Active Removal of Silicone Oil With 25-Gauge Sutureless System

摘要

As a general principle, silicone oil (SiO) should be removed once the objectives of the tamponade have been achieved and the retinal status is stable. Previously there has been disagreement regarding the use of 25-gauge (25 g) systems in SiO surgery. In this study, we report a sutureless technique for active removal of SiO through our newly designed 25 g microcannulas. In this surgical technique, a standard microcannula is placed with a beveled trocar and a 25 g infusion cannula is connected to this microcannula at the inferotemporal region. Two additional microcannulas of our design are placed in the superotemporal and superonasal regions with the help of trocars. The outer portions of these microcannulas have grooves like the ones on the outer portion of anterior chamber maintainers (Figure 1, top left). These are designed to connect two separate silicone vacuum tubes which allow very effective aspiration throughout the entire lumen of the microcannulas. The vacuum tubes are secured to a three-way stopcock (Figure 1, top right), and the remaining outlet of the three-way stopcock is connected to the viscous fluid extraction syringe which enables aspiration with the vitrectomy machine. The height of the infusion bottle is increased to 95 cm. SiO of both 1,000 and 5,000 centistokes were removed with active suction using a 500-600 mm Hg vacuum (Figure 1, bottom left, right). After removal of SiO, the bottle height is decreased to 60 cm and retinal status is examined with the 25 g light probe. If necessary, additional procedures involving the retina, such as endolaser photocoagulation or epiretinal membrane peeling, are performed with 25 g instruments. Microcannulas are removed after fluid-air exchange and the entry sites are examined for leakage and bleb formation.