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Background & Purpose:

Achieving a near-100% fill of silicone oil is desirable for PVR surgery in order to:

1.Better support retinal breaks, especially inferiorly;

2. Provide a more complete tamponade to holes;

3. Maximize oil conformation to irregularities in eyewall contour;

4. Minimize emulsification due to oil bubble motion against irregular surfaces;

5. Avoid inferior retinal detachments due to underfill;

6. Avoid prolapse of oil into anterior chamber due to over fill; and

7. Avoid too high or too low intraocular pressure. 100% fills are never technically achieved, but near-100% should be the goal.

This “My Way” presentation will describe and defend the author’s methodology of oil injection that typically achieves the elusive 100% silicone oil fill for PVR surgery.

Methods:

Seven criteria are required to achieve the perfect€ silicone oil (SO) fill with the author’s technique:

1. Remove ALL fluid from the eye during SO injection, which mandates an air intermediate step. Direct PFO-SO exchange may trap some fluid in eye;

2. Then, remove ALL from the eye by chasing the air into a vent at the pupil, not the pars plana;

3. Keep the eye pressurized during all steps of the SO injection;

4. Avoid things that keep the eye from being spherical, e.g. buckles;

5. Create as small a pupil as possible to contain SO in posterior segment using pupilloplasty;

6. Maintain the exact anatomic depth of the anterior chamber (AC) by reformation with a viscoelastic rather than air of BSS;

7. Close with normal IOP, confirmed by true intraoperative tonometry, not finger tension.

Results:

The author will briefly report a retrospective 15 year review of 246 PVR cases managed with this technique. IOP’€™s were successfully managed despite placing viscoelastic to fill the AC by using prophylactic IOP drops. 99% of eyes had SO fills >90%. 1.6% had mild overfill. 86% of cases were totally flat plus another 10% were macula-on with stable inferior RD. Only 4% were macula off.

Conclusion:

Near 100% silicone oil fills can be achieved with careful attention to technique during SO injection. The biggest mistakes made by surgeons include inattention to careful recreation of anterior segment anatomy (small pupil and normal AC depth), or by guessing at the closing IOP by finger tension assessment. The more the surgeon deviates from a 100% oil fill, the more likely the PVR surgery may fail.

Precis:

Careful attention to oil injection technique will be more likely to achieve a near-100% oil fill.