T Pearl

For eyes with serious posterior segment trauma, silicone oil, not long-acting gas, is the preferred tamponade.

With regard to silicone oil tamponade:

• If it is possible to know before surgery that silicone oil will be used, it makes sense to determine the eye's axial length. The measurement is much less reliable in a silicone oil-filled eye. The reading comes handy when the silicone oil is removed; simultaneous IOL implantation can be performed should the lens become cataractous and be extracted at the time of silicone oil removal.

• Implant the silicone oil after a fluid-air exchange to achieve a complete fill.65

• There is BSS lining the retinal surface; it takes time for this fluid to collect at the disc during fluid-air exchange (Table 2.9.6). It takes much longer for this BSS to "trickle down" to the bottom of the eye if there

64 Detailed discussion of the indications for, and selection of, different tamponade options is beyond the scope of this book. Table 2.9.6 shows selected suggestions regarding intravitreal exchanges.

65 100% is not feasible, but the fill should be as close to it as possible.

Table 2.9.6 Exchanges in the vitreous cavity

Exchange from

Exchange to

Yes (+) or no (-)

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