Outcomes of Silicone Oil Removal in Complex Retinal Detachment

Abstract

Introduction: Pars plana vitrectomy in combination with intraocular tamponade with silicone oil is a standard technique in the treatment of complex retinal detachment. Although the use of silicone oil has improved the results of retinal detachment surgery, its removal is recommended due to the ocular complications related to its long term use. However, retinal redetachment can occur after silicone oil removal.
 Objective: To evaluate the anatomical and visual outcome after silicone oil removal (SOR) in eyes with complicated retinal detachment.
 Material and Methods: We retrospectively analyzed 64 eyes of 64 consecutive patients of silicone oil removal over a period of 12 months. All eyes had undergone standard 3 ports pars plana vitrectomy with silicone oil placement for complicated retinal detachment. Cases that completed at least 1 month follow up duration after SOR were included in the study. Anatomical success after SOR was achieved in 56 of 64 eyes (87.5%). Seven of 8 redetachments (87.5%) were seen in eyes with silicone oil tamponade duration of less than 6 months. Visual acuity improved or was stabilized in 49 of 64 eyes (76.6%). Using paired T-test, it was found that there was no significant difference in pre and post SOR visual acuity. Postoperative ocular hypertension, corneal decompensation, band shaped keratopathy and hypotony was observed in 9.4%, 4.7%, 6.4% and 21.9% respectively.
 Conclusion: Although there was no significant improvement in visual acuity, redetachment and complication rates were comparable to other studies. The duration of endotamponade was not significantly associated with the redetachment rate. Key words: Silicone oil removal, Redetachment, Visual outcome, Keratopathy, ocular hypertension.

Sociodemographic Factors and Comorbidities Including Hyperparathyroidism Are Associated With an Increased Risk of Band Keratopathy: A Population-Based Study in Taiwan

“…Silicone oil is either removed 3–6 months postoperatively or long-term silicone tamponade is performed depending on various diseases and situations. The observation is the same as that in several studies, which demonstrated that silicone oil tamponade is an important risk factor for band keratopathy ( 6 , 7 , 37 ) even after removal ( 38 ). Although the mechanism of band keratopathy is multifactorial, many studies have shown that silicone oil plays a significant role in the development of band keratopathy ( 7 , 37 ) and that the tissue toxicity of silicone oil or pH changes due to from decreased flow across the corneal tissue may be associated with band keratopathy development ( 39 ).…”

Risk Factors for Band Keratopathy in Aphakic Eyes With Silicone Oil Tamponade for Open-Globe Injuries: A Multicenter Case-Control Study

“…Furthermore, Dooley et al (22) reported that corneal pathology (13.8%) and anterior segment emulsification (8.3%) occurred in eyes with long-term heavy silicone oil tamponade. In contrast, incidences of postoperative corneal decompensation (4.7%) and band-shaped keratopathy (6.4%) were lower after silicone oil was removed (9). In this study, the other independent risk factor for BK was zone III of the OGI, which suggests that the globe opening location would extend more posteriorly than the pars plana (4).…”

“…Secondary intraocular pressure (IOP) changes and silicone oil entering the anterior chamber should also be considered. Shah et al (9) found that the incidences of postoperative corneal decompensation, BK, ocular hypertension, and hypotony were 4.7, 6.4, 9.4, and 21.9%, respectively, after silicone oil removal. Yüksel et al (10) placed silicone oil barrier sutures in aphakic eyes with iris defects; hypotony and BK still occurred in 31% of eyes.…”

Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

“…The pathophysiology of BK can be multifactorial, oftentimes resulting from chronic inflammation, corneal ulcers, chemical burns and multiple surgeries 37. However, it has been reported that SO can contribute to the development of BK,38 which usually occurs following prolonged SO contact with the corneal endothelium,38–40 with an incidence of 6% to 28% 38,39,41,42. SO blocks the transport of nutrients from the aqueous humor, leading to a lower endothelial metabolic rate 43.…”

“…As such, lighter oils allow for easier injection and faster removal, while heavier oils are less likely to emulsify in the vitreous cavity 67. Although there are no reported differences in the rate of corneal complications based on the type of oil, the rate of complications does increase the longer the oil remains inside the vitreous cavity, with a significantly increased risk after 6 months 38,39,41,42…”