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Table 1. 
Patient Characteristics
Patient Characteristics
Table 2. 
Preoperative Ocular Characteristics
Preoperative Ocular Characteristics
Table 3. 
Baseline Visual Acuity by Type of Oil and Cause of Retinal Detachment
Baseline Visual Acuity by Type of Oil and Cause of Retinal Detachment
Table 4. 
Retinal Redetachment Rates by Type of Oil and Length of Follow-up
Retinal Redetachment Rates by Type of Oil and Length of Follow-up
Table 5. 
Cumulative Retinal Redetachment Rate by Type of Oil and Cause of Original Retinal Detachment
Cumulative Retinal Redetachment Rate by Type of Oil and Cause of Original Retinal Detachment
Table 6. 
Macula-Off Retinal Redetachment Rates by Type of Oil and Follow-up Visit
Macula-Off Retinal Redetachment Rates by Type of Oil and Follow-up Visit
Table 7. 
Change in Visual Acuity by Type of Oil and Cause of Retinal Detachment at 6 Months of Follow-up
Change in Visual Acuity by Type of Oil and Cause of Retinal Detachment at 6 Months of Follow-up
Table 8. 
Outcomes by Follow-up Visit
Outcomes by Follow-up Visit
1.
Cibis  PABecker  BOkun  ECanaan  S The use of liquid silicone in retinal detachment surgery. Arch Ophthalmol 1962;68590- 599
PubMedArticle
2.
Irvine  ARLonn  LSchwartz  DZarbin  MBallesteros  FKroll  S Retinal detachment in AIDS: long-term results after repair with silicone oil. Br J Ophthalmol 1997;81180- 183
PubMedArticle
3.
Davis  JLSerfass  MSLai  MYTrask  DKAzen  SP Silicone oil in repair of retinal detachments caused by necrotizing retinitis in HIV infection. Arch Ophthalmol 1995;1131401- 1409
PubMedArticle
4.
Garcia  RFFlores-Aguilar  MQuiceno  JI  et al.  Results of rhegmatogenous retinal detachment repair in cytomegalovirus retinitis with and without scleral buckling. Ophthalmology 1995;102236- 245
PubMedArticle
5.
Geier  SAKlauss  VBogner  JRSchmidt-Kittler  HSadri  IGoebel  FD Retinal detachment in patients with acquired immunodeficiency syndrome. Ger J Ophthalmol 1994;39- 14
PubMed
6.
Lim  JIEnger  CHaller  JA  et al.  Improved visual results after surgical repair of cytomegalovirus-related retinal detachments. Ophthalmology 1994;101264- 269
PubMedArticle
7.
Chuang  ELDavis  JL Management of retinal detachment associated with CMV retinitis in AIDS patients. Eye 1992;628- 34
PubMedArticle
8.
Freeman  WRQuiceno  JICrapotta  JAListhaus  AMunguia  DAguilar  MF Surgical repair of rhegmatogenous retinal detachment in immunosuppressed patients with cytomegalovirus retinitis. Ophthalmology 1992;99466- 474
PubMedArticle
9.
Regillo  CDVander  JFDuker  JSFischer  DHBelmont  JBKleiner  R Repair of retinitis-related retinal detachments with silicone oil in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 1992;11321- 27
PubMed
10.
Dugel  PULiggett  PELee  MB  et al.  Repair of retinal detachment caused by cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1991;112235- 242
PubMed
11.
Jabs  DAEnger  CHaller  Jde Bustros  S Retinal detachments in patients with cytomegalovirus retinitis. Arch Ophthalmol 1991;109794- 799
PubMedArticle
12.
Sima  PZoran  T Long-term results of vitreous surgery for proliferative diabetic retinopathy. Doc Ophthalmol 1994;87223- 232
PubMedArticle
13.
Karel  IKalvodova  B Long-term results of pars plana vitrectomy and silicone oil for complications of diabetic retinopathy. Eur J Ophthalmol 1994;452- 58
PubMed
14.
Mathis  APagot  VDavid  JL The use of perfluorodecalin in diabetic vitrectomy. Fortschr Ophthalmol 1991;88148- 150
PubMed
15.
Gabel  VPBeck  P Verbessert Silikanöl die Prognose bei Schwerer proliferativer diabetischer Retinopathie? Klin Monatsbl Augenheilkd 1990;197112- 117
PubMedArticle
16.
Brourman  NDBlumenkranz  MSCox  MSTrese  MT Silicone oil for the treatment of severe proliferative diabetic retinopathy. Ophthalmology 1989;96759- 764
PubMedArticle
17.
Yeo  JHGlaser  BMMichels  RG Silicone oil in the treatment of complicated retinal detachments. Ophthalmology 1987;941109- 1113
PubMedArticle
18.
Laqua  HLucke  KFoerster  M Results of silicone oil surgery. Jpn J Ophthalmol 1987;31124- 131
PubMed
19.
Karel  IMichalickova  MSoucek  P Long-term results of pars plana vitrectomy and silicone oil for giant tears. Eur J Ophthalmol 1996;6315- 321
PubMed
20.
Leaver  PK Vitrectomy and fluid/silicone oil exchange for giant retinal tears: 10-year follow-up. Ger J Ophthalmol 1993;220- 23
PubMed
21.
Aylward  GWCooling  RJLeaver  PK Trauma-induced retinal detachment associated with giant retinal tears. Retina 1993;13136- 141
PubMedArticle
22.
Mathis  APagot  VGazagne  CMalecaze  F Giant retinal tears: surgical techniques and results using perfluorodecalin and silicone oil tamponade. Retina 1992;12 ((3 suppl)) S7- S10
PubMedArticle
23.
Kreiger  AELewis  H Management of giant retinal tears without scleral buckling: use of radical dissection of the vitreous base and perfluoro-octane and intraocular tamponade. Ophthalmology 1992;99491- 497
PubMedArticle
24.
Camacho  HBajaire  BMejia  LF Silicone oil in the management of giant retinal tears. Ann Ophthalmol 1992;2445- 49
PubMed
25.
Le Mer  YKroll  P Die Anwendung von flussigem Perfluorocarbon bei Riesenrissen. Klin Monatsbl Augenheilkd 1991;198264- 267
PubMedArticle
26.
Karel  IKalvodova  BDotrelova  DBedrich  P Pars plana vitrectomy with implantation of silicone oil in surgery for very large retinal tears [in Czech]. Cesk Oftalmol 1989;45420- 427
PubMed
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Leaver  PKBillington  BM Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: 5 years follow-up. Graefes Arch Clin Exp Ophthalmol 1989;227323- 327
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Glaser  BM Treatment of giant retinal tears combined with proliferative vitreoretinopathy. Ophthalmology 1986;931193- 1197
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Fisk  MJCairns  JD Silicone oil insertion: a review of 127 consecutive cases. Aust N Z J Ophthalmol 1995;2325- 32
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Körner  FBöhnke  M Vitrektomie bei proliferativer Vitreoretinopathie: anatomische und funktionelle Resultate bei 501 Patienten. Klin Monatsbl Augenheilkd 1995;206239- 245
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Van Meurs  JCMertens  DAPeperkamp  EPost  J Five-year results of vitrectomy and silicone oil in patients with proliferative vitreoretinopathy. Retina 1993;13285- 289
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Zauberman  HHemo  L Silicone oil tamponade for retinal detachment and delayed treatment of retinal tears. Ophthalmic Surg 1993;24600- 603
PubMed
33.
Sell  CHMcCuen  BW  IILanders  MB  IIIMachemer  R Long-term results of successful vitrectomy with silicone oil for advanced proliferative vitreoretinopathy. Am J Ophthalmol 1987;10324- 28
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Stern  WHJohnson  RNIrvine  AR  et al.  Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy. Br J Ophthalmol 1986;70911- 917
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Rinkoff  JSde Juan  E  JrMcCuen  BW  II Silicone oil for retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. Am J Ophthalmol 1986;101181- 186
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Gonvers  M Temporary silicone oil tamponade in the management of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol 1985;100239- 245
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Claes  CZivojnovic  R Treatment of posterior eye segment complications after perforating trauma. Bull Soc Belge Ophtalmol 1992;24561- 63
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Alexandridis  E Silicone oil tamponade in the management of severe hemorrhagic detachment of the choroids and ciliary body after surgical trauma. Ophthalmologica 1990;200189- 193
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Clinical Sciences
April 01, 2005

Outcomes of Complex Retinal Detachment Repair Using 1000- vs 5000-Centistoke Silicone Oil

Author Affiliations

Author Affiliations: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Fla.

Arch Ophthalmol. 2005;123(4):473-478. doi:10.1001/archopht.123.4.473
Abstract

Objective  To compare anatomic and visual acuity outcomes, as well as complication rates, after retinal detachment repair using 1000- vs 5000-centistoke silicone oil.

Methods  Records of all patients who underwent retinal detachment repair with silicone oil at one institution between January 1, 1995, and December 31, 2000, were reviewed. Anatomic outcomes included retinal redetachment and macula-off retinal redetachment. Visual acuity outcomes included ambulatory vision (≥5/200) and change in visual acuity from preoperative examination. Complications included rates of secondary intraocular pressure elevation, hypotony, corneal opacification, cataract, and oil emulsification. Outcomes were assessed at 1 week, 1 month, 3 months, 6 months, and 1 year.

Results  The study included 82 eyes that underwent retinal detachment repair with 1000-centistoke silicone oil and 243 eyes that underwent retinal detachment repair with 5000-centistoke silicone oil. Demographic characteristics, cause of retinal detachment, and preoperative ocular characteristics were similar in the 2 groups. There was no significant difference in the rate of retinal redetachment at each of the follow-up intervals investigated. The cumulative retinal detachment rate was also similar between the 2 groups except among trauma cases, for which 1000-centistoke silicone oil was associated with a higher cumulative redetachment rate (P<.001). There was no significant difference between the groups with respect to (1) change in visual acuity from preoperatively to 6 months postoperatively and (2) the proportion of patients who achieved ambulatory vision at each of the follow-up intervals investigated. Rates of elevated intraocular pressure, hypotony, corneal abnormality, cataract, and silicone oil emulsification were similar in the 2 groups.

Conclusions  Anatomic and visual acuity outcomes, as well as complication rates, were similar in both groups; retinal reattachment and ambulatory vision were achieved in most eyes regardless of oil viscosity.

Silicone oil was first reported for the treatment of retinal detachment in 19621 and has been used increasingly as a retinal tamponade in the management of complex retinal detachments associated with cytomegalovirus necrotizing retinitis,211 proliferative diabetic retinopathy,1218 giant retinal tears,1928 proliferative vitreoretinopathy,2937 and ocular trauma.3845 The National Eye Institute Silicone Study demonstrated the superiority of 1000-centistoke silicone oil compared with sulfur hexafluoride, and its comparability with perfluoropropane, for the treatment of complex retinal detachment associated with advanced proliferative vitreoretinopathy.4648 Several other publications have also reported outcomes after the use of 1000-centistoke silicone oil during retinal detachment repair.4951 To our knowledge, and based on a literature search of the MEDLINE database, there has been no published report comparing the outcomes and complication rates after the use of 1000- vs 5000-centistoke silicone oil retinal tamponade during retinal detachment repair.

The purpose of the present study was to compare anatomic and visual acuity outcomes, as well as complication rates, after retinal detachment repair using 1000- vs 5000-centistoke silicone oil.

METHODS

Medical records of all patients who underwent retinal detachment repair with 1000- or 5000-centistoke silicone oil at Bascom Palmer Eye Institute, Miami, Fla, between January 1, 1995, and December 31, 2000, were reviewed (informed consent was not required for this retrospective chart study). During this period, either 1000- or 5000-centistoke silicone oil (but not both) was available at Bascom Palmer Eye Institute at any one time; thus, there was no selection bias in terms of which type of oil was used. Surgeons had no proprietary interest in either product.

In general, operative procedures consisted of pars plana vitrectomy, relief of epiretinal traction, retinal reattachment by fluid-air exchange, simultaneous internal drainage of subretinal fluid, and cryopexy or laser photocoagulation. Fluid-silicone exchange and/or perfluorocarbon liquids were used in selected cases. The vitreous cavity was filled with silicone oil to the iris plane. An inferior iridectomy was usually performed in aphakic eyes and occasionally in pseudophakic eyes. Eyes without cytomegalovirus necrotizing retinitis were usually treated with scleral buckling if a scleral buckle was not already present. Phakic eyes without cytomegalovirus necrotizing retinitis frequently underwent lensectomy.

For the purposes of this study, a change in visual acuity was defined as a change of at least 0.3 logMAR (logarithm of the minimum angle of resolution) units; this represents a doubling (visual worsening) or halving (visual improvement) of the minimum angle resolvable. Ambulatory vision was defined as a visual acuity of 5/200 or better. Elevated intraocular pressure (IOP) was defined as an IOP greater than 25 mm Hg; hypotony was defined as an IOP less than 5 mm Hg. Corneal abnormality included corneal abrasion, corneal edema, corneal scar, and band keratopathy.

Interval level variables were compared with the 2-sample 2-sided t test. Categorical variables were compared with Fisher exact test or the χ2 test. The exact permutation χ2 test was used when small expected values were encountered. Cumulative rates of retinal redetachment and silicone oil removal were calculated with Kaplan-Meier time-to-failure methods and compared with the log-rank test; Cox proportional hazards survival regression was used to perform multivariate adjustments of time-to-failure data. Rates of complications and visual outcomes were also presented for uniform follow-up visits (1 week, 1 month, 3 months, 6 months, and 1 year). These rates were calculated as ordinary percentages of the number of cases available at each visit and compared with Fisher exact test or, as documented in the text and tables, with logistic regression to adjust for the cause of retinal detachment.

RESULTS

The study included 82 eyes that underwent retinal detachment repair with 1000-centistoke silicone oil and 243 eyes that underwent retinal detachment repair with 5000-centistoke silicone oil. There were no significant differences between the 2 groups in terms of demographic characteristics or cause of retinal detachment (Table 1). Preoperative ocular characteristics were similar between the 2 groups except for a higher proportion of patients with preexisting glaucoma in the 1000-centistoke silicone oil group (Table 2). There was no significant difference between the groups in baseline visual acuity (Table 3). A relaxing retinectomy (an indicator of the complexity of retinal detachment) was performed in 17% of eyes in the 1000-centistoke silicone oil group and 18% in the 5000-centistoke group (P >.99).

There was no significant difference in the rate of retinal redetachment at each of the follow-up intervals investigated (Table 4). The cumulative retinal detachment rate was also similar between the 2 groups except among trauma cases, for which 1000-centistoke silicone oil was associated with a higher cumulative redetachment rate (P<.001) (Table 5). If retinal redetachment occurred, it was more likely to be macula-off in the 5000-centistoke silicone oil group (Table 6). The cumulative proportion of patients who had their silicone oil removed by 6 months was 20% in the 1000-centistoke silicone oil group and 19% in the 5000-centistoke group; at 1 year, these cumulative percentages were 38% and 41%, respectively (P = .71, log-rank test).

There was no significant difference between the groups with respect to change in visual acuity preoperatively compared with 6 months postoperatively (Table 7). There was also no significant difference between the groups with respect to the proportion of patients who achieved ambulatory vision at each of the follow-up intervals (Table 8). There was no significant difference between the groups in the rates of elevated IOP, hypotony, corneal abnormality, or new cataract at each of the follow-up intervals analyzed except for elevated IOP at 6 months (higher rate in the 1000-centistoke group) and corneal abnormality at 1 year (higher in the 5000-centistoke group) (Table 8). Silicone oil emulsification was noted in 3 patients (4%) in the 1000-centistoke group and 4 patients (2%) in the 5000-centistoke group (P = .37).

COMMENT

Silicone oil is commonly used for the repair of complex retinal detachments, but published data on outcomes of such surgery are limited primarily to patients treated with 1000-centistoke silicone oil.4651 Although 1000- and 5000-centistoke silicone oil are similar in terms of surface tension (21.2 dynes/cm and 21.3 dynes/cm, respectively) and specific gravity (0.971 and 0.973, respectively), they differ significantly in terms of molecular weight (25 000 and 50 000, respectively).52 Higher-viscosity silicone oil has been reported to have a lower tendency to emulsify.5357 Although the emulsification rates in the present series were not significantly different between the 2 groups, the emulsification rates observed in both groups in the present retrospective study were low; a prospective study with gonioscopy performed at follow-up visits may show higher emulsification rates and may demonstrate a significant difference between the groups.

Results of the present study indicate that anatomic and visual acuity outcomes were similar between the 2 groups. Retinal reattachment and ambulatory vision were achieved in most eyes in both groups at each follow-up interval investigated, with the retina completely attached in approximately 80% of eyes in each group at 1 year and ambulatory vision achieved in approximately 60% in each group at 1 year.

Complication rates were also similar with each type of silicone oil. The proportion of patients with elevated IOP at 6 months was significantly higher in the 1000-centistoke group, and the proportion of patients with corneal abnormality at 1 year was significantly higher in the 5000-centistoke group. Because these 2 findings were in opposite directions with respect to the type of oil used and were not consistent throughout follow-up, they do not appear to represent clinically significant differences between the 2 types of oil.

The decision of which type of silicone oil to use may depend on surgeon preference. For example, 1000-centistoke silicone oil is easier and faster to inject and to remove from the eye, while a more complete fill of the vitreous cavity with silicone oil may be easier to achieve when 5000-centistoke silicone oil is used (because there may be less egress of 5000- compared with 1000-centistoke silicone oil through the sclerotomy sites during sclerotomy closure).

In summary, there were no significant differences between the 2 groups with respect to anatomic and visual acuity outcomes, as well as complication rates. Retinal reattachment and ambulatory vision were achieved in most eyes undergoing complex retinal detachment repair with either 1000- or 5000-centistoke silicone oil.

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Article Information

Correspondence: Ingrid U. Scott, MD, MPH, Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136 (iscott@bpei.med.miami.edu).

Submitted for Publication: March 6, 2004; final revision received June 29, 2004; accepted July 16, 2004.

Financial Disclosure: None.

Funding/Support: This study was supported in part by Research to Prevent Blindness Inc, New York, NY.

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Cibis  PABecker  BOkun  ECanaan  S The use of liquid silicone in retinal detachment surgery. Arch Ophthalmol 1962;68590- 599
PubMedArticle
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Irvine  ARLonn  LSchwartz  DZarbin  MBallesteros  FKroll  S Retinal detachment in AIDS: long-term results after repair with silicone oil. Br J Ophthalmol 1997;81180- 183
PubMedArticle
3.
Davis  JLSerfass  MSLai  MYTrask  DKAzen  SP Silicone oil in repair of retinal detachments caused by necrotizing retinitis in HIV infection. Arch Ophthalmol 1995;1131401- 1409
PubMedArticle
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Garcia  RFFlores-Aguilar  MQuiceno  JI  et al.  Results of rhegmatogenous retinal detachment repair in cytomegalovirus retinitis with and without scleral buckling. Ophthalmology 1995;102236- 245
PubMedArticle
5.
Geier  SAKlauss  VBogner  JRSchmidt-Kittler  HSadri  IGoebel  FD Retinal detachment in patients with acquired immunodeficiency syndrome. Ger J Ophthalmol 1994;39- 14
PubMed
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Lim  JIEnger  CHaller  JA  et al.  Improved visual results after surgical repair of cytomegalovirus-related retinal detachments. Ophthalmology 1994;101264- 269
PubMedArticle
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Chuang  ELDavis  JL Management of retinal detachment associated with CMV retinitis in AIDS patients. Eye 1992;628- 34
PubMedArticle
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Freeman  WRQuiceno  JICrapotta  JAListhaus  AMunguia  DAguilar  MF Surgical repair of rhegmatogenous retinal detachment in immunosuppressed patients with cytomegalovirus retinitis. Ophthalmology 1992;99466- 474
PubMedArticle
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Regillo  CDVander  JFDuker  JSFischer  DHBelmont  JBKleiner  R Repair of retinitis-related retinal detachments with silicone oil in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 1992;11321- 27
PubMed
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Dugel  PULiggett  PELee  MB  et al.  Repair of retinal detachment caused by cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1991;112235- 242
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PubMedArticle
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Karel  IKalvodova  B Long-term results of pars plana vitrectomy and silicone oil for complications of diabetic retinopathy. Eur J Ophthalmol 1994;452- 58
PubMed
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Mathis  APagot  VDavid  JL The use of perfluorodecalin in diabetic vitrectomy. Fortschr Ophthalmol 1991;88148- 150
PubMed
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Gabel  VPBeck  P Verbessert Silikanöl die Prognose bei Schwerer proliferativer diabetischer Retinopathie? Klin Monatsbl Augenheilkd 1990;197112- 117
PubMedArticle
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Brourman  NDBlumenkranz  MSCox  MSTrese  MT Silicone oil for the treatment of severe proliferative diabetic retinopathy. Ophthalmology 1989;96759- 764
PubMedArticle
17.
Yeo  JHGlaser  BMMichels  RG Silicone oil in the treatment of complicated retinal detachments. Ophthalmology 1987;941109- 1113
PubMedArticle
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Laqua  HLucke  KFoerster  M Results of silicone oil surgery. Jpn J Ophthalmol 1987;31124- 131
PubMed
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Karel  IMichalickova  MSoucek  P Long-term results of pars plana vitrectomy and silicone oil for giant tears. Eur J Ophthalmol 1996;6315- 321
PubMed
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Leaver  PK Vitrectomy and fluid/silicone oil exchange for giant retinal tears: 10-year follow-up. Ger J Ophthalmol 1993;220- 23
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PubMedArticle
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Mathis  APagot  VGazagne  CMalecaze  F Giant retinal tears: surgical techniques and results using perfluorodecalin and silicone oil tamponade. Retina 1992;12 ((3 suppl)) S7- S10
PubMedArticle
23.
Kreiger  AELewis  H Management of giant retinal tears without scleral buckling: use of radical dissection of the vitreous base and perfluoro-octane and intraocular tamponade. Ophthalmology 1992;99491- 497
PubMedArticle
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Camacho  HBajaire  BMejia  LF Silicone oil in the management of giant retinal tears. Ann Ophthalmol 1992;2445- 49
PubMed
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Le Mer  YKroll  P Die Anwendung von flussigem Perfluorocarbon bei Riesenrissen. Klin Monatsbl Augenheilkd 1991;198264- 267
PubMedArticle
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Karel  IKalvodova  BDotrelova  DBedrich  P Pars plana vitrectomy with implantation of silicone oil in surgery for very large retinal tears [in Czech]. Cesk Oftalmol 1989;45420- 427
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