gms | German Medical Science

Background: Vitrectomy and silicone oil tamponade for retinal detachment from giant retinal tears is a highly successful method and has become a standard procedure. Visual loss in silicone-filled eyes has been anecdotally reported, but few is known about the incidence. As eyes with giant retinal tear often present with macula-on detachments and therefore, visual prognosis is principally good, we investigated this complication in a consecutive series.

Method: Analysis of functional and anatomic results after vitrectomy/silicone oil tamponade for giant retinal tears without PVR that were operated on between Jan. 2003 and Dec. 2008.

Results: 33 patients were identified who had vitreoretinal surgery with silicone oil injection ± lens surgery. Intraoperatively, the macula was attached in 54.5% (group 1) and was already detached in 45.5% (group 2). The tamponade was removed after a mean of 4 months. Follow-up was 15.6 months (range: 4–46 months). The total cohort showed visual improvement after surgery. Mean visual acuity (VA) improved from 0.03 to 0.25. Functional recovery, however, occurred in group 2 only (VA preop vs. postop = 0.03 vs. 0.3). Group 1 with primary attached macula did not show an increase in VA (0.24 vs. 0.22). Detailled subanalysis revealed that 9/18 eyes (50%) had postop VA of 0.1–0.2. These patients had initially good VA recovery, but noticed functional deterioration and a central scotoma after a few weeks. No postperative complications that would have given an explanation were recorded.

Conclusions: Silicone oil-associated visual loss appears to be more frequent than expected. Becoming aware of this complication, we observed visual loss occuring from the 2nd month after initial surgery that did not recover. As long as the mechanism of retinal/optic nerve damage remains obscure, either very early removal of silicone oil or the use of long-acting gas should be considered for cases with macula-on complex retinal detachments.