Abstract
BackgroundSilicone oil tamponade has become a mainstay in treatment of advanced retinal detachment due to multiple etiologies. The aim of this study is to assess the characteristics, fates and complications of long-term silicone oil tamponade after par plana vitrectomy (PPV), and to compare the outcomes of different silicone oil viscosities used in a cohort of consecutive patients.MethodsThis is a retrospective comparative case series of eyes undergoing vitrectomy with silicone oil tamponade for retinal detachment by a single surgeon using different oil viscosities that were followed for one year with the silicone oil in situ. Visual acuity (VA), intraocular pressure (IOP) and complications associated with the follow up period were analyzed and compared.ResultsEighty-five eyes of 85 patients were included in this study. Forty three patients had 1000 centistoke (cs) oil injected and 42 patients had 5000cs oil utilized. Demographic, cause of retinal detachment and preoperative ocular characteristics were similar in both groups. Long term complications in both groups included ocular hypertension (67.4% vs 66.7%), keratopathy due to silicone oil emulsification and migration to the anterior chamber (7.0% vs 11.9%), recurrent retinal detachment (4.7% vs 19%) and epiretinal membrane formation (7% vs 19%). In the 1000cs oil group, there was no significant difference between baseline IOP and any subsequent visit. There was a significant difference between baseline IOP and visits at day 1 (with IOP difference of 2.61 mmHg (±6.5)) (p = 0.028), 1 month (with IOP difference of 3.52 mmHg (±8.1)) (p = 0.026), 4 months (with IOP difference of 6.38 mmHg (±9.3)) (p = 0.005), and one year (with IOP difference of 4.24 mmHg (±11.1)) (p = 0.048), all higher in the post-operative period in the 5000cs oil group. Excluding the first post-operative day, no significant difference was found for VA between baseline visits and subsequent visits for either silicone oil groups.ConclusionIn this cohort of patients with long-term silicone oil tamponade after PPV to treat retinal detachment, IOP increased significantly in patients who received 5000cs silicone oil. There was no significant difference between other complication rates in patients receiving either oil viscosities. Long term silicone oil tamponade remains a viable option in certain cases, and a vigilant follow up for complications is necessary to limit any adverse effects and improve visual and surgical outcomes.
Highlights
Silicone oil tamponade has become a mainstay in treatment of advanced retinal detachment due to multiple etiologies
Long term silicone oil tamponade remains a viable option in certain cases, and a vigilant follow up for complications is necessary to limit any adverse effects and improve visual and surgical outcomes
Upon analyzing the intraocular pressure (IOP) postoperatively compared to the pre-operative baseline for the 5000cs silicone oil group, we found a significant difference between baseline IOP and visits on day 1 (with IOP difference of 2.61 mmHg (±6.5) higher in postoperative) (p = 0.028), 1 month (with IOP difference of 3.52 mmHg (±8.1) higher in post-operative)(p = 0.026), 4 months (with IOP difference of 6.38 mmHg (±9.3) higher in post-operative)(p = 0.005), and last visit (with IOP difference of 4.24 mmHg (±11.1) higher in postoperative)(p = 0.048)
Summary
Silicone oil tamponade has become a mainstay in treatment of advanced retinal detachment due to multiple etiologies. The aim of this study is to assess the characteristics, fates and complications of long-term silicone oil tamponade after par plana vitrectomy (PPV), and to compare the outcomes of different silicone oil viscosities used in a cohort of consecutive patients Ever since their introduction in 1962, silicone oils have increasingly been used in the treatment of advanced retinal detachment (RD) due to multiple etiologies. Silicone oils as tamponading agents were used to provide anatomical reattachment of the retina in cases of rhegmatogenous RDs, giant retinal tears, proliferative vitreoretinopathy, proliferative diabetic retinopathy and ocular trauma [1, 2] Their use was studied in cases of macular hole repair in patients with high myopia, RD due to choroidal coloboma involving the disc, and uveitis associated hypotony [3, 4]. Increasing the extensional viscosity of silicone oil was found to reduce its tendency for emulsification [8]
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