and Mitrofanis Pavlidis2
(1)
Department of Ophthalmology, Uppsala University Hospital, Uppsala, Sweden
(2)
Augencentrum Köln, Cologne, Germany
15.1.1 Primary Retinal Detachment
15.1.2 PVR Detachment
15.1.3 Diabetes
15.1.4 Macular Hole
15.3.1 Introduction
15.4.1 Introduction
15.4.2 Surgery
Electronic supplementary material
The online version of this chapter (doi:10.1007/978-3-319-20236-5_15) contains supplementary material, which is available to authorized users.
Electronic supplementary material
for this chapter is accessible online at http://extras.springer.com/ by searching via the ISBN.
The surgical method of choice regarding silicone oil exchange is the injection of silicone oil into an air-filled eye. This applies for light and heavy silicone oil. The injection of silicone oil into a PFC-filled eye is also possible but technically more difficult. This applies for light and heavy silicone oil. Also heavy silicone oil can be exchanged with PFC. The risk that heavy silicone oil and PFCL will blend during the short exchange time is low, and both fluid phases can be well distinguished.
15.1 Different Indications, Different Methods
Each pathology requires a different approach to inject the silicone oil.
15.1.1 Primary Retinal Detachment
1.
Air against light silicone oil exchange
15.1.2 PVR Detachment
1.
Air against light silicone oil exchange
2.
PFCL against light silicone oil exchange
3.
Air against Densiron 68 exchange
4.
PFCL against Densiron 68 exchange
15.1.3 Diabetes
1.
Air against light silicone oil exchange
15.1.4 Macular Hole
1.
Air against light silicone oil exchange
15.2 Duration of Silicone Oil Tamponade
Duration of light silicone oil tamponade:
-
Retinal detachment: 6 weeks
-
Diabetic retinopathy: 2–3 months
-
Macular hole: 4–6 weeks
Duration of heavy silicone oil tamponade:
-
Inferior detachment: 6 weeks
-
Macular hole: 4–6 weeks
15.3 Air Against Light and Heavy Silicone Oil Exchange
-
Video 15.1: 27G silicone oil injection
15.3.1 Introduction
We use predominantly 1000 or 1300 cSt silicone oil. Earlier on, we used 5000 cSt silicone oil, but we switched almost completely to 1000/1300 cSt silicone oil. We reserve 5000 cSt silicone oil for cases which require silicone oil for a long time such as recurrent detachments or hypotony eyes. Apart of these rare cases, we use 1000/1300 cSt silicone oil for all pathologies. We remove the oil after 6 weeks in detachments and after 3 months in diabetics. There are no problems with emulsification.
Silicone oil injection with 27G is technically no problem. A 27G polyamide cannula (DORC) is available (Fig. 15.1a). The injection, however, takes approximately 10–15 min. It may therefore be advisable to use a 25G cannula instead (Fig. 15.1b).
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