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First Author: R.Fayzrakhmanov RUSSIA
Co Author(s): M. Bikbov A. Yarmukhametova
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To identify indications for the choice of silicone oil tamponade method in the vitreal cavity in patients with primary retinal detachment depending on the state of the Zinn ligamentṀs functionality after phacoemulsification.
Ufa Eye Research Institute, Ufa, Russia.
250 patients (50-eyes) aged 46 to 63 years who had primary rhegmatogenous retinal detachment and cataract were included in the study. Duration of a disease ranged from 1 week to 4 months. All of them previously had phacoemulsification of cataract with implantation of intraocular lens. Special attention was paid to the support function of the ligament of Zinn. All patients underwent 25g vitrectomy according to a standard technique. The first series (125 eyes). Instead of Perfluorodecalin Liquids the silicone was injected into all the patients by means of the air mixture. During the sterile air-feeding Perfluorodecalin Liquids were aspirated by a vitreous-cutter. After the complete evacuation of Perfluorodecalin Liquids from the vitreal cavity silicone oil Oxane 5700 was injected. The second series (125 eyes). All the patients were divided into 2 groups depending on the functional state of the ligament of Zinn: group 1 no ligament defect, group 2 - partial separation of the ligament of Zinn. Patients of the 1st group underwent the same replacement of PFOS by silicone as the patients of the first series of studies with the use of the air mixture. Patients of the 2nd group received a direct silicone injection.
In the first series of the experiment in 16% patients a partial leakage of silicone oil into the anterior chamber was revealed and it caused the necessity of further evacuation through paracentesis with the air. In the second series of studies leakage of silicone oil was observed in 1 patient of the 1st group. In other patients there was an adequate tamponade of vitreal cavity with the absence of silicone leakage. The silicone leakage into the anterior chamber in patient with the defect of ligament of Zinn is caused by the tension of tamponade solution in a confined space. The silicone oil provides a satisfactory tamponade of the retina due to its power of compression. Not only the tension forces affects surrounding tissues but the direction of solution spread in vitreal cavity is very important. When perfluorodecalin liquid is replaced by silicon with the use of air mixture, the silicone oil spreads directly to the forepart of the anterior eye segment. Therefore, the defect ligament of Zinn may cause the leakage to the anterior chamber due to the direction of tamponade material.
The defect of the ligament of Zinn in patients with vitreoretinal intervention on the RRD implantation of silicone in the vitreal cavity must be conducted according to the following scheme perfluorodecalin liquid - silicone oil. This method prevents the dislocation of tamponade material in the anterior chamber. If no damage of ligament of Zinn is observed the replacement of tamponade material can be carried out through the air pump.