Method of tamponade of the vitreous cavity with silicone oil in concomitant aniridia and aphakia

Objective. To demonstrate a method of vitreal cavity tamponade with silicone oil in concomitant aniridia and aphakia using a clinical case as an example. Method. Patient A., 65 years old, was admitted with complaints of low visual acuity in the left eye. According to the patient, the diagnosis of keratoconus OU was made at the Scientific and Technical Complex of the Moscow City Hospital (Moscow) in 2019. In 2020, surgical treatment of OU was performed - penetrating keratoplasty (corneal transplantation) + cataract phacoemulsification with implantation of an intraocular lens (IOL). According to the patient, in October 2024, she fell down the stairs and hit her left eye. Primary surgical treatment of the wound and removal of the IOL were performed at the place of residence. In November 2024, she contacted the Scientific and Technical Complex of the Moscow City Hospital (Moscow). According to the examination data: visual acuity of the left eye (Visus) pr.l.incertae, intraocular pressure (pneumotonometry) 8 mm Hg. During biomicroscopy of the left eye: the transplant is edematous, the corneal sutures are adapted, the aqueous humor of the anterior chamber is transparent, the iris is completely aniridia, the vitreous cavity is hemophthalmos. The fundus of the eye is not ophthalmoscoped. According to the results of ultrasound ophthalmoscanning in B-mode - in the vitreous body there are fine-grained opacities, fibrous structures. Total V-shaped detachment of the retina. Subretinal hemorrhagic inclusions. The choroid is exfoliated in the outer and lower segments H - 2.8 mm, hemorrhagic in nature. The diagnosis was: OS Consequence of trauma to the eye and periorbital region. Posttraumatic aniridia. Aphakia. Total retinal detachment. Choroidal detachment. As a result, a decision was made to perform surgical treatment in 2 stages: Stage 1 - microinvasive subtotal vitrectomy + epiretinal membrane removal + schwartectomy + circular retinotomy + endolaser coagulation (ELC) + administration of a perfluororganic compound (PFOC); Stage 2 - microinvasive revision of the vitreous cavity + PFOC removal + ELC + silicone. During the intervention, three 25G ports were installed at 2, 8 and 10 o'clock and 1 paracentesis was formed at 12 o'clock. A revision of the vitreous cavity was performed - the retina is adjacent. Then, to create a barrier between the silicone oil and the aqueous humor, a star-shaped suture was applied 2 mm from the limbus with a 10/0 polypropylene thread. Next, using a thermal cautery, flanges were formed at the ends of the thread. Then, the silicone was successively replaced with air. After that, endolaser coagulation of the retina was performed along the edge of the retinotomy and tamponade of the vitreous cavity with silicone oil. To ensure complete tamponade of the vitreous cavity, an adhesive viscoelastic was introduced into the anterior chamber, which intraoperatively prevents silicone from entering the anterior chamber. Then the ports were removed. The sclerotomies were sealed with 8/0 polypropylene thread. Results. The surgical intervention was performed without complications. In the postoperative period, standard anti-inflammatory and antibacterial therapy were prescribed. On the 1st day after the operation: visual acuity of the left eye 0.05 n/c, intraocular pressure (IOP) of the left eye (pneumotonometry) 19 mm Hg. According to the ultrasound ophthalmoscanning in B-mode: silicone in the vitreous cavity, membranes are adjacent, the retina is moderately edematous. One month after the intervention: visual acuity of the left eye is 0.1 n/c, IOP is 20 mm Hg. Conclusions. The specified method of surgical treatment allows preventing the migration of silicone oil into the anterior chamber in patients with aniridia and aphakia. Key words: silicone oil, aniridia, aphakia