Removal Of Silicone Oil

REMOVAL OF SILICONE OIL
Prognostic Factors and Incidence
of Retinal Redetachment
MARIA M. CHOUDHARY, MD,* MOAZ M. CHOUDHARY, MD,† MUSAB U. SAEED, MD,‡
AZAM ALI, MD†
Purpose: To evaluate the incidence of retinal redetachment after the removal of silicone
oil endotamponade for complicated retinal detachment and identify possible factors
affecting outcome.
Methods: This is a retrospectivereview of 173 patients who underwent pars plana
vitrectomy with silicone oil tamponade for complex retinal detachment and subsequent
removal of silicone oil (ROSO). The outcome factors studied included anatomical success,
best-corrected visual acuity and intraocular pressure pre- and post-ROSO.
Results: Anatomical success was achieved in 167 of the 173 eyes (96.5%) after ROSO.
The mean durationof silicone oil tamponade was 70 ± 48 weeks (median, 56 weeks; mode,
48 weeks). The cause for primary retinal detachment was proliferative diabetic retinopathy
in 36 (20.8%) and proliferative vitreoretinopathy in 137 of 173 cases (79.2%). Bestcorrected
visual acuity of greater than 20/100 was achieved in 83 cases (49.4%) at 3
months after ROSO. Levene’s test for equality of variances was usedto determine the
association between previous unsuccessful retinal surgeries and redetachment (P = 0.523)
and between duration of endotamponade and anatomical success (P = 0.451).
Conclusion: The incidence of retinal redetachment after ROSO in our study was 3.46%.
Aggressive removal of the vitreous base, performing retinotomies, ensuring complete silicone
oil filling for adequate tamponade,and argon retinopexy can lead to low complication rates
and improved outcomes.
RETINA 32:2034–2038, 2012
The concept of using silicone oil as an endotamponade
medium for managing complex retinal detachment
(RD) was first introduced by Cibis et al in 1962.1
For a very long time, RD associated with complex vitreoretinal
abnormalities was considered unmanageable,
with a majority of casesresulting in complete loss of
vision. Pars plana vitrectomy with silicone oil injection is
the standard for treating RDs.2–5 Silicone oil has proved
to be one of the best substitutes for vitreous body; however,
it can also lead to various complications when
left in situ. Most commonly reported complications in
order of increasing frequency include corneal endothelial
decompensation, progressivecataract formation, and
increased intraocular pressure (IOP) or secondary glaucoma
either open angle or secondary to acute papillary
blockade.6–9 It also causes decrease in the visual acuity
with the passage of time because of its optical and
refractive properties. As a result of the above-mentioned
complications, silicone oil is not usually left in the eye
for long and is normallyremoved. Because it repositions
the mobile detached retina stabilizing it in position,
removal often leads to redetachment.10–15
The aim of this study was to evaluate the frequency
of retinal redetachment after the removal of silicone oil
(ROSO) and evaluate the factors that may influence
the outcome at a tertiary care hospital of a resourcepoor
developing country. We have made an attempt toevaluate outcomes, which include changes in bestcorrected
visual acuity and IOP with and without
silicone oil.
Patients and Methods
This study is a retrospective review of medical
records of 165 patients, which included 173 eyes, who
From the *Cleveland Clinic Foundation, Cleveland, Ohio; †Aga
Khan University Hospital, Stadium Road, Karachi, Pakistan; and
‡Quincy Medical Group, Quincy,Illinois.
The authors report no conflicts of interest.
Reprint requests: Musab U. Saeed, MD, QMG/SIU, 1025 Maine
Street, Quincy, IL 62301; e-mail: msaeed@quincymedgroup.com
2034
underwent pars plana vitrectomy with silicone oil
tamponade followed by ROSO for RD between 2000
and 2008 at the Aga Khan University Hospital,
a tertiary care hospital in Karachi, Pakistan. Inclusion
criteria for this...