RESUMO
La silicona líquida es usada intravítrea cuando se requiere un taponamiento prolongado intraocular para mantener la retina aplicada. A pesar de sus ventajas, su uso se ha asociado a algunas complicaciones como catarata, queratopatía, hipertensión ocular, glaucoma entre otras. La hipertensión ocular secundaria por aceite de silicona aparece por varios mecanismos, la migración de partículas a la malla trabecular junto con el proceso inflamatorio que genera es un reto para los cirujanos, de ahí los diferentes criterios de tratamiento que existen para su completa resolución. A continuación, se presenta un paciente operado de desprendimiento de retina recidivado con hipertensión ocular secundario a aceite de silicona 9 meses después de su primera intervención. Llevó tratamiento con hipotensores oculares tópicos, orales y no resolvió por lo que se decide realizar ciclocrioterapia en dos cuadrantes. A pesar que este tratamiento no es el de elección en estos casos, podemos decir que en este paciente se logra controlar la presión intraocular luego de una sola sesión(AU)
Liquid silicone is used intravitreally when prolonged intraocular insulation is required to keep the retina applied. Despite its advantages, its use has been associated with some complications such as cataract, keratopathy, ocular hypertension, glaucoma, among others. Secondary ocular hypertension due to silicone oil appears by several mechanisms. The migration of particles to the trabecular meshwork, together with the inflammatory process it generates, represents a challenge for surgeons, hence the different treatment criteria that exist for its complete resolution. The following is a patient operated on for recurrent retinal detachment with ocular hypertension secondary to silicone oil 9 months after the first operation. He was treated with topical and oral ocular hypotensors and it did not resolve, so it was decided to perform cyclocriotherapy in two quadrants. Although this treatment is not the treatment of choice in these cases, we can say that in this patient intraocular pressure control was achieved after only one session(AU)
Assuntos
Humanos , Catarata/complicações , Óleos de Silicone/uso terapêutico , Descolamento Retiniano/etiologia , Hipertensão Ocular , Glaucoma/complicaçõesRESUMO
RESUMO O óleo de silicone é um importante tampão utilizado na retinopexia cirúrgica de casos graves de descolamento de retina. O aumento da pressão intraocular e o desenvolvimento de glaucoma secundário são frequentes complicações da sua utilização. A depender do período de aparecimento, diversos mecanismos justificam a ocorrência de tais complicações. Compreender os fatores de riscos e a patogênese do aumento da pressão intraocular associada a aplicação de óleo de silicone em cirurgia retiniana ajuda a orientar o tratamento adequado para cada paciente. O objetivo deste artigo é revisar a literatura sobre a patogenia, a incidência, os fatores de risco e o tratamento desta condição clínica.
ABSTRACT Silicone oil has been an important intraocular tamponade in retinopexy in cases of complicated retinal detachment surgery. The increase of intraocular pressure and development of secondary glaucoma are a known complication of its use. A variety of mechanisms have been proposed for the pathogenesis, depending on the onset. This article aims to review the literature about pathogenesis, the incidence and risk factors, as well as the treatment of this pathology.
Assuntos
Humanos , Óleos de Silicone/efeitos adversos , Óleos de Silicone/uso terapêutico , Descolamento Retiniano/terapia , Glaucoma/induzido quimicamente , Hipertensão Ocular/induzido quimicamente , Pressão Intraocular/efeitos dos fármacos , Complicações Pós-Operatórias , Malha Trabecular , Descolamento Retiniano/cirurgia , Trabeculectomia , Glaucoma/cirurgia , Fatores de Risco , Implantes para Drenagem de Glaucoma , Terapia a Laser , Oclusão Terapêutica/métodos , FotocoagulaçãoRESUMO
La inyección de aceites de silicona ha sido utilizada para modificar el contorno corporal en todo el mundo, especialmente en Japón desde 1940 y para el aumento mamario. Como cirujanos, nos encontramos cada vez más frecuentemente llamados a enfrentar los problemas generados por esta forma ilegal de aumento mamario: tumores de mama bilaterales, algunos dolorosos; masas duras que a menudo se confunden con un cáncer de mama avanzado, tumores axilares. La extrema dificultad para descartar un cáncer de mama a través del examen físico, mamografías, ecografías e incluso resonancia magnética (MRI) con gadolinio complican aún más el tratamiento en estas pacientes. Nuestra experiencia, de más de 20 años investigando esta patología, nos ha mostrado claramente que, para tratar a pacientes con esta enfermedad tan compleja, se requiere de un equipo terapéutico multidisciplinario. Este equipo debe tener una visión integral del paciente y comprometerse en el tratamiento de cada caso. Actuando de manera coordinada, abordando todas las diferentes sintomatologías de la enfermedad, ya sean locales o sistémicas, físicas o psicológicas. La inyección de siliconas y otros aceites tiene un impacto social muy desfavorable, ya que enferma e incapacita a un gran número de personas durante los años más productivos de su vida. Analizaremos los enfoques terapéuticos apropiados para cada forma de presentación de las enfermedades producidas por la inyección de siliconas en las mamas
The injection of silicone oils has been used to modify body contours around the world and especially in Japan, since 1940, most commonly to increase breast size. As surgeons, we find ourselves increasingly being called to deal with problems generated by this illegal form of breast augmentationbilateral breast tumors, some painful, some not; hard masses that are often confused with advanced breast cancer; and axillary tumorsall caused by silicones. To this is added the extreme difficulty ruling out breast cancer through physical examinations, mammography, ultrasound, and even magnetic resonance imaging (MRI) with gadolinium. Our experience, over 20 years treating and investigating this pathology, has clearly shown us that, to treat these patients with such complex disease, a multidisciplinary therapeutic team is required. Moreover, that team must have a comprehensive vision and be committed to tailoring treatment to each patient individually. The team also must act in a coordinated manner, addressing all the different implications of disease, whether local or systemic, physical or psychological. The injection of silicones and other oils has had an unfavorable social impact, because it incapacitates a large number of people during the most productive years of their life. We will now present the appropriate therapeutic approaches for each form of mammary siliconoma presentation.
Assuntos
Humanos , Terapêutica , Algoritmos , Óleos de Silicone/uso terapêutico , Neoplasias da Mama/terapia , Prevenção de Doenças , Contorno CorporalRESUMO
Objetivo: determinar si el sistema Scheimpflug por Pentacam tiene utilidad en la cuantificación objetiva de la opacidad de la cápsula posterior en los pacientes pseudofáquicos con aceite de silicona. Métodos: se realizó un estudio descriptivo, prospectivo y observacional en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre abril del año 2012 y abril de 2014. Se evaluó, mediante sistema Scheimpflug del Pentacam para la cuantificación de la opacidad de cápsula posterior, a un grupo de 31 pacientes seudofáquicos sometidos a una vitrectomía previa con aceite de silicona y se compararon los resultados con los obtenidos en 26 pacientes operados solo de cirugía del cristalino con lente intraocular, para lo cual se utilizaron las variables edad, sexo, opacidad en grados por lámpara de hendidura y la intensidad media de píxeles en un área circular de 3 mm centrales seleccionada en los tomogramas, analizadas por el software Image J 1.42 q. Resultados: en los pacientes pseudofáquicos con aceite de silicona el sistema Scheimpflug no fue capaz de discernir entre los diferentes grados de opacidad de la cápsula posterior(p= 0,210) y no existió concordancia entre ambas mediciones (p= 0,120). Las mediciones realizadas en los pacientes pseudofáquicos con aceite de silicona con la lámpara de hendidura por dos observadores fueron similares (p= 0,042), al igual que existió buena correlación en las realizadas con el sistema Scheimpflug (r= 0,981). Cuando se compararon las mediciones realizadas con el sistema Scheimpflug en los dos grupos de pacientes se observó que las medias de intensidad en los grados 1 y 2 eran superiores a las halladas en los pacientes no vitrectomizados previamente, no así en los grados 3; solo en este último caso la diferencia fue significativa (p= 0,001). Conclusiones: el sistema Scheimpflug no es útil para cuantificar la opacidad de la cápsula posterior en los pacientes vitrectomizados previamente que aún tienen aceite de silicona(AU)
Objective: to determine whether the Pentacam Scheimpflug imaging system is useful for objective quantification of the posterior capsule opacity in pseudophakic patients with silicon oil-filled eyes. Methods: observational, prospective and descriptive study conducted in Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period of April 2012 through April 2014. With the Pentacam Scheimpflug imaging system for the quantification of the posterior capsule opacity, 31 pseudophakic patients, who had undergone previous vitrectomy with silicon oil, were evaluated and their results were then compared with those of patients operated on through crystalline lens surgery and intraocular lens implantation (26 patients). To this end, the analyzed variables were age, sex, opacification degrees measured with slit lamp and average intensity in pixels in a 3mm round area selected from tomographs and analyzed by Image J 1.42 q software. Results: in pseudophakic patients with silicon oil-filled eyes, the Scheimpflug system could not differentiate the different levels of the posterior capsule opacity (p= 0.210) and there was no agreement between both measurements (p= 0.120). The measurements taken by two observers in pseudophakic patients using silicon oil and slit lamp were similar (p= 0.042) and good correlation in those taken with the Scheimpflug system (r= 0.981). When comparing the Scheimpflug system measurements taken in the two groups of patients, it was observed that the intensity means in grades 1 and 2 were higher than those found in non-vitrectomized patients, but in grade 3, the difference was significant (p= 0.001). Conclusions: Scheimpflug system is not useful to measure the posterior capsule opacity in previously vitrectomized patients who still have silicon oil-filled eyes(AU)
Assuntos
Humanos , Idoso , Opacidade da Córnea/complicações , Cápsula Posterior do Cristalino/cirurgia , Pseudofacia/complicações , Óleos de Silicone/uso terapêutico , Tomografia/métodos , Epidemiologia Descritiva , Estudo Observacional , Estudos Prospectivos , Vitrectomia/métodosRESUMO
We retrospectively evaluated a heavy silicone oil (HSO) as a long-term intraocular endotamponade agent to treat complicated RD by inferior PVR in 25 eyes of 25 patients. Patients underwent PPV and injection of Oxane HD as an internal tamponade agent. A comparison of preoperative and postoperative BCVA at month 1, month 6, and last visit was made in the group in which HSO was removed and in the group in which HSO was not removed. Statistical calculations were performed using the Wilcoxon test. The HSO was removed from 11 patients after a mean of 26.55 ± 21.38 months. The HSO remained inside the vitreous cavity in 14 eyes due to a high chance of PVR recurrence (mean follow-up period, 11.07 ± 7.44 months). Anatomic success was achieved in 92%. The BCVA in the group, in which HSO was not removed, improved significantly during the first 6 months. Among the patients who had the oil removed, there was improvement in BCVA after 1 month. Oil emulsification was the most common adverse effect in 52% of eyes. HSO is an effective tamponade in complex rhegmatogenous and tractional RD complicated by PVR. HSO can remain in the eye for long periods with relative tolerability and safety.
Assuntos
Tamponamento Interno/métodos , Descolamento Retiniano/cirurgia , Óleos de Silicone/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitreorretinopatia Proliferativa , Adulto JovemRESUMO
BACKGROUND: complications of proliferative diabetic retinopathy require surgical treatment. In 2007 Flaxel reported visual improvement after vitreoretinal surgery in 37% of Latino diabetics; in our country it is estimated that a higher proportion of patients improves, but this has not been documented. AIM: to identify the efficacy of vitreoretinal surgery for improving best corrected visual acuity, in diabetic patients treated at a hospital in Mexico City. METHODS: an observational, longitudinal, retrospective, descriptive study was conducted in diabetics who underwent vitreoretinal surgery (2007-2010) with one year follow-up. Visual acuity was measured before surgery and one year after, and it was registered when the retinopexy orphacoemulsification was performed, or silicone tamponade wasused. The proportions and 95% confidence intervals (CI) of patients whose visual acuity improved, did not change or worsened, were compared with those reported by Flaxel in Latino patients (χ(2), relative risk [RR]). RESULTS: 63 patients, mean age 58.5 ± 11.6 years, 26 with retinal detachment (41.3%), phacoemulsification was performed in 50 (79.4%), and silicone was used in 27 (42.9%). BCVA worsened in 12 patients (19%), did not change in 5 (8%) and improved in 46 (73%, 95% CI 62-84); the latter proportion exceeded that reported by Flaxel (p = 0.0005, RR 1.97, 95% CI 1.25-3.1). DISCUSSION: although the difference was not clinically significant, the efficacy of vitreoretinal surgery to improve visual acuity in the sample was consistently higher than that reported by Flaxel in Latinos, and did not vary from other studies. These results do not support an association between an ethnic group and a lower surgical efficacy.
Assuntos
Retinopatia Diabética/cirurgia , Facoemulsificação , Retina/cirurgia , Acuidade Visual , Vitrectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/etnologia , Etnicidade , Feminino , Seguimentos , Humanos , Implante de Lente Intraocular/estatística & dados numéricos , Fotocoagulação/estatística & dados numéricos , Edema Macular/cirurgia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Facoemulsificação/estatística & dados numéricos , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Óleos de Silicone/uso terapêutico , Resultado do Tratamento , Vitrectomia/estatística & dados numéricos , Hemorragia Vítrea/cirurgia , Adulto JovemRESUMO
Wyburn-Mason is a rare vascular disorder, comprised of arteriovenous malformations (AVMs) of the midbrain and retina. It can cause visual symptoms depending on its localization and extension. Vitreous and intraretinal hemorrhage and neovascular glaucoma have been previously described. A case of rhegmatogenous retinal detachment in a patient with Wyburn-Mason syndrome is described. A 27 year-old woman previously diagnosed with Wyburn-Mason syndrome, sought attendance with sudden low vision in right eye 3 months before. She presented moderate vitreous hemorrhage and retinal detachment with a superior tear. She underwent a successful posterior vitrectomy with implantation of silicone oil, with reattachment of the retina. Rhegmatogenous retinal detachment in a patient with Wyburn-Mason syndrome has been not previously described in the literature. Vitrectomy in this case present challenges related to intraoperatory bleeding risk, to a posterior pole tear among AVMs and the difficulty of obtaining free retina for photocoagulation.
Assuntos
Malformações Arteriovenosas Intracranianas/complicações , Artéria Retiniana/anormalidades , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Veia Retiniana/anormalidades , Adulto , Feminino , Humanos , Descolamento Retiniano/diagnóstico , Óleos de Silicone/uso terapêutico , Síndrome , VitrectomiaRESUMO
Wyburn-Mason is a rare vascular disorder, comprised of arteriovenous malformations (AVMs) of the midbrain and retina. It can cause visual symptoms depending on its localization and extension. Vitreous and intraretinal hemorrhage and neovascular glaucoma have been previously described. A case of rhegmatogenous retinal detachment in a patient with Wyburn-Mason syndrome is described. A 27 year-old woman previously diagnosed with Wyburn-Mason syndrome, sought attendance with sudden low vision in right eye 3 months before. She presented moderate vitreous hemorrhage and retinal detachment with a superior tear. She underwent a successful posterior vitrectomy with implantation of silicone oil, with reattachment of the retina. Rhegmatogenous retinal detachment in a patient with Wyburn-Mason syndrome has been not previously described in the literature. Vitrectomy in this case present challenges related to intraoperatory bleeding risk, to a posterior pole tear among AVMs and the difficulty of obtaining free retina for photocoagulation.
A síndrome de Wyburn-Mason é uma desordem vascular rara, caracterizada por malformações arteriovenosas (MAV) do mesencéfalo e retina. Pode causar sintomas visuais por sua localização e extensão. Hemorragia vítrea, intrarretiniana e glaucoma neovascular já foram descritos. Descreve-se um caso de descolamento regmatogênico de retina em uma paciente com síndrome de Wyburn-Mason. Uma paciente feminina de 27 anos com diagnóstico prévio de síndrome de Wyburn-Mason procurou atendimento com queixa de baixa acuidade visual súbita no olho direito há três meses. Apresentava hemorragia vítrea moderada e descolamento de retina com rotura superior. Foi submetida a vitrectomia posterior com implante intravítreo de óleo de silicone, com reaplicação da retina. Descolamento regmatogênico de retina em paciente com síndrome de Wyburn-Mason não havia sido previamente descrito na literatura. A vitrectomia nesse caso apresentou dificuldades relacionadas ao risco de sangramento intraoperatório, à presença de rotura no polo posterior entre as MAVs e à dificuldade de obtenção de retina livre para fotocoagulação.
Assuntos
Adulto , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Artéria Retiniana/anormalidades , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Veia Retiniana/anormalidades , Descolamento Retiniano/diagnóstico , Síndrome , Óleos de Silicone/uso terapêutico , VitrectomiaRESUMO
PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90 masculine to 210 masculine were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80%) after a mean follow-up of 16.2 +/- 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10%) case, and there was no attachment of the retina in two (20%) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50%) cases. CONCLUSION: Good results (80%) and improvement of the visual acuity (50%) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.
Assuntos
Fluorocarbonos/uso terapêutico , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Óleos de Silicone/uso terapêutico , Vitrectomia/métodos , Vitreorretinopatia Proliferativa/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação , Descolamento Retiniano/etiologia , Perfurações Retinianas/complicações , Índice de Gravidade de Doença , Tampões Cirúrgicos , Resultado do Tratamento , Acuidade Visual , Vitreorretinopatia Proliferativa/complicaçõesRESUMO
OBJETIVOS: Relatar os resultados de vitrectomia via pars plana com utilização de perfluocarbono líquido (Perfluoroctano-Ophtalmos®), como tamponante vítreo-retiniano de curta duração, no pós-operatório de portadores de descolamento de retina, por ruptura gigante. MÉTODOS: Estudaram-se dez desses pacientes. Todos os casos eram complicados por vitreorretinopatia proliferativa grau B ou pior com rupturas que variavam em extensão de 90° a 210°. O perfluorocarbono líquido foi introduzido, por via pars plana, com o volume necessário para ultrapassar o limite posterior da ruptura, permanecendo no pós-operatório por cinco dias, estando os pacientes em decúbito dorsal. Após esse período submetiam-se a segunda intervenção para troca do perfluorocarbono líquido para gás ou óleo de silicone. RESULTADOS: Após período de acompanhamento médio de 16,2 ± 12,4 meses (2 a 43 meses), 80 por cento das retinas estavam aplicadas, sendo necessária a repetição desta técnica em 1 caso (10 por cento) caso e em 2 casos (20 por cento) não houve reaplicação da retina por vitreorretinopatia avançada. Houve melhora da acuidade visual em 5 casos (50 por cento). CONCLUSÃO: Observaram-se bons resultados quanto à aplicação da retina (80 por cento) e melhora da acuidade visual (50 por cento) quando do uso do perfluorocarbono líquido como tamponante vitreorretiniano de curta duração no pós-operatório de cirurgias de descolamento de retina por rupturas gigantes.
PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90° to 210° were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80 percent) after a mean follow-up of 16.2 ± 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10 percent) case, and there was no attachment of the retina in two (20 percent) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50 percent) cases. CONCLUSION: Good results (80 percent) and improvement of the visual acuity (50 percent) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.