For an ophthalmologist, a smooth vitreoretinal surgery can be very disturbing when silicone oil is found to have entered the anterior chamber after surgery. When silicone oil enters the anterior chamber, it can be as little as a large or small ball of silicone oil in the anterior chamber, or as much as a full anterior chamber, with varying degrees of elevated intraocular pressure. It is not easy to deal with it, often is released out of how much, and then out of how much; not put not, and then put and fear of silicone oil filling the posterior chamber is not enough. It is indeed disturbing, combined with their own experience to talk about the reasons and treatment methods.
One of the reasons is the imbalance of pressure between the anterior and posterior sides at the end of surgery. Once the patient turns over to face upward after sleeping, silicone oil can easily enter the anterior chamber, which is one of the most common reasons for silicone oil entering the anterior chamber on the first day after surgery. The second reason, high silicone oil filling pressure in the posterior atrium, is another cause of silicone oil entering the anterior atrium, including two meanings, 1) indeed the amount of silicone oil injection is high; 2) there is postoperative active bleeding, especially in patients with PDR, secondary to elevated posterior atrial pressure. Reason number three, the patient’s poor compliance and inability to implement the position maintenance explained by the meaning.
Points to note: joint surgery, airtight cataract surgical incision, and maintaining normal anterior chamber depth are crucial. For those who enter the gas in the anterior chamber during gas-liquid exchange, filling with silicone oil results in silicone oil entering the anterior chamber very easily. Therefore, it is best to replace the gas in the anterior chamber (which is not easy) before injecting silicone oil. Those who do all the above well, once there is a postoperative silicone oil into the anterior chamber, in addition to asking the patient’s postural maintenance, be sure to find out the patient’s blood pressure and check the fundus to see if there is a bleeding package after the silicone oil.
Treatment of silicone oil in the anterior chamber: silicone oil balls, if they do not affect the pupil and intraocular pressure, can be placed for observation, or can be chosen to be treated together when the silicone oil is removed in 2-3 months. When the amount of silicone oil is large, choose to go on the operating table and replace the silicone oil with viscoelastic first, and then BSS with viscoelastic. The presence of pressure in the anterior chamber must be ensured throughout the operation, otherwise the silicone oil in the posterior chamber will spill out at any time.
Small experience, may the patient benefit and share with colleagues.