silicone into the anterior chamber at the end of PFOS-to-silicone replacement, and therefore, in order to prevent further release of silicone, each patient was instilled with miotic solution (acetylcholine solution), and each patient was transferred to the prone position immediately after surgery .

During the operations, a causal relationship was revealed between the diameter of the pupil before the replacement of PFOS with lightweight silicone and the release of silicone into the anterior chamber.

In order to determine the maximum allowable pupil diameter, at which light silicone will not escape into the anterior chamber during the replacement of PFOS with light silicone in aphakia, we developed a mathematical formula for calculating the pupil diameter before surgery.

The method is carried out as follows. Preoperative standard patient preparation for retinal detachment includes drug-induced pupil dilation, which may decrease during the operation, but not always to a size that prevents silicone from escaping into the anterior chamber. Therefore, before the operation, according to the invention, the length of the eye is determined and the maximum allowable pupil diameter is calculated when replacing PFOS with lightweight silicone according to the formula:

where: D is the maximum pupil diameter before replacing PFOS with lightweight silicone, mm;

L - eye length, mm;

Force - surface tension force of light silicone at the border with water, dyne/cm;

Strength - the density of light silicone, g / cm 3;

Force - viscosity of light silicone, cSt.

Vitrectomy is performed according to standard technology. To straighten the retina and adapt it, PFOS is injected, after which laser coagulation of the retina is performed. Before replacing PFOS with lightweight silicone, under ophthalmoscopic control, the pupil diameter is measured using an ophthalmic surgical compass, and if during the measurement it is detected that the pupil diameter exceeds the calculated one, then the pupil is narrowed medically to a diameter not exceeding the calculated one. Next, proceed to the direct replacement of PFOS with lightweight silicone.

According to the invention, 10 patients (10 eyes) were operated on with a positive result: during the operation, no release of light silicone into the anterior chamber was observed in any patient.

Patient K., 65 years old

Diagnosis: OD - total rhegmatogenous retinal detachment with macular hole, proliferative vitreoretinopathy (PVR) stage B-C1, postoperative aphakia, high myopia.

Status: the cornea is transparent, the anterior chamber is 3.5 mm, the iris is subatrophic, the pupil is round, drug-induced mydriasis is 6 mm, the lens is absent, there is turbidity in the vitreous body, subtotal retinal detachment with a rupture in the macula is determined in the fundus, partial reattachment from 15 to 16 hours .

According to the B-scan - subtotal funnel-shaped retinal detachment up to 11.5 mm high, floaters in the vitreous body, posterior vitreous detachment.

Before surgery: visual acuity OD = light perception with incorrect light projection, intraocular pressure (IOP) OD=15 mm Hg, echobiometry OD - 29.58 mm.

Before the operation, using the formula, we calculate the pupil diameter, the maximum allowable to prevent silicone from escaping into the anterior chamber:

D is the maximum allowable pupil diameter before replacing PFOS with lightweight silicone, mm;

L - 29.58, mm;

Force - 44.9, dyne/cm;

Strength - 0.98, g / cm 3;

Strength - 5700, cSt.

The operation was performed: subtotal vitrectomy, PFOS injection, endolaser coagulation of the retina, before replacing PFOS with light silicone, the pupil diameter was measured to be 4.5 mm, which turned out to be less than the calculated one, PFOS was replaced with light silicone, drug constriction of the pupil was not performed.

On examination 1 month after surgery, visual acuity is 0.02 with sph+3.0=0.2 no longer corrects (n/a), IOP=25 mm Hg, cornea is transparent, anterior chamber is 3 mm, pupil is round , pupil diameter 4.5 mm, reaction to light is weakened, silicone fills the vitreous cavity, the retina is adjacent throughout.

6 months after the operation, silicone was in the vitreal cavity, the cornea was transparent, the anterior chamber was 3 mm, the retina was adjacent throughout, IOP was 23 mm Hg, the silicone was removed.

Patient V., 40 years old

Diagnosis: OD - subtotal rhegmatogenous retinal detachment with detachment from the dentate line, PVR stage B, postoperative aphakia, high myopia.

Before surgery: visual acuity = 0.01 n/a, IOP=24 mm Hg.

Status: transparent cornea, anterior chamber 2.5 mm, structural iris, round pupil, drug-induced mydriasis 5.5 mm, lens absent, turbidity in the vitreous body, ligaments fixed to the retina in the area of ​​detachment, retinal detachment with detachment is determined in the fundus from 9:00 to 13:30 and retinal inversion, the macular area is detached.

According to the B-scan - subtotal retinal detachment up to 5.7 mm high, with a giant separation in the upper segment, mooring, fixed to the retina.

Before the operation, using the formula, we calculate the maximum allowable pupil diameter to prevent the release of light silicone into the anterior chamber:

D is the maximum allowable pupil diameter before replacing PFOS with lightweight silicone, mm;

L - 32.04, mm;

Force - 44.9, dyne/cm;

Strength - 0.98, g / cm 3;

Strength - 5700, cSt.

The operation was performed: subtotal vitrectomy, schwartectomy, the introduction of PFOS, endolaser coagulation of the retina, before replacing PFOS with light silicone, the pupil diameter of 5.0 mm was measured, which turned out to be larger than the calculated one. A medicated pupil constriction to 4.0 mm was performed, after which PFOS was replaced with lightweight silicone. The next day after the operation, the cornea is transparent, the anterior chamber is 3 mm, the pupil diameter is 3 mm, silicone is in the vitreal cavity.

When viewed 1 month after the operation, visual acuity was 0.03 с sph - 7.0 D cyl - 2.0 D x 140=0.1 n/k, intraocular pressure 26 mm Hg, transparent cornea, anterior chamber 3 mm, the pupil is round, the pupil diameter is 3 mm, the reaction to light is weakened, the silicone fills the vitreal cavity, the retina is adjacent throughout.

2 months after the operation, silicone was in the vitreal cavity, the cornea was transparent, the anterior chamber was 3 mm, the retina was adjacent throughout, IOP was 26 mm Hg. The silicone has been removed.

CLAIM

A method for preventing the release of light silicone into the anterior chamber of the eye when replacing a liquid perfluoroorganic compound (PFOS) with a light silicone in aphakia, characterized in that the length of the eye is measured before the operation and the maximum allowable pupil diameter is calculated, at which the light silicone will not escape into the anterior chamber , according to the formula:

Sil - viscosity of silicone oil, cSt,

then, during the operation, the pupil diameter is measured immediately before the replacement of PFOS with light silicone, and if the pupil diameter is found to exceed the calculated value, then the pupil is narrowed medically to a diameter not exceeding the calculated value.