[Silicone oil in the surgical treatment of retinal detachment--indications and clinical experience]

Abstract

Silicone oil is being used with increased frequency for retinal tamponade during vitreous surgery for complicated retinal detachments. Though it is now possible to reattach most detached retinas, the visual outcome of the silicone oil procedure is often disappointing. This is due to the well known complications of silicone oil (i.e. cataract, glaucoma, corneal opacification), and the necessity to remove the silicone oil in a second surgical procedure with a certain risk of redetachment. Possible toxicity to retina and optic nerve has not yet get been completely evaluated. An alternative method is the use of expanding gases for internal retinal tamponade. Expanding gases are not as effective as silicone oil in advanced stages of proliferative vitreoretinopathy (PVR), but are afflicted with much less complications. We reviewed the charts of our patients, operated on for retinal detachment, to analyse the anatomical and functional results with silicone oil versus gas tamponade. Regarding the last 421 consecutive surgical procedures for retinal detachment (368 eyes), silicone oil has been used in 5%, expanding gases in 14%. The silicone oil procedure was restricted to the most advanced cases of PVR. The anatomic success rate with silicone was 72%, with gas tamponade 87%. Visual acuity of 0.05 and better achieved 19% of the eyes treated with silicone oil versus 61% of the eyes with gas tamponade. These results confirm the findings of other investigators: despite of the high anatomic success rate with silicone oil, the functional results are poor. Because many complicated cases of retinal detachment can also be treated successfully with gas tamponade, silicone oil should remain the last step in retinal detachment surgery.