Long-term prognosis after removal of silicone oil

PURPOSE. To investigate surgical and functional results six or more months after silicone oil (SiO) removal in patients undergoing pars plana vitrecto my (PPV) and tamponade for various reasons. METHODS. Retrospective chart review. Inclusion criteria were recurrent reti nal detachment with PVR grade C (R-RD), primary PVR grade C longer than 9 h ours, recurrent vitreous hemorrhage in PDR (PDR-RVH) with traction RD, gian t retinal tears (GRT) with PVR grade C and total RD with vitreous hemorrhag e and hypotony in penetrating traumas (PT). Indications for removal of SiO included attached retina and intra-ocular pressure (IOP) more than 10 mmHg after 60 days or IOP more than 30 mmHg despite medication. RESULTS. Of the 212 patients undergoing PPV and SiO tamponade between 1994- 1997 91 met the inclusion criteria, 8 had incomplete charts so 83 eyes were included in the study. The mean interval between PPV and SiO removal was 1 63.1 +/- 111.0 days and follow-up was 351.5 +/- 148.6 days. At the time of SiO removal, 30.6% of phakic eyes had cataract, 14.4% keratopathy and 8.4% IOP more than 30 mmHg. At the last visit after SiO removal, 43.5% had catar act, 12.0 keratopathy, 6.0% IOP > 30 mmHg and 3.6% IOP <5 mmHg. After SiO r emoval, 6.0% eyes developed R-RD. There was no significant difference in Si O duration for patients with and without R-RD. VA was more than 5/200 in 16 .8% of eyes preoperatively, 79.5% at the time of SiO removal (p<0.05) and 7 8.3% at the last visit (n.s.) and better than 20/400 in respectively 2.4%, 51.8% (p<0.05) and 53% (n.s.). There was a tendency for VA to improve after SiO removal (p = 0.011). CONCLUSIONS. SiO is an effective tamponade for complex RD, although its pos sible benefits must always be weighted carefully against the complications and the need for further intervention. The present series compares favorabl y with the current literature in terms of complication rates. The optimal t iming of SiO removal and precise screening and decisionmaking guidelines be fore removal are still the main issues and need careful consideration.