Dr. Avnindra Gupta, G06870, Dr. Dinesh Talwar, Dr. Lalit Verma, Dr. Ritesh Narula
Aim – To evaluate the efficacy and safety of silicone oil barrier sutures in aphakic eyes with traumatic aniridia with retinal detachment.
METHODS:
5 patients of traumatic Aniridia with retinal detachment underwent pars plana vitrectomy. Silicone oil retention sutures were placed in grid fashion leaving the central 5mm with 10 .0 mersiline sutures
RESULTS:
The mean follow-up time after silicone oil barrier suture operations was 8.0 ±2.8 months. UBM studies and slit lamp examination showed silicone oil behind the silicone oil retention sutures in four patients (80%) Silicone oil was present in the anterior chamber in 1 eyes (20%) at the last visit. Migration of silicone oil in AC was attributed to Anterior PVR changes in these eye
CONCLUSION:
In this study, silicone oil retention sutures were proven to be safe and effective in preventing silicone oil-corneal endothelium touch in aphakic eyes with iris defects,
Silicone oil is toxic to the corneal endothelium, and with prolonged contact, the cornea can lead to severe edema and/or band keratopathy. Silicone Oil in AC will also cause secondary glaucoma In aphakic patient inferior iridectomy allows aqueous to enter the anterior chamber and prevents SO from touching the cornea and pupillary block. This procedure requires the presence of an intact iris diaphragm . In cases of traumatic Aniridia with complex retinal detachment, silicone injection is a challenge and is a relative contradiction
Method
We Created a grid with 10.0 prolene sutures to prevent the migration of silicone oil in Anterior Chamber. Patients underwent pars plana vitrectomy. Silicone oil retention sutures were placed in grid fashion leaving the central 5mm zone.10.0 Mersiline sutures on STC-6 needle was taken . Sutures were passed 1mm behind the limbus and were exited from opposite side. In this fashion a grid of sutures were made in horizontal and vertical fashion. Sutures were removed at the time of Silicone oil removal
Results
The mean follow-up time after silicone oil Retention suture operations was 8.0 ±2.8 months. UBM studies and slit lamp examination showed silicone oil behind the silicone oil retention sutures in four patients (80%) Silicone oil was present in the anterior chamber in 1 eyes (20%) at the last visit. Migration of silicone oil in AC occurred after 6 weeks of surgery and was attributed to Anterior PVR changes and early band shaped keratopathy
Discussion
Silicone oil is toxic to the corneal endothelium, and with prolonged contact, the cornea can lead to severe edema and/or band keratopathy. Silicone Oil in AC will also cause secondary glaucoma. In aphakic patient inferior iridectomy allows aqueous to enter the anterior chamber and prevents SO from touching the cornea and pupillary block. This procedure requires the presence of an intact iris diaphragm. In cases of traumatic Aniridia with complex retinal detachment, silicone injection is a challenge and is a relative contradiction
As demonstrated in our cases, SO retention sutures offer a method to prevent SO from entering the anterior chamber and touching the corneal endothelium in eyes with iris loss. The surface tension of SO in water, also called the silicone oil/water interface surface tension, is considered high (50 erg/cm2), although not as high as the gas/water interface surface tension (70 erg/cm2). The sutures take advantage of the high SO-aqueous interface surface tension. This interfacial tension, a result of both van der Waals and polar bonding forces, helps SO maintain a spheroidal shape in the eye. These forces are not only able to prevent the suture from breaking the surface of the silicone globule but are strong enough to overcome the low buoyancy force of the SO. This phenomenon was demonstrated by ultrasound biomicroscopic images of our patients in the supine position. The sutures enhance the natural barrier that exists between the oil and the aqueous. Because the sutures rely on an intact SO-aqueous interface, success in using this technique would not be expected in an eye with an overfill of SO and/or inadequate aqueous production (ie, hypotony).
Conclusion
With this new technique oil remained away from the cornea behind the prolene suture mess thus preventing the above complication of silicone oil keratopathy and secondary glaucoma
In our series of 5 patients we were able to prevent migration of silicone oil in to the anterior segment by maintaining the the meniscus of SO due to its surface tension. Late migration occurred in one case because of anterior PVR and subsequent hypotony
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