Abstract
Purpose :
Silicone oil is an important intraocular agent used for tamponade in retinal surgery; however, controversy exists regarding its indications, success rate, and complications. Here we seek to characterize the visual and anatomic outcomes of silicone oil tamponade for complex posterior segment conditions at a tertiary academic ophthalmology department.
Methods :
Retrospective review of 133 surgeries in 76 patients over a period of ten years from 2010 - 2020. Inclusion criteria included any posterior segment surgery involving silicone insertion, removal, or exchange and at least 6 months of follow up data. Demographic, visual and anatomic data were recorded for baseline and post-operative month 3, 6 and 12 visits.
Results :
Average age of patients undergoing surgery was 51 (range 11-98). The most common indications for silicone oil injection during pars plana vitrectomy (PPV) included repair of proliferative vitreoretinopathy (PVR) retinal detachment (RD) (28.7%), and recurrent RD (27.9%). Mean pre-operative visual acuity was counts fingers (CF) at 2ft (1.89 LogMar). Visual acuity was significantly improved at post-operative months 3, 6, and 12 (p-values of 0.02, 0.011, and 0.011, respectively). There was no significant change in intraocular pressure (IOP) compared to pre-operative IOP at any post-operative time point (p>0.05). After silicone oil removal, 79% (15 out of 19 eyes) achieved anatomic reattachment. There was no association with the duration time of endotamponade and redetachment rate. Complications occurred in 32 of 76 (42%) patients. The most common complications were hypotony (22.4%), ocular hypertension (14.5%), recurrent retinal detachment (6.6%), band keratopathy (5.3%), and corneal edema (3.9%). Hypotony stabilized in all cases with time or subsequent surgery. All cases of ocular hypertension resolved with aqueous suppressants or silicone oil removal. Recurrent RD and band keratopathy were managed with subsequent surgeries. Corneal edema was treated with steroids and/or silicone oil removal.
Conclusions :
Silicone oil tamponade is a useful tool in achieving retinal reattachment and visual acuity improvement for complex RDs, especially RDs with PVR and those that are recurrent. However, surgeons should be vigilant as almost one half of patients may experience post-operative complications requiring management.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.