How to remove silicone oil from the eye. Restoration of vision after removal of silicone oil

More than half of the volume. Vicctomy involves its complete or partial removal.

It is performed under general anesthesia and has the following indications:

• severe infection inside the eye;
• organ;
• turbidity vitreous;
• dislocation.

During the operation, the doctor makes three small incisions in the eye into which the instruments are inserted. Then the vitreous body is sucked off with a vacuum and the blood with scars is removed. The transparent mass is replaced with silicone oil, sterile air with gas or organofluorine.

There are 2 types of surgery:

1. Total.
2. Subtotal (content eyeball is not completely removed).

The latter type is divided into two more subspecies. Vitrectomy is:

1. Back... It is performed in case of pathology of the posterior segment.
2. Front... In this case, the vitreous body enters the anterior chamber of the eye as a result of lens problems, injury, or.

Variety surgical intervention is an microinvasive vitrectomy ... It is carried out with the help of tools small size, which are inserted into micro-punctures.

This operation has many advantages, including:

• short rehabilitation period;
• low level of trauma;
• reduced risk of bleeding;
• optional hospitalization.

The success of the procedure depends on the skill of the surgeon and the availability of special instruments.

Video:

Price

You will have to pay a lot for the operation. This manipulation is carried out only in large eye centers that have all the necessary equipment. There are not very many such clinics in Russia.

Only experienced vitreoretinal surgeons perform vitrectomy.

The cost of the operation starts from 20 thousand rubles and comes up to 100 thousand rubles .

It depends on several parameters:

• type of surgical intervention;
• difficulty category;
• type of anesthesia;
• surgeon qualification;
• region.

So, anterior vitrectomy 1 category complexity will cost about 20 thousand rubles, and the same operation, but already 2 categories complexity - 25 thousand rubles. Surgical intervention for complicated conditions the highest category costs about 100 thousand rubles.

In each case, the price will be different. It can only be fully determined by a doctor and an anesthesiologist after an examination.

Postoperative period

Usually, after the operation, the patient stays in the hospital for no more than 3 days.

After the procedure, the doctor covers the eye with a bandage to protect it from dirt. It must be removed the next morning and carefully treated with a sterile swab, which is pre-moistened in an aqueous solution of an antibacterial drug.

Recovery speed depends on several factors:

• the presence of serious illnesses;
• condition cranial nerves;
• the ability to perceive objects.

In the case of replacing the vitreous with saline solution clouding of the eye persists for several weeks. In the presence of a gas mixture, a black film appears, which disappears after a week.

After the operation, it is prohibited for six months:

• read for more than half an hour;
• lift objects over 2 kg;
• stand leaning over the fire;
• engage in active sports;
• drive;
• rubbing or pressing on an eye;
• look at UV rays;
• skip a doctor's appointment;
• ignore the doctor's recommendations.

No special diet is required after vitrectomy. When washing your face, avoid getting soap and water in your eyes. It is better to wash your head tilting back. If water gets into the healing organ of vision, rinse it aqueous solution 0.02% furacilin.

Some complications may arise after the operation:

• peeling of the inner shell;
• an infection inside the eye;
• cataract;
• swelling of the outer shell of the eye;
• glaucoma;
• the ingress of blood into the vitreous body;
• macular;
• increase.

You can avoid negative consequences if you carefully prepare for the operation and carry out a high-quality one before vitrectomy.

In any case, delayed treatment causes irreversible consequences, a rehabilitation period drags on.

Holders of the patent RU 2478354:

The invention relates to medicine, namely to ophthalmology, and can be used to remove silicone oil from the eye cavity. After performing local anesthesia, performing 3 transconjunctival scleral punctures and installing 25G ports in them through the irrigation port, saline is injected using the Assistant ophthalmic surgical system in the mode of silicone injection under a controlled pressure of no more than 1 bar. Saline displaces the silicone oil, which exits through free ports. After removing the silicone oil, a light guide is inserted to inspect the vitreous cavity, after which the ports are removed. The method makes it possible to increase the efficiency of performing the stage of vitreoretinal surgery, first of all, due to the use of 25G ports for the aspiration-irrigation system and the light guide, which is necessary and must be installed in vitreoretinal surgery; no stitching is required when using 25G ports, which significantly reduces trauma surgical intervention, and due to the use of the proposed method, the time for replacing the silicone oil with physiological solution is significantly reduced and averages from 3 to 10 minutes, depending on the volume of the vitreous cavity and the viscosity of the silicone. 1 ex.

The invention relates to medicine, namely to ophthalmology, and can be used to remove silicone oil from the eye cavity.

There is a known method of removing silicone oil from the eye cavity (see the User's Guide for the MILLENNIUM microsurgical system from BAUSCH & LOMB, pp. 4-124-4-125) using the Millenium microsurgical systems, Assistant, which consists in aspiration of silicone oil through a 19G cannula and replacing it saline. To implement this method at least one incision of the conjunctiva and sclera is required to accommodate the 19G suction cannula. At the end of the operation, it is necessary to suture the scleral and conjunctival incisions. In addition, the silicone removal time is about 50 minutes.

With the general desire of ophthalmologists to perform incisions without suturing in this known device, the invasiveness of surgical intervention is increased due to the incisions requiring suturing due to the use of the 19G cannula. The duration of the surgical intervention to remove silicone also refers to the disadvantages of the known operation, since the longer the operation time, the more the patient needs anesthesia, the likelihood increases postoperative complications, the risk of violations increases metabolic processes in the structures of the eye.

There is a known method for removing silicone oil from the eye cavity, widely used in ophthalmic practice, which consists in carrying out anesthesia, connecting an aspiration-irrigation system, for which 3 transconjunctival scleral punctures are performed with the installation of 25G ports in them for a light guide and irrigation and replacement of silicone oil with saline after deleting it. The container with the saline solution is placed above the area of ​​the surgical intervention, and under the action of the natural pressure of the solution, silicone oil is displaced from the eye cavity and, accordingly, the silicone oil is completely replaced with saline.

However, the effectiveness of this method is extremely low, since the complete replacement of silicone oil, especially with a viscosity of 5000 cSt, 5700 cSt, with saline occurs over a long period of time. At the same time, the time of surgical intervention increases, which is extremely undesirable for the patient and the likelihood of possible complications v postoperative period.

The proposed invention solves the problem of developing a new method for removing silicone oil from the eye cavity. The resulting technical result consists in increasing the efficiency of the vitreoretinal surgery stage, primarily through the use of 25G ports for the aspiration-irrigation system and the light guide, which is necessary and must be installed in vitreoretinal surgery. When using 25G ports, no suturing is required, which significantly reduces the invasiveness of surgery. In addition, due to the use of our proposed method, the time for replacing silicone oil with saline is significantly reduced and averages from 3 to 10 minutes, depending on the volume of the vitreous cavity and the viscosity of the silicone.

The specified technical result is achieved by the fact that in the method of removing silicone oil from the eye cavity, which consists in carrying out anesthesia, connecting the aspiration-irrigation system, for which 3 transconjunctival scleral punctures are performed with the installation of 25G ports for the light guide and irrigation and replacement of the silicone oil with saline after its removal, through the port for irrigation, physiological solution is injected under a controlled pressure of not more than 1 bar, which displaces the silicone oil through the free ports.

The method for removing silicone oil from the eye cavity is as follows.

After local anesthesia and treatment of the operating field, 3 transconjunctival scleral punctures are performed 4 mm from the limbus in 3 meridians (for example) at 2, 10 and 11 hours. They are equipped with 25 G ports for light guide, irrigation and replacement of silicone oil with saline after its removal. Through the port for irrigation at 2 o'clock, physiological solution is injected using the Millenium ophthalmic surgical system, Assistant in the mode of silicone injection under a controlled pressure of not more than 1 bar. Saline displaces silicone oil, which exits through free ports at 10 and 11 o'clock due to the creation of increased intraocular pressure. After removing the silicone oil, a light guide is inserted through the port at 11 o'clock to inspect the vitreous cavity, after which the ports are removed. Sclera and conjunctiva sutures are not required.

Clinical example: patient K., born in 1961, no. To. 316123, No. and.b. 19913,

Ds .: OD - operated retinal detachment, condition after subtotal vitrectomy, silicone in the vitreous cavity, myopia high degree, initial cataract, condition after laser coagulation of the retina,

OS - high myopia, complex myopic astigmatism.

On June 1, 2011, an operation was performed for OD retinal detachment. Operative treatment was carried out in 2 stages: stage 1: circling + subtotal vitrectomy + introduction of PFOS + ELA, after 10 days stage 2: removal of PFOS, silicone tamponade (Oxane silicone oil with a viscosity of 1300 cSt). An additional restrictive laser coagulation of the OS retina was performed 1 month after stage 2. On September 15, 2011, an operation was performed on OD to remove silicone oil.

The course of the operation to remove silicone oil: treatment of the skin of the eyelids with a disinfectant and the surgical field with 1% betadine solution, 0.9% sodium chloride solution, 0.5% ophthaquix. Local anesthesia: epibulbar (0.5% alkaine solution) - 3 times. The operating field was covered with an ophthalmic napkin with a pocket and a sticky layer. Imposed a blepharostat. Performed 3 transconjunctival scleral punctures 4 mm from the limbus in 3 meridians at 2, 10 and 11 hours. Introduced ports 25G. At 2 o'clock, physiological saline was injected through the port using the Assistant ophthalmic surgical system in the mode of silicone injection under a controlled pressure of no more than 1 bar. With the help of physiological solution, silicone oil was displaced through the free ports at 10 and 11 o'clock due to the creation of increased intraocular pressure. It took 10 ml of saline to remove the silicone. The silicone was removed in 5 minutes. After removing the silicone oil through the port at 11 o'clock, a light guide was introduced to inspect the vitreous cavity, a silicone was placed on the cornea contact lens... The vitreous cavity was examined. The retina is attached to all departments. There is no hemophthalmos. The light guide was taken out. The ports were removed. Casing penetrations are self-sealing. Sclera and conjunctiva sutures are not required. Subconjunctival injection of dexazone 2 mg and ceftazidime 50 mg. An aseptic bandage was applied to the eye.

A method for removing silicone oil from the eye cavity, which consists in conducting anesthesia, connecting an aspiration-irrigation system, for which 3 transconjunctival scleral punctures are performed with the installation of 25G ports for light guide and irrigation in them, and replacing the silicone oil with physiological saline after its removal, characterized in that, that through the port for irrigation, physiological solution is injected under a controlled pressure of no more than 1 bar, which displaces silicone oil through free ports, including for aspiration 25G.

Vitrectomy is called surgery, at which a partial or complete removal vitreous body of the eyeball. The operation is carried out in a specialized ophthalmological hospital using special high-tech equipment.

An ophthalmologist who has a sufficient level of professionalism should operate.

Indications and contraindications for surgery

Eye vitrectomy is performed for hemophthalmos (vitreous hemorrhage), trauma and surgical interventions with significant loss of the vitreous humor, large retinal tears, severe proliferative retinopathy, as well as with significant opacity of the vitreous body with the failure of conservative therapy.

There are also contraindications to this type of surgery. Vitrectomy is not done with significant corneal opacity, the presence allergic reactions, severe blood clotting disorders, the general serious condition of the patient.

Procedure for the operation

Vitrectomy is performed either under general anesthesia or local anesthesia. The position of the patient is lying on the operating table, the head is located near the surgeon. With the help of an eyelid dilator, the eyelids are diluted, after which they are fixed in this position for the entire duration of the operation.

An ophthalmologist makes several incisions on the sclera, through which they enter the eye necessary tools... The instruments used in the operation include a vitreotome, a light device and an infusion cannula, with the help of which the vitreous body is detached and sucked out.

The resulting cavity is filled with a gas-air mixture or silicone oil, with the help of which the retina is pressed against the underlying layers and held in this position.

On average, the duration of the operation is one and a half hours, but the duration of the intervention may be longer - it depends on the severity of the pathological process.

Postoperative period

The restoration of vision after surgery depends not only on the condition optic nerve and the retina, but also from the transparency of the optical medium of the eye.

In cases where the vitreous humor is replaced with a low-viscosity saline solution, vision is not restored immediately, since cellular elements and blood are present in the eye cavity, which go away after a few weeks.

If gas was introduced into the eye cavity, the patient sees a black veil after the operation. It goes away much faster - usually within one week.

Since in most cases, patients have retinal dysfunctions, it takes a certain amount of time to recover. However, there are cases when there are irreversible changes in the retina, which complicate the rehabilitation of the patient.

In such cases, even if a positive anatomical result was achieved during the operation (the retina is adjacent, the vitreous cavity is transparent), vision remains low due to disturbances in the functioning of the retina and optic nerve.

Sometimes, when filling the eye cavity with silicone oil, “plus” glasses are needed to correct vision.

After the operation, you should be registered with an ophthalmologist for a certain time, limit physical and visual stress. The use of underground modes of transport is not recommended for people whose eye cavity is filled with gas.

Possible complications

When performing the intervention, complications are possible - they can occur during vitrectomy or after surgery.
During the operation, retinal rupture, detachment, bleeding and damage to the lens can occur.

Some time after the vitrectomy of the eye, repeated bleeding may occur, inflammatory process in the tissues of the eyeball, the cataract of the lens develops, the intraocular pressure increases, the retina peels off (even on later dates after the intervention).

Features of modern microinvasive vitrectomy

Today, microinvasive vitrectomy is already practiced, which does not require hospitalization in a hospital due to the following features:

1. Since the technique does not stand still, and is developing more and more every day, today the diameter of the working instruments has significantly decreased, which makes it possible to perform the operation through three microscopic punctures of 0.3 mm in size.
2. Improved options of vitreoretinal devices, an increase in the cutting frequency of the knife to the level of 5 thousand beats per minute make it possible to reduce the time of the operation, reduce the risk of injury and increase its efficiency.
3. The use of multi-point self-fixing light sources frees the surgeon from using additional instruments, which also has a positive effect on the duration of the operation.
4. The use of optical wide-angle systems allows you to visually cover all parts of the retina, which makes vitrectomy more accurate and of high quality. That is, now the patient does not need to go to the hospital, but it is enough to spend only 4-5 hours in it (in the absence of complications).

An immediate doctor's consultation is mandatory at the first signs of discomfort (pain, pain) in the operated eye - this will help minimize complications and prevent loss of vision.

Vitrectomy: reviews

Unfortunately, reviews about this operation are not unambiguous, there are people for whom vitrectomy helped preserve their vision, but there are also reviews about problems and complications after surgery.

If you have already undergone a vitrectomy, we will be grateful for your feedback left in the comments, they will greatly help people who have not yet decided whether they should do this operation.

Love | 2013/10/03

Vitrectomy performed by surgeon I.Kh. Sharafetdinov. at the S. Fedorov Institute of Eye Microsurgery. Wonderful on the highest level... I recommend to everyone.

admin | 2013/10/03

Daria | 2013/10/22

I underwent a vitrectomy by I.M. Gorshkov, head. Department of Vitreoretinal Surgery of the Fedorov Institute of Science and Technology. The surgeon has golden hands, I recommend.

admin | 2013/11/01

Thank you for your feedback, Daria, as you can see from your feedback, an excellent team of highly qualified specialists was selected at the Fedorov Institute of Science and Technology.

Coward | 2014/05/26

Good article, conveys the mood of the patient who is about to undergo such an operation. When I went to her, I already knew a lot of information, but I was determined to have an operation. I talked with a vitreoretinal surgeon in the “Moscow eye clinic” with Oleg Evgenievich Ilyukhin, he patiently answered my questions, in the end I tuned in for the operation, it was done 9 months ago. Complications (which I was terribly afraid of) did not happen, which I am very happy about (although my eye hurt for the first week and was red). I think that in the future, too, everything will be fine. I want to advise people who are shown this operation not to be afraid, medicine in this area has made a big step forward, so tune in and regain your vision. Take care of your eyes!

Julia | 2014/06/24

I did a vitrectomy at the Stolyarenko clinic, everything went well. For those who are afraid - do not be afraid, everything is absolutely painless and not scary there. Be sure to go and the sooner, the more potential the eye has. All health!

Olga | 2014/12/14

For me vitrectomy + FEC with IOL was done by Professor A.A. Kozhukhov. A doctor from God, golden hands! The operation was successful, the air left in a week, and on the second day I began to see over the black film, which was getting smaller every day. There was no pain either during the operation or afterwards! Now I see better than before the operation, although only 2 weeks have passed. Everyone who is recommended to have a vitrectomy, do the operation without hesitation, because this is a chance to preserve your eyesight, otherwise you will definitely lose it. I wish everyone successful operations, preservation and restoration of vision, health!

Asya | 2015/01/11

Hello, three years ago I had a vitrectomy in one eye. Can eye massagers be used after vitrectomy?

Ludmila | 2015/03/02

Hello, I have a congenital cataract in my left eye, the vision on it was 0.04%. On January 26, 2015, a retinal hemorrhage occurred in this eye, immediately consulted a doctor, carried out a full diagnosis, there was no retinal detachment, only a hemorrhage was a dark spot in the center of the eye. 10 days later, hemophthalmus occurred in the same eye. Went for a consultation at the MNTK Fedorov in Moscow. They carried out a full diagnosis, diagnosed retinal detachment, but it is questionable, since the fundus of the eye cannot be examined due to hemorrhages and a cloudy lens. They offered vitrectomy with lens replacement, but there is no guarantee of restoration of vision. Moreover, a black spot but the center may remain. My attending physician says that there is no point in this operation, since the eye for 65 years has forgotten how to see normally and replacing the lens will not help, but it can be observed, everything can be treated slowly. Is this so? And what am I risking not having an operation.

Oksana | 2016/09/20

In 2013, I had a retinal detachment in my left eye from the side of the temple. I went to the MAPO ophthalmological clinic (Zanevsky, 1/82, St. Petersburg) for the VHI. I got to the surgeon Anton Khakimov. He proposed to perform vitrectomy with replacement of the vitreous with gas - a complex operation that has many sad consequences for humans. Many time later I found out that in my case it was enough to put a so-called "patch" on me and make laser coagulation(laser stitching of the retina).
Vitrectomy lasted about 2 hours and was performed under general anesthesia... After the operation, you need to lie on your stomach, face down, for two to three days. I spent five days in the MAPO hospital. The ophthalmology department is very clean, polite and caring staff, good food and true patient care.
After discharge, the retina immediately fell back and I saw a kind of "curtain" on the eye. As it later became clear from a conversation with A. Khakimov, he hoped that the gas would be able to press the retina sufficiently and did not flash it with an additional laser, it is not surprising that everything fell off. After that, he recommended to perform the vitrectomy again, but this time replacing the remaining gas there with silicone (silicone oil). Silicone has a very dense structure and can press the detached retina down enough that it actually grows back. Why I was not immediately offered vitrectomy with silicone is unclear.
This operation was performed for me in the same place. The operation was performed by the head of the department, Elena Vladimirovna Klyushnikova. In my case, the remaining gas was removed from the previous unsuccessful vitrectomy and changed to silicone.
After the operation, the image, which passes through the lens, through the silicone ball, is transmitted to the retina. Since silicone is an artificial material, the image that you see seems to float all the time, there are no clear contours, light is refracted in a completely different way, you see objects not as they really are, light sources blur, text after vitrectomy you cannot read.
Silicone really presses the retina, so if you need to do a vitrectomy, then agree to this material. But he has one BUT! - this is a material that collapses, the longer it is in your eye, the more it breaks down into small, small bubbles. I walked with silicone in my eye for about 11 months, during which time it managed to fulfill its function, but almost completely collapsed.
Do not repeat after me, do not walk with silicone for more than 5-6 months. It will be necessary to carry out the next operation, the so-called "revision" - this is the removal of the remains of silicone from the anterior chamber of the eye, because by itself it will not evaporate from there. Retinal detachment is a serious ailment, but you can and should fight for your eyes, for a long time, as long as it takes!

Oksana | 2016/09/29

If you have performed a vitrectomy operation with replacing the vitreous with silicone oil, then you must understand that the longer the silicone is in the eye, the more it falls apart like a material, turning into many separate bubbles of emulsified silicone. To see the world with the operated eye again in about 5-6 months (no longer!) After vitrectomy, you need to do the so-called "revision" - an operation to remove the remaining silicone from the eye, because it will not evaporate from there.
In my case, the first time I didn’t manage to “clear” my eyes, the remnants of emulsified silicone still floated in my eye like a school of fish. This is due to the fact that I did not do the "revision" for too long, I walked with silicone oil for about 11 months, during which time it managed to pretty much fall apart. Twice I did such a "revision" in the Ophthalmological Clinic of the MAPO (Zanevsky 1/82, St. Petersburg). For the first time, the operation was carried out by the head of the department, Elena Vladimirovna Klyushnikova, for the second time she, too, together with Anatoly Viktorovich Kononov. Both times I was in the MAPO hospital for five days. MAPO is very good conditions, clean, bright rooms, friendly and caring staff, very good food, there is also a paid dining room for those who wish, in the courtyard there are benches, trees, flowers.
The operation to "revise" the remnants of emulsified silicone is performed under general anesthesia and lasts about two hours, since surgeons need to "flush" the microscopic anterior chamber of the eye from even more microscopic bubbles of silicone. After both attempts to carry out the "revision", my bubbles still remained in quite a large number... It was only on the third operation that it was possible to achieve real success with the removal of silicone residues!
During the time that the microscopic bubbles of silicone were in the eye, they clogged up the smallest channels through which healthy person the ophthalmic fluid leaves the anterior chamber of the eye and, due to this, intraocular pressure is regulated. Since my canals were clogged, I got glaucoma (increased intraocular pressure).

After two attempts to "clean" the eye, I realized that the success of the next "revision" of the eye depends on the skill of the surgeon. I was lucky to be in the hands of Sergei Viktorovich Sosnovsky. I think he is the best ophthalmic surgeon in St. Petersburg!
"Revision" to remove the remnants of emulsified silicone was done in the Ophthalmological Clinic Military Medical Academy(Clinical street 6, St. Petersburg). The operation was performed on VHI, was in the hospital for five days. Conditions in the Military Medical Academy are a bit Spartan, food is prepared, as I understand it, by conscripts, so there is no need to do it once at a time. Order and discipline are military. The operation was performed under general anesthesia and lasted about an hour.
The most important thing is that this particular operation gave the desired result! I really got rid of 99% of the remaining silicone bubbles in the anterior chamber of the eye, and finally I can see this world not as through dirty glass, but for real!

Valentine | 2016/10/05

In Voronezh I underwent a victrotomy operation, doctor Rodugin, a complication of cataract, they will perform an operation to remove it, the doctor is very wonderful, the conditions in the hospital are excellent, and the entire staff is just super, I want to express my gratitude to nurse Strelkova and the whole team

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Vitrectomy is an operation during which the vitreous body is completely or partially removed. It was first carried out by R. Machemer in 1971.

This is a rather complicated operation that requires high-tech equipment and a good qualification of the surgeon. But at the same time, she is the only solution some eye diseases.

Indications and contraindications for surgery

Vitrectomy is advisable in the following cases:

Vitrectomy is not done in the presence of blood diseases (especially in violation of the coagulation system), severe opacity of the cornea and the serious condition of the patient.

Stages of vitrectomy surgery

Today vitrectomy is performed in outpatient under local anesthesia. The patient is in a supine position, his head is fixed with a special device.

The sequence of actions of the surgeon is as follows:

The duration of vitrectomy varies from 2 to 3 hours, depending on the skill of the surgeon and the severity of the patient's condition.

Vitreous substitutes

Currently there are several vitreous substitutes: silicone oil, complex saline solution, liquid perfluoroorganic compound or sterile gas bubble. The use of these substances ensures close contact choroid and retina and prevents the development of complications.

Use of silicone oil

The light refractive index of silicone oil is almost the same as that of the natural refractive medium of the eye

Silicone oil is a unique substance that is characterized by biological and chemical inertness. Due to this property, the oil is easily tolerated by patients and does not cause allergic reactions. Its refractive index of light is almost the same as that of the natural refractive media of the eye.

These features allow you to leave silicone oil in the eye cavity for a long time (up to 1 year).

Silicone oil ensures the correct anatomical position of the retina and quick restoration of its function.

Using a gas mixture

The introduction of an air bubble into the eye cavity requires the patient to strictly adhere to certain rules. This mainly concerns long-term holding of the head in a certain position, which is discussed with the doctor and depends on the volume of the operation.

The advantage of the gas bubble is that it completely dissolves over time (12-20 days) and is replaced by natural intraocular fluid.

During this period, air travel is categorically contraindicated for a person. This is because a change in atmospheric pressure expands the gas and can cause an uncontrolled increase in intraocular pressure.

Use of liquid perfluoroorganic compounds

They are also known as "heavy water" because their molecular weight is almost twice as heavy as that of ordinary water.

After the introduction of such a substance into the vitreous cavity, the patient is not required to comply with any special regimen.

The only drawback of liquid perfluoro-organic compounds is that they need to be changed every two weeks.

Postoperative period after vitrectomy

After the intervention, the patient can go home on the same day. For a speedy recovery, the following recommendations must be followed:

The timing of the restoration of visual functions directly depends on the volume of the operation and what kind of vitreous substitute was used.

For example, if only part of the vitreous body is removed during vitrectomy, improvement in vision may occur as early as the first week. If the operation was performed at an advanced stage of the disease, when tissue changes have become irreversible, a noticeable improvement in vision may not occur.

Complications that can develop after a vitrectomy

Like any surgical intervention, vitrectomy carries a certain risk of postoperative complications.

Possible postoperative complications:

• Progression. If the patient already had a cataract at the time of the intervention, then there is a possibility of its progression in the first six months or a year after the intervention. This happens more often when silicone oil is used as a substitute for the vitreous body.
• Secondary development.
• Recurrence (repetition) of retinal detachment.
• Ophthalmic hypertension, or increased intraocular pressure... This complication occurs when an excessive amount of the substitute is injected into the eye cavity. To eliminate this complication, the patient must use drops against glaucoma for some time.
• Infectious and inflammatory complications (for example, endophthalmitis).
• Corneal opacity. It is rare and is due to the toxic effects of the vitreous substitute.

Achieving a permanent retinal adhesion effect after removing the silicone oil from the vitreous cavity is the desired outcome of retinal detachment surgery. The presence of silicone oil in the vitreous cavity ensures reliable fixation of the retina during the formation of chorioretinal adhesions after laser coagulation. After the retinal adherence is achieved, the next step is to remove the silicone oil from the vitreous cavity within a period of 1 to 4 months.

There are known methods for removing silicone oil from the eye cavity using microsurgical systems Millennium, Assistant, using self-sealing tunnel scleral incisions 20G without suturing, when connecting a 3-port 25G aspiration-irrigation system for a light guide, irrigation and replacement of silicone oil, which have the main disadvantages: long duration of surgical intervention to remove silicone, which affects the duration of the operation and pain relief, the likelihood of postoperative complications increases, and the risk of metabolic disturbances in the structures of the eye increases.

Target- to develop a method for the seamless removal of silicone oil using microinvasive techniques.

Material and methods... All studied patients were operated on for retinal detachment of various origins with tamponade of the vitreous cavity with silicone oil 1300, 5700 cSt, and its removal was performed within 2–4 months. after endotamponade.

We operated on 26 patients (25 eyes) with previously operated retinal detachment, using silicone oil 1300cSt in the vitreous cavity - 20 eyes, silicone oil 5700cSt - 6 eyes. Most common reason detachment was myopia of high degree with peripheral vitreochorioretinal dystrophy of the retina (PVCRD). The age of retinal detachment ranged from 3 to 12 months. All patients underwent removal of silicone oil from the vitreous cavity according to the method developed by the authors using 25G instruments using seamless technology. The age of the patients ranged from 18 to 65 years. The term of the silicone tamponade was from 1.5 to 4 months. Postoperative observation - up to 12 months.

All patients underwent a comprehensive ophthalmological examination. Visual acuity was measured, keratorefractometry, tonometry, tonography, perimetry, biomicroscopy, biomicro-ophthalmoscopy, echobiometry, B-scan, ultrasound biomicroscopy, electrophysiological studies of the retina and optic nerve were performed.

The method for removing silicone oil from the eye cavity is as follows.

After local anesthesia and treatment of the operating field, 3 transconjunctival scleral punctures are performed 4 mm from the limbus in 3 meridians, for example, at 1, 2 and 11 o'clock. They are equipped with 25G ports for light guide, irrigation and replacement of silicone oil with saline after it has been removed.

Through the port for irrigation at 2 o'clock, physiological solution is injected using the Millenium ophthalmic surgical system, Assistant in the mode of silicone injection under a controlled pressure of no more than 1 Bar.

Saline displaces the silicone oil, which exits through the free ports at 1 and 11 o'clock, due to the creation of increased intraocular pressure. After removing the silicone oil, a light guide is introduced through the port at 11 o'clock to inspect the vitreous cavity, after which the ports are removed. Casing penetrations are self-sealing. Sclera and conjunctiva sutures are not required.

Results and discussion... Corrected visual acuity ranged from 0.02 to 0.3, depending on the initial state and the duration of retinal detachment. The results of the study showed that IOP was on average 18.6 mm Hg. Art. at the stage of silicone tamponade and 14.1 mm Hg. Art. - after removing the silicone. During surgical treatment, intraoperatively, no complications were observed.

In the early postoperative period, transient hypotension of the eyeball was noted in 3 cases, hemorrhages were noted in 2 cases, exudative reaction - in 2 cases. There were no recurrences of retinal detachment in the early postoperative period. In the late postoperative period, a relapse of retinal detachment occurred in 4 (6.25%) cases within about 3 months. after removal of silicone oil due to progression of PVR (proliferative vitreoretinopathy).

When using 25G ports, suturing is not required, which significantly reduces the trauma of surgery, the possibility of complications such as trauma to the choroid, hemorrhagic complications, scarring of the mucous membrane of the eye. In addition, due to the use of our proposed method, the time for replacing silicone oil with physiological solution is significantly reduced, averaging from 3 to 10 minutes, depending on the volume of the vitreous cavity and the viscosity of the silicone.

conclusions... The use of a modified 25G microinvasive technique when removing silicone oil from the vitreous cavity shortens the duration of the operation, reduces intraoperative trauma, which leads to a decrease in the severity of the inflammatory reaction in the postoperative period.