Silicone oil removal strategies

Although it is widely accepted to use silicone oil in the treatment of very complex retinal detachments, there is no definite agreement on when and why silicone oil should be removed. Frequently found is a statement on the necessity of silicone oil removal after a certain period of time. However, the rate of retinal redetachment after silicone oil removal varies widely and appears to correlate with the underlying disease process and its severity. The literature on strategies of silicone oil removal, the rate of complications, and, thus, the risk-benefit ratio is scant. Therefore, for the discussion of silicone oil removal we rely on personal experience and the rather rare studies on silicone oil removal. Regarding the data given in the literature, the rate of vitreoretinal complications after silicone oil removal, even in cases with a clinically stable-appearing retinal situation, is rather high in severe proliferative vitreoretinopathy (PVR) and lower in most advanced cases of severe proliferative diabetic retinopathy (PDR) requiring silicone oil tamponade. The benefits of silicone oil removal are better in cases of cytomegalovirus retinitis or other situations without a PVR component. Silicone oil removal has to be considered a procedure of ill-defined risks, especially if silicone oil is really used as a last therapeutic resort in most severe cases of complicated retinal detachment. Further, exact criteria for the timing and safe removal of silicone oil in these complex vitreoretinal disorders still needs to be defined. A strategy for the removal of silicone oil is discussed.