Silvia Bopp (Bremen, Germany)

Advantages:

To address the problem of retinal redetachments after silicone oil removal in eyes that had undergone vitreous surgery with silicone oil tamponade for complicated rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR).

Methods:

Retrospective chart review of 73 patients who had vitrectomy / silicone oil tamponade and consecutive oil removal between 2007-2010. Data analysis included: timing of silicone oil removal, surgical maneuvers that were applied during silicone oil removal and the role of visualization aids (trypan blue) used during the tamponade removal.

Effectiveness / Safety:

Silicone oil was removed after 236 days (range 68-1436). During silicone oil removal, careful inspection of the posterior segment using wide-angle observation and eventually trypan blue application for membrane visualization was performed. With respect to the surgical maneuvers, tamponade removal only was done in 31% of eyes. In the remaining eyes additional maneuvers, such as membrane peeling (39%) and/or endolaser, and gas tamponade seemed necessary. Redetachment after silicone oil removal occurred in 9,6% (7/73 eyes). Six eyes developed new PVR-membranes and had additional surgery. In 5 of them was used silicone oil again and in the sixth eye C2F6-gas tamponade was used only. One eye developed a peripheral tear that was sealed with pneumatic retinopexy.

Take home message:

Redetachment rate after silicone oil surgery are to be expected in 15%-25%. The outcomes reported here appear more favorable most likely due to the meticulous fundus examination and additional corrective surgical maneuvers during silicone oil removal. Nevertheless, PVR as a clinically silent, still active process is the most threatening complication leading to redetachments in a significant number of patients. Patients should be followed up closely within the first 6-12 weeks after silicone oil removal.