Silicone Oil Complications

Table of Contents

Silicone oil indications

We are going to talk about the silicone oil complications but first we need to know what are the indications of the use of silicone oil. Silicone oil is the agent of choice as tamponade at the end of a retina surgery in complex cases, including retinal detachments with proliferative vitreoretinopathy (PVR), giant retinal tears, tractional retinal detachment due diabetic retinopathy, trauma, viral retinitis and recurrent retinal detachment.

In other cases when patients are not local, we see many patients from other cities even other countries. It must be remembered that patients who have gas inside the eye after retinal detachment surgery cannot travel or take a flight because this gas expands when the height above sea level changes and increases intraocular pressure until the patient is blinded which is why silicone is left behind.

And Lately there’s been a lot of discussion about the abuse of silicone oil, we need to know what are the options to treat and resolve these type of complications.

giant retinal tear

What are the complications of the silicone oil injection?

The most frequent silicone oil complications includes cataract formation, then increased intraocular pressure that is between 2-56%, and less frequent keratopathy or corneal edema, inflammation with membrane formation and iritis.

Among surgeons who perform many combined phaco and vitrectomy surgeries the number one is the increased intraocular pressure.

In a study that include almost 3,000 patients with newly diagnosed glaucoma vitreoretinal surgery was found to be the most frequent cause of secondary glaucoma. 73% had silicone oil and 60% of them had it for more than 3 months. They found that in the late postoperative period, glaucoma is most often the result of the emulsification of silicone oil in the anterior chamber.

Silicone oil complications Increased intraocular pressure

Increased intraocular pressure in a patient with emulsified silicone oil in the anterior chamber
Normal eye pressure is between 10-21 mmHg Copyright Retina Center

Treatment of silicone oil complications

Silicone oil removal

One of the treatments is to remove the silicone oil but in patients with moderate or high intraocular pressure, uncontrolled high intraocular pressure persists even when silicone oil is extracted. Fortunately this can be managed with medication drops but some cases will require other procedures.

Trabeculectomy

Another procedure is trabeculectomy but usually fails due to damaged conjunctiva from previous surgeryes or emulsified silicon oil induces inflammation and fibrosis. Inferior trabeculectomy increases risk of infections. And finally when everything goes well, failure still happens in most cases in the first 6 months.

Failed trabeculectomy Copyright Retina Center

Drainage device Ahmed Glaucoma Valve

Another option is to place a drainage device most frequent choice is Ahmed Glaucoma Valve. This procedure has 62 to 80% success rate combined with silicone oil removal.

However you need good candidates for these device specifically healthy conjunctiva and this is reserved for eyes with good visual potential and there are complications too. Complications include the remains of emulsified silicone oil blocks the tube or moves to subconjunctival space and cause inflammation and fibrosis.

Ahmed-Glaucoma-Valve
Photograph of Ahmed valve in a patient with advanced glaucoma Copyright Retina Center

Transscleral cyclophotocoagulation

Another treatment for silicone oil complications is transscleral cyclophotocoagulation The goal of this procedure is to reduce the introcular pressure by destroying the ciliary body epithelium.

The advantages are:

  • This type of surgery doesn’t depend on conjunctival integrity
  • Not influenced by the presence of silicone oil
  • Retreatment is possible and simple
  • You can regulate the energy depending on intraocular pressure (micropulse or continuos wave)

The success rate is between 60 to 80% and 90% with antiglaucoma medication.

The risk of hypotony is similar to other procedures and loss of light perception frequently is the result of evolution of glaucomatous optic neuropathy.

Silicone oil removal and Transscleral Cyclophotocoagulation in a Patient with Secondary Glaucoma

Support material from the National Library of Medicine

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