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.