Combined removal of silicone oil plus internal search (ROSO-plus) following retinal detachment surgery

Abstract

Purpose To report the rate of retinal redetachment and intervention with combined removal of silicone oil plus internal search (ROSOplus) and to report the pathology identified. Methods Preoperative and peroperative findings were related to postoperative failure of the surgery defined as retinal redetachment postoperatively or silicone oil in situ at the final follow-up. Results Sixty-three patients were included in the study. Mean follow-up was 13 months. Retinopexy and further tamponade were used in 22 patients. Overall 'ROSO-plus' failed in 13 (21%) patients. Patients with subretinal fluid (SRF) in the inferior quadrants of the fundus during 'ROSO-plus' were particularly at risk of failure at 86% (six of seven patients) vs 12.5% (7/56) for the remainder (P ¼ 0.0002, relative risk ¼ 6.9, 95% confidence interval 3.2-14.6). The overall success rate at final follow-up (after any further surgery) for a flat retina without oil in situ was 83%. Conclusion The 'ROSO-plus' procedure allowed identification of problems expected to result in anatomical failure. Treatment did not prevent a high rate of postoperative retinal detachment. Refinement of the treatment algorithm is required with perhaps more use of silicone oil reinsertion in high-risk eyes.

Combined phacoemulsification and transpupillary removal of heavy silicone oil

“…It is a mixture of liquid semifluorinated alkane perfluorohexyloctane (F6H8) and silicone oil and has a specific gravity of 1.06g/cm 3 (compared with 1.00g/cm 3 for water and 0.97g/cm 3 for silicone oil) and a viscosity of 1400 mPas. 10 Being heavier than water, it has to be actively aspirated from the vitreous cavity in contradistinction to standard silicone, which can be ''floated'' out. Because of the high viscosity, this is best accomplished using an automated viscous fluid removal system.…”

Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment

“…With the currently used tamponades such as intraocular gas (C 3 F 8 ) and silicone oil or newer agents, recurrent RD occurs in view of inadequate, inferior retinal support. [ 1 2 3 4 5 6 7 8 ] The above-described sandwich technique leads to the formation of two bubbles – gas bubble superiorly and silicone oil inferiorly. This technique will essentially provide support to both superior and inferior retina, unlike conventional silicone oil and gas tamponades which predominantly provide support to the superior retina only.…”

“…Therefore, the inferior retina is poorly supported by these tamponading agents and is more prone to the development of proliferative vitreoretinopathy (PVR) changes. [ 3 4 ]…”