Silicone oil tamponade

Table 4. Heavier than water silicone oil tamponades...

If the intra-operative use of PFCL is followed by a silicone oil tamponade and residual PFCL is still present (up to 3 months) during the removal of silicone oil, then sticky behaviour of the silicone oil can be promoted [40]. 

No serious systemic or ocular complications were observed, and retinal reattachment was achieved in 60% of patients postoperatively. The number of patients studied was small. However, the authors believed this therapy resulted in an improved success rate compared with other studies of the reattachment rate following surgery for advanced PVR without use of silicone oil and that the reattachment rate was comparable with the reattachment rate achieved in studies using silicone oil tamponade (47). 

Figure 4 (A) The reflection of silicone oil is noted in the posterior pole in. (A, B) Silicone oil tamponade was used for CMV-related retinal detachment repair and a ganciclovir implant was used to treat active CMV retinitis. The object noted inferotemporally is the ganciclovir implant as visualized when the camera is focused posteriorly on the retina. Abbreviation CMV, cytomegalovirus.

Rivas S, Pandya AG. Treatment of melasma with topical agents, peels, and lasers an evidence-based review. Am J Clin Derm 2013 14(5) 359-76. Le Q, Wang X, Lv L, Sun X, Xu J. In vivo laser scanning confocal microscopy of the cornea in patients with silicone oil tamponade after vitreoretinal surgery. Cornea 2012 31(8) 876-82. 

In the 60s, Cibis [13,14] introduced silicone oil injection in non-vitrectomied eyes. Then, Haut combined silicone oil with pars plana vitrectomy [15]. The technique was later refined by Zivojnovic [16]. Silicone oil was then used as a means of permanent internal tamponade. It was only in 1983 that Gonvers used silicone oil as a means for temporary internal tamponade [17]. 

Unlike gases, silicone oil permits prolonged internal tamponade with a constant volume. The absence of spontaneous resorption requires a second surgical operation to remove it. Its effectiveness in the surgical treatment of RD and... 

More recently, other heavier than water products have been developed for temporary internal tamponade. These are fluorosilicones [46,47], semifluorinated alkanes [1,7], heavy fluorocarbon liquid (HFCL) oligomers [5,7] and solutions of fluorine-containing compound and silicone oil [8-10,47],... 

It is noteworthy that this formulation is different from fluorosilicones. Fluorosili-cones are fluorine-containing silicone oils with a 1.35 g/cm density. Their poor tolerance in animals and men was demonstrated by experimental studies [45,46] ocular hypertonia, keratopathy, early emulsification and severe inflammatory reactions. They cannot therefore be used as a heavy internal tamponade product. 

Fig. 4. Experimental study of RMN3-silicone oil mixture in rabbits (electron microscopy after 1-month internal tamponade with heavy silicone oil) (a) moderate intercellular oedema between photoreceptor external articles note the presence of a mundane vesicle (b) normal aspect of retina internal layers and (c) normal aspect of internal limiting layer and vitreous cavity.

On the basis of the results, it appears that heavy silicone oil Oxane Hd , the first formulation of this type on the market, as a temporary internal tamponade is equally tolerated as standard silicone oil in the surgical treatment of complex retinal detachment. It does not pose any emulsification or major fragmentation problem, as encountered with other heavier than water products. Its effectiveness on inferior and posterior dehiscence tamponade appears to be very effective to currently available anatomical results. Oxane Hd , moreover, presents in this context a real benefit in the treatment of complex retinal detachment [48]. Retinopexy quality and the absence of residual subretinal fluid in internal tamponade of inferior lesions, extensive inferior retinectomies in particular, may reduce the risk of recurrence of complex retinal detachment by PVR. More extensive studies are now in course to see the limits of Oxane Hd in comparison with new analogues such as Densiron 68 , which has been marketed recently. 

S. Wolf, V. Schdn, P. Meier, P. Wiedemann, Silicone oil-RMN3 mixture ( heavy silicone oil ) as internal tamponade for complicated retinal detachment, Retina 23 (2003) 335-342. 

V. Pagot-Mathis, X. Benouaich, A. Mathis, I. Rico-Lattes, A. Dumoulin, Management of complicated retinal detachment using a heavy silicon oil as temporary tamponade, J. Fr. Ophthalmol. 29 (2006) 137-145. 

They could not replace the PFCL in interoperative use because their performance was not better than that of PFCLs, and they were more expensive. The hydrodynamic force and, consequently, the tamponade effect are limited by the reduced density. Possibly, they will find a niche in special applications in which the different shape of the droplet, in comparison to PFCLs, may support special manoeuvres or processes in which their higher potential to dissolve substances is needed (removal of silicone oil remnants). Especially the expectations for a better long-term tolerance have not been fulfilled. 

Surgery is the primary form of therapy used to manage eyes with retinal detachment and PVR. Epiretinal and occasionally subretinal membranes (Fig. 3) are removed to release retinal traction, followed by reattachment and tamponade with either gas or silicone oil. In a multicenter randomized clinical trial of 340 eyes with... 

Silicone oU has had extensive use for long-term tamponade of the retina. Complications from silicone oil use include glaucoma, cataract formation, corneal edema, corneal band keratopathy, and retinal toxicity. 

M. Doi, M.F. Refojo, Flistopathology of rabbit eyes with silicone-fluorosilicone copolymer oil as six months internal retinal tamponade, Exp. Eye Res. 61 (1995) 469-478. 

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