Clinical observation on the efficacy of modified anterior approach transpupillary silicone oil removal combined with phacoemulsification and intraocular lens implantation_Chinese Journal of Ocular Fundus Diseases

Authors：

Shen Chenxiao ¹ , Zhang Liang ¹ , Huang Zhongning ¹ , Cheng Zhixing ¹ , Cao Dan ¹ , Cui Ying ¹ , Chen Yesheng ² , Chen Ruoyu ³ , Yu Honghua ¹ ,  Liang Anyi ¹

1. Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China;
2. Department of Ophthalmology, Department of Ophthalmology, The People's Hospital of Torch Development Zone (Zhongshan Sixth People's Hospital), Zhongshan 528400, China;
3. Department of Optometry, The Hong Kong Polytechnic University, Hong Kong 999077, China;

Corresponding author：

Liang Anyi, Email: lianganyi@gdph.org.cn

Keywords：

Silicone oil removal; Phacoemulsification; Irrigation; Complication

DOI：

10.3760/cma.j.cn511434-20250225-00074

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Objective To investigate and evaluate the clinical efficacy and safety of a modified anterior approach for transpupillary silicone oil removal combined with phacoemulsification and intraocular lens (IOL) implantation. Methods A retrospective case-control study. A total of 148 patients (148 eyes) who underwent silicone oil removal combined with cataract surgery at the Department of Ophthalmology, Guangdong Provincial People's Hospital between January 2020 and November 2024 were included in the study. All affected eyes underwent preoperative examinations including best-corrected visual acuity (BCVA), intraocular pressure, corneal topography, and optical coherence tomography (OCT). Based on the method of silicone oil removal, the eyes were divided into two groups: group A (modified anterior approach transpupillary silicone oil removal combined with phacoemulsification and IOL implantation, 99 eyes) and group B (standard pars plana vitrectomy for silicone oil removal combined with phacoemulsification and IOL implantation, 49 eyes). The surgical duration, changes in BCVA and intraocular pressure at 1 day, 7 days, and 1 month postoperatively, as well as the incidence of complications such as corneal edema and its resolution, conjunctival congestion, iris prolapse, posterior capsule rupture, nucleus drop, IOL position, residual silicone oil in the vitreous cavity or anterior chamber, vitreous hemorrhage, recurrent retinal detachment (RD), and choroidal detachment or hemorrhage, were compared between the two groups. The independent sample t-test was used for the comparison of measurement data between the two groups, and the χ² test was used for the comparison of count data. Results The operation time of group A and group B was (17.01±1.28) min and (31.62±2.32) min, respectively. The operation time of group A was significantly shorter than that of group B, and the difference was statistically significant (t=−41.002, P＜0.001). The comparison of BCVA (t =−0.561, −0.833, −1.386) and IOP (t =−0.055, 1.375, −0.507) between the two groups of affected eyes before surgery and at 1 day and 7 days after surgery showed no statistically significant differences (P＞0.05). There was no silicone oil residual in group A, while 3 eyes in group B were observed with silicone oil residual (6.1%, 3/49). Neovascular glaucoma was observed in one eye. Compared to group A, group B exhibited a statistically significant increase in the incidence of postoperative conjunctival congestion, silicone oil retention, and posterior capsular opacification (χ²=10.600, 6.187, 92.617; P＜0.05). In contrast, no statistically significant differences were observed between the groups in the incidence of corneal edema or recurrent retinal detachment (RD) (χ²=0.272, 1.557; P＞0.05). No intraoperative complications, such as iris prolapse, posterior capsular rupture, nucleus drop, zonular dehiscence, choroidal detachment, or hemorrhage, occurred in any of the operated eyes. Furthermore, no postoperative complications, including corneal endothelial decompensation, IOL displacement, or endophthalmitis, were observed during the follow-up period. Conclusion Compared to the conventional pars plana approach for silicone oil removal combined with cataract surgery, the modified anterior perfusion transpupillary approach demonstrated significantly shorter surgical duration and a reduced incidence of postoperative complications.

Citation： Shen Chenxiao, Zhang Liang, Huang Zhongning, Cheng Zhixing, Cao Dan, Cui Ying, Chen Yesheng, Chen Ruoyu, Yu Honghua, Liang Anyi. Clinical observation on the efficacy of modified anterior approach transpupillary silicone oil removal combined with phacoemulsification and intraocular lens implantation. Chinese Journal of Ocular Fundus Diseases, 2025, 41(10): 780-786. doi: 10.3760/cma.j.cn511434-20250225-00074 Copy

1.	Jonas JB, Budde WM, Panda-Jonas S. Cataract surgery combined with transpupillary silicone oil removal through planned posterior capsulotomy[J]. Ophthalmology, 1998, 105(7): 1234-1237. DOI: 10.1016/S0161-6420(98)97026-9.
2.	Cheng L, Azen SP, El-Bradey MH, et al. Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study[J]. Am J Ophthalmol, 2001, 132(6): 881-887. DOI: 10.1016/s0002-9394(01)01263-6.
3.	Karacorlu M, Hocaoglu M, Sayman Muslubas I, et al. Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment[J]. Int Ophthalmol, 2019, 39(1): 117-124. DOI: 10.1007/s10792-017-0787-9.
4.	Issa R, Xia T, Zarbin MA, et al. Silicone oil removal: post-operative complications[J]. Eye (Lond), 2020, 34(3): 537-543. DOI: 10.1038/s41433-019-0551-7.
5.	Oliveira RA, Magalhaes Junior O, Rossi J, et al. Complications of silicone oil as vitreous tamponade in pars plana vitrectomy: a mini review[J]. Curr Eye Res, 2025, 50(4): 353-361. DOI: 10.1080/02713683.2024.2409883.
6.	Soliman MK, Hardin JS, Jawed F, et al. A database study of visual outcomes and intraoperative complications of postvitrectomy cataract surgery[J]. Ophthalmology, 2018, 125(11): 1683-1691. DOI: 10.1016/j.ophtha.2018.05.027.
7.	邵敬芝, 杜珊珊, 袁超峰, 等. 硅油取出联合晶状体超声乳化术中3 种取油方式效果比较[J]. 中华眼外伤职业眼病杂志, 2022, 44(4): 246-252. DOI: 10.3760/cma.j.cn116022-20211007-00353.Shao JZ, Du SS, Yuan CF, et al. Comparison of efficacy among three methods of silicone oil removal combined with phacoemulsification[J]. Chin J Ocul Traum Occupat Eye Dis, 2022, 44(4): 246-252. DOI: 10.3760/cma.j.cn116022-20211007-00353.
8.	王应飞, 吴众. 自制灌注器进行硅油取出联合白内障超声乳化术的临床观察[J]. 中华眼外伤职业眼病杂志, 2022, 44(4): 273-278. DOI: 10.3760/cma.j.cn116022-20211123-00438.Wang YF, Wu Z. Clinical observation of self-made infusion cannula-assisted silicone oil removal combined with phacoemulsification cataract surgery[J]. Chin J Ocul Traum Occupat Eye Dis, 2022, 44(4): 273-278. DOI: 10.3760/cma.j.cn116022-20211123-00438.
9.	Zhu YC, Yuan DQ, Xie P, et al. Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation[J]. Int J Ophthalmol, 2017, 10(11): 1693-1697. DOI: 10.18240/ijo.2017.11.09.
10.	Goezinne F, Nuijts RM, Liem AT, et al. Corneal endothelial cell density after vitrectomy with silicone oil for complex retinal detachments[J]. Retina, 2014, 34(2): 228-236. DOI: 10.1097/IAE.0b013e3182979b88.
11.	Dada VK, Talwar D, Sharma N, et al. Phacoemulsification combined with silicone oil removal through a posterior capsulorhexis[J]. J Cataract Refract Surg, 2001, 27(8): 1243-1247. DOI: 10.1016/s0886-3350(00)00864-6.
12.	Thulasidas M, Gupta H, Sachdev MS, et al. Microincision phacoemulsification combined with sutureless transpupillary passive silicone oil removal[J]. Indian J Ophthalmol, 2021, 69(9): 2311-2316. DOI: 10.4103/ijo.IJO_3538_20.
13.	Boscia F, Cardascia N, Sborgia L, et al. Evaluation of corneal damage by combined phacoemulsification and passive efflux of silicone oil in vitrectomized eyes[J]. J Cataract Refract Surg, 2003, 29(6): 1120-1126. DOI: 10.1016/s0886-3350(03)00069-5.
14.	Cacciatori M, Aspinall P, Bennett HG, et al. Corneal endothelial evaluation after phacoemulsification and silicone oil removal via an anterior approach[J]. Retina, 2007, 27(6): 755-758. DOI: 10.1097/IAE.0b013e31802eacce.
15.	荣翱, 李厚硕, 李雯, 等. 硅油取出联合白内障超声乳化术的临床探讨[J]. 中国实用眼科杂志, 2007, 25(9): 1026-1028. DOI: 10.3760/cma.j.issn.1006-4443.2007.09.031.Rong A, Li HS, Li W, et al. Clinical investigation of concurrent silicone oil removal and phacoemulsification cataract surgery[J]. Chin J Pract Ophthalmol, 2007, 25(9): 1026-1028. DOI: 10.3760/cma.j.issn.1006-4443.2007.09.031.
16.	Diaz-Valle D, Benitez Del Castillo Sanchez JM, Toledano N, et al. Endothelial morphological and functional evaluation after cataract surgery[J]. Eur J Ophthalmol, 1996, 6(3): 242-245. DOI: 10.1177/112067219600600303.
17.	Dick HB, Kohnen T, Jacobi FK, et al. Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision[J]. J Cataract Refract Surg, 1996, 22(1): 63-71. DOI: 10.1016/s0886-3350(96)80272-0.

1. Jonas JB, Budde WM, Panda-Jonas S. Cataract surgery combined with transpupillary silicone oil removal through planned posterior capsulotomy[J]. Ophthalmology, 1998, 105(7): 1234-1237. DOI: 10.1016/S0161-6420(98)97026-9.
2. Cheng L, Azen SP, El-Bradey MH, et al. Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study[J]. Am J Ophthalmol, 2001, 132(6): 881-887. DOI: 10.1016/s0002-9394(01)01263-6.
3. Karacorlu M, Hocaoglu M, Sayman Muslubas I, et al. Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment[J]. Int Ophthalmol, 2019, 39(1): 117-124. DOI: 10.1007/s10792-017-0787-9.
4. Issa R, Xia T, Zarbin MA, et al. Silicone oil removal: post-operative complications[J]. Eye (Lond), 2020, 34(3): 537-543. DOI: 10.1038/s41433-019-0551-7.
5. Oliveira RA, Magalhaes Junior O, Rossi J, et al. Complications of silicone oil as vitreous tamponade in pars plana vitrectomy: a mini review[J]. Curr Eye Res, 2025, 50(4): 353-361. DOI: 10.1080/02713683.2024.2409883.
6. Soliman MK, Hardin JS, Jawed F, et al. A database study of visual outcomes and intraoperative complications of postvitrectomy cataract surgery[J]. Ophthalmology, 2018, 125(11): 1683-1691. DOI: 10.1016/j.ophtha.2018.05.027.
7. 邵敬芝, 杜珊珊, 袁超峰, 等. 硅油取出联合晶状体超声乳化术中3 种取油方式效果比较[J]. 中华眼外伤职业眼病杂志, 2022, 44(4): 246-252. DOI: 10.3760/cma.j.cn116022-20211007-00353.Shao JZ, Du SS, Yuan CF, et al. Comparison of efficacy among three methods of silicone oil removal combined with phacoemulsification[J]. Chin J Ocul Traum Occupat Eye Dis, 2022, 44(4): 246-252. DOI: 10.3760/cma.j.cn116022-20211007-00353.
8. 王应飞, 吴众. 自制灌注器进行硅油取出联合白内障超声乳化术的临床观察[J]. 中华眼外伤职业眼病杂志, 2022, 44(4): 273-278. DOI: 10.3760/cma.j.cn116022-20211123-00438.Wang YF, Wu Z. Clinical observation of self-made infusion cannula-assisted silicone oil removal combined with phacoemulsification cataract surgery[J]. Chin J Ocul Traum Occupat Eye Dis, 2022, 44(4): 273-278. DOI: 10.3760/cma.j.cn116022-20211123-00438.
9. Zhu YC, Yuan DQ, Xie P, et al. Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation[J]. Int J Ophthalmol, 2017, 10(11): 1693-1697. DOI: 10.18240/ijo.2017.11.09.
10. Goezinne F, Nuijts RM, Liem AT, et al. Corneal endothelial cell density after vitrectomy with silicone oil for complex retinal detachments[J]. Retina, 2014, 34(2): 228-236. DOI: 10.1097/IAE.0b013e3182979b88.
11. Dada VK, Talwar D, Sharma N, et al. Phacoemulsification combined with silicone oil removal through a posterior capsulorhexis[J]. J Cataract Refract Surg, 2001, 27(8): 1243-1247. DOI: 10.1016/s0886-3350(00)00864-6.
12. Thulasidas M, Gupta H, Sachdev MS, et al. Microincision phacoemulsification combined with sutureless transpupillary passive silicone oil removal[J]. Indian J Ophthalmol, 2021, 69(9): 2311-2316. DOI: 10.4103/ijo.IJO_3538_20.
13. Boscia F, Cardascia N, Sborgia L, et al. Evaluation of corneal damage by combined phacoemulsification and passive efflux of silicone oil in vitrectomized eyes[J]. J Cataract Refract Surg, 2003, 29(6): 1120-1126. DOI: 10.1016/s0886-3350(03)00069-5.
14. Cacciatori M, Aspinall P, Bennett HG, et al. Corneal endothelial evaluation after phacoemulsification and silicone oil removal via an anterior approach[J]. Retina, 2007, 27(6): 755-758. DOI: 10.1097/IAE.0b013e31802eacce.
15. 荣翱, 李厚硕, 李雯, 等. 硅油取出联合白内障超声乳化术的临床探讨[J]. 中国实用眼科杂志, 2007, 25(9): 1026-1028. DOI: 10.3760/cma.j.issn.1006-4443.2007.09.031.Rong A, Li HS, Li W, et al. Clinical investigation of concurrent silicone oil removal and phacoemulsification cataract surgery[J]. Chin J Pract Ophthalmol, 2007, 25(9): 1026-1028. DOI: 10.3760/cma.j.issn.1006-4443.2007.09.031.
16. Diaz-Valle D, Benitez Del Castillo Sanchez JM, Toledano N, et al. Endothelial morphological and functional evaluation after cataract surgery[J]. Eur J Ophthalmol, 1996, 6(3): 242-245. DOI: 10.1177/112067219600600303.
17. Dick HB, Kohnen T, Jacobi FK, et al. Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision[J]. J Cataract Refract Surg, 1996, 22(1): 63-71. DOI: 10.1016/s0886-3350(96)80272-0.

Chinese Journal of Ocular Fundus Diseases

Clinical observation on the efficacy of modified anterior approach transpupillary silicone oil removal combined with phacoemulsification and intraocular lens implantation

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