The development of the secondary glaucoma in patients with rhegmathogenous retinal detachment after surgical treatment using silicone tamponade remains insufficiently studied.
The aim of the study was to investigate the changes in hydrodynamics of the eye during the silicone tamponade in the surgery of rhegmathogenous retinal detachment. The observation group was included 66 patients with a diagnosis of rhegmathogenous retinal detachment. All patients had a three-port vitrectomy 23-gaych. Silicone oil was used with a viscosity of 1300 Ss (Baush + Lomb). Patients were received a standard ophthalmologic examination, which included visometry, refractometry, contactless biometrics, biomicroscopy, indirect ophthalmoscopy, and the recording of hydrodynamic parameters.
In silicone tamponades, which have been performed at detachment of the retina in the eutrophic eyes in the first month after the operation, there are changes in hydrodynamics, which are normalized by the end of the month after medication therapy.
In the myopic eyes, the violation of hydrodynamics is expressed to a greater extent and by the end of the month it is normalized only in part of the patients. In 2 weeks after surgery, the intraocular pressure above 21 mm Hg was noted in 59% of cases in a high myopia group and 41% in the group with eutrophic refraction. A month later, with hypotensive drip therapy, intraocular pressure above 21 mm Hg. was marked in 40% of cases, and above 31 mm Hg – in 13% of cases.
In order to improve the removal of silicone oil from the eye after the surgical treatment of rhegmathogenous retinal detachment, it was made the comparison between two methods for withdrawal of silicone. The effectiveness of surgical techniques was compared by the following criteria: the number of residual fragments of silicone in the cavity of the eye, the duration of the operation, the number of additional manipulations on the fundus. The degree of clogging of the vitreal cavity with residual fragments of silicone it was estimated by ultrasonic B-scans.
The average duration of the operation with active removal of silicone oil was 34.13 ± 11.84 minutes, while in the group with the passive method of withdrawal of silicone – 26.25 ± 8.41 min. Methods of the mechanical removal of silicone oil, even when repeatedly washing the cavity of vitreous body, do not allow to achieve the complete purification of the posterior pole of the eye from small fragments of silicone. The repeated washing of the vitreous cavity by the liquid / gas method of replacement and washing of the anterior chamber allows to achieve a reduction in the number of residual fragments of silicone.
To assess the quality of withdrawal of silicone oil from the eye, it was proposed a classification of quantitative evaluation of residual silicone. The analysis of the degree of clogging of the vitreal cavity with the silicone residues, the indicators of visual functions and intraocular pressure before and after the operation did not show a close correlation with any of the parameters.
For the studying of the effectiveness of selective laser trabeculoplasty in the treatment of post-silicone ocular hypertension, after the surgical treatment of rhegmathogenous retinal detachment, 16 patients (16 eyes) were examined, in which, it was observed the increasing intraocular pressure after withdrawal of silicone. The abolition of additional antihypertensive therapy with the preservation of the median IOP below 21 mm Hg was performed in 24% of cases.
For the studying were investigated of physicochemical patterns of interaction of silicone oil and eye during retina tamponade after the surgical treatment of rhymatogenic retinal detachment, 23 samples of silicone oil aspirated from the vitreal eye of patients. The density, aspirated from the eye of patients, the samples was determined at a temperature of 20.00 ± 0.050 C using the pycnometric method, taking into account the correction for the loss of body weight in the air (0.00129 g / cm3). The viscosimetry method, using Ostwald’s viscometry (at a temperature of 20,00 ± 0,050С), determined the relative viscosity of the samples. Depending on the density of the oil phase, the patients were divided into 4 groups.
It was proposed the densimetric mathematical model to determine the degree of emulsion of silicone oil after prolonged contact with the intraocular fluid. It consists of two interconnected equations, and allows on the interval of values of the density, aspirated from the eyes of patients, of silicone oil, to predict changes in the degree of emulsificati
