Heavy silicone oil and intraocular inflammation

Abstract

In the past two decades, many advances have been made in vitrectomy instrumentation, surgical techniques, and the use of different tamponade agents. These agents serve close retinal breaks, confine eventual retinal redetachment, and prevent proliferative vitreoretinopathy (PVR). Long-acting gases and silicone oil are effective internal tamponade agents; however, because their specific gravity is lower than that of the vitreous fluid, they may provide adequate support for the superior retina but lack efficacy for the inferior retina, especially when the fill is subtotal. Thus, a specific role may exist for an internal tamponade agent with a higher specific gravity, such as heavy silicone oils (HSOs), Densiron 68, Oxane HD, HWS 45-300, HWS 46-3000, and HeavySil. Some clinical evidence seems to presume that heavy tamponades are more prone to intraocular inflammation than standard silicone if they remain in the eye for several months. In this review, we discuss the fundamental clinical and biochemical/molecular mechanisms involved in the inflammatory response after the use of heavy tamponade: toxicity due to impurities or instability of the agent, direct toxicity and immunogenicity, oil emulsification, and mechanical injury due to gravity. The physical and chemical properties of various HSOs and their efficacy and safety profiles are also described.

Figure 1

Optic disc swelling in presence of heavySil tamponade.

Figure 2

Small specimen of peripheral retinal biopsy showing convoluted basal lamina and retinal microvasculature (arterioles, venules, and intervening capillaries) with prominent reactive endothelium and multiple clusters of pigmented macrophages.

Figure 3

Convoluted basal lamina and retinal microvasculature with reactive endothelium and many pigmented macrophages.

Figure 4

Large aggregates of pigmented macrophages with interdispersed not pigmented histiocytes on the left perivascular lymphoid infiltrate.