Vitreous Substitute, Retinal Detachment , Indication and Complications of using Silicone oil.

1. OIL AND FLOURO SILICONE OILS (PART -I)
DR.PUSHKAR DHIR , DR.JITENDER
VR FELLOW
SRI SANKARADEVA NETHRALAYA
Moderator
Dr.Manab Jyoti Barman
HOD , SSN

4. WHICH IS HEAVIER ?

6. Q. WHAT SUBSTITUTE WILL U PUT TO PUSH IT BACK ?
Q. WHAT DO U SEE IN THIS PICTURE?

7. 1.HOW MUCH PRESSURE IT WILL PUT ON
RETINAL SURFACE?
2.WHY OIL WHY NOT SOME PASTE
3.WHY NOT JUST WATER.
4.IF OIL IS LIGHTER THAN WATER THEN WHY
USE OIL FOR RD ATTACHEMTN (ASK WITH A
PIC)

8. HB SIR VIDEO OF RETINAL DETACHMENT

10. CHEMICAL COMPOSITION & HISTORY
• Silicone is made up of repeating units of siloxane.
• Term silicone is a generic term referring to all materials made up of
siloxane, including silicone in its fluid form (e.g., SO), as well as
silicone in its solid form (e.g., encircling band, gutters, and tires).
• Siloxane consists of a silicone and an oxygen molecule, with the
chemical formula [−Si-O−].
• Silicone is capable of forming two additional bonds on its sides,
different organic or inorganic side chains could be attached to the
silicone molecule to form polymers with different properties.
• Silicone oil (SO) was first introduced as an internal tamponade agent
in the early 1960s.

11. • Heavier-than-water SO = solution of a mixture of
polymethylsiloxane + semifluorinated alkanes or
alkenes.
• MC SO consists of polydimethylsiloxane (siloxane
with two attached methyl side chains), also known
as PDMS.
• Methyl and a trifluoropropyl side chain could be
added to the siloxane unit to form
polytrifluoropropylmethylsiloxane, also known as
fluorosilicone oils.
• Fluorosilicone oils have a specific gravity of 1.25–
1.3, hence its heavier-than-water properties.

12. TYPE OF
SILICONE OILS
• Heavier-than-water SO = solution of a
mixture of polymethylsiloxane +
semifluorinated alkanes or alkenes.

14. PHYSICAL PROPERTIES OF SILICONE OIL
Specific Gravity
Buoyancy
Matlab Pani se
Bhari hai ya Halka
OIL will float or sink

15. PHYSICAL PROPERTIES OF SILICONE OIL
Surface Tension
Viscosity
Matlab Pani Par Chal Sakte ho Jane nah denge tujhe..akele

16. MODE OF ACTION OF SILICONE OIL
• Tamponade
• Space Filler
• Haemostasis
• Inhibition of Membrane
Contraction
• Maintain IOP

17. PREFERABLE INDICATIONS FOR USING SILICONE OIL
• RD with proliferative Vitreoretinopathy (prevents vasoproliferativhe factor
migration , decrease post of haem)
• Giant retinal tear - Unfolding the retina
• Traumatic RD- Long term tamponade
• Diabetic TRD with Rhegmatogenous detachment
• Retinal Detachment complicated by iris neovascularization
• Patient noncompliance with position
• Patient intends to travel by air
• Endophthalmitis - Antibacterial properties , drug concentration , support to
fragile retina.
• Infectious retinitis-CMV retinitis with gancyclovir implant.

18. COMPLICATIONS WITH SILICONE OIL
•Emulsification
•Cataract
•Glaucoma
•Band shaped keratopathy——> Bullous Keratopathy
•Unexplained Visual Loss
•Redetachment
•Absorption of silicone oil by silicone intraocular lenses,
•Migration of silicone oil into the optic nerve and rarely into
the brain.

20. Unexplained Visual Loss
Investigators studies K+ ions in retro-oil fluid and they were found to be same as vitreous.
Mg & Cl levels were lower than vitreous. LDL were higher

21. OPTICS
WITH
SILICONE OIL

22. GAS OR OIL

23. 25 YR OLD PATIENT OPERATED FOR RD ELSEWHERE WITH SO FILLED EYE , NOW
DEVELP TOTAL CATARACT .
Q.HOW WILL U MEASURE AXIAL LENGTH?
Q.WHICH FORMULA U WILL USE TO CALCULATE IOL POWER?
SPEED OF SOUND , CONCEPT OF CORRECTION FACTOR

26. SOR

27. Q. HOW LONG CAN U KEEP SILICON OIL IN VIT CAVITY ?

28. EMULSIFICATION OF SILICONE OIL

29. REFERENCES
• RYAN RETINA- SPECIAL ADJUNCTS TO TREATMENT
• GOOGLE
• SLIDESHARE

30. For feedback & Brickbats plz mail at
• ykush@yahoo.co.in./drdhir2014@gmail.com

31. PROGRAMME SCHEDULE
TITLE SPEAKER
How to get best from OCT Imaging
(acquiring images, follow up images,
OCT report regeneration and
interpretation)
45 Min Mr.Hansel Anthony
Discussion 30 Min
OCT’s Imaging in special reference to
Macular Diseases
45 Min Dr.Rohan Chawla
Discussion 30 Min
OCT based Case Discussions 60 Min SSN team
Newer Imaging Modalities & where the
future holds
30 Min Dr.Rohan Chawla
Grand Discussion 45 Min
OCT OASIS
“WHERE BLACK &WHITE MAKE SENSE”
SATURDAY 10 AM OCTOBER 27 2018
VENUE
SRI SANKARDEVA NETRALAYA
K.D LAHKAR AUDITORIUM
REGISTRATION FREE BUT COMPULSORY
For inquiry:- Dr.Awaneesh Upadhyay
Tel:- +91-9995987969
drawaneesh@gmail.com, ssnghy1@gmail.com
Invited Faculty :-Dr.Rohan Chawla MD
Assitant Professor
AIIMS New Delhi
Vitreo Retina Services :-Dr.Manab Jyoti Barman, Dr.Hemlata Deka
Dr.Ronel Soibam, Dr.Awaneesh Upadhyay
Dr.Parvez Bhat, Dr.Debojit Deka
Dr.Divakant Misra, Dr.Pushkar Dhir
Dr.Chitan Desai , Dr.Jitender Singh
Dr.Harsha Bhattacharjee

32. Q.CONVENTIONAL SO IS LIGHTER THAN WATER , SO CAN IT BE
USE IN INFERIOR BREAKS RD?