[Active drainage combined with air-fluid exchange for silicone oil removal: advantages and long-term follow-up]

A number of silicone oil removal procedures are in use today. The purpose of this study was to evaluate the advantages of active drainage with air-fluid exchange for silicone oil removal.

We conducted a prospective study on patients operated on for retinal detachment with vitrectomy with silicone oil intraocular tamponade between January 2005 and January 2006. The surgical procedures were three-port vitrectomy with silicone tamponade. Silicone oil was removed with active drainage and air-fluid exchanges. Visual acuity, floaters, intraocular pressure, emulsion, and silicone oil complications were evaluated at 3, 6, 12, and 18 months.

Fifty patients (50 eyes) underwent vitrectomy with silicone oil intraocular tamponade for RD with proliferative vitreoretinopathy. The mean duration of intraocular silicone oil tamponade was 4.5 months (1-15 months). Seventeen patients had complementary procedures such as phacoemulsification, epimacular membrane peeling, complementary retinopexy or intravitreal triamcinolone. At 1 year, the mean visual acuity was 3.2/10. One patient reported floaters. One patient had recurrent retinal detachment, one patient had intraocular hypertony, and significant emulsion was found in one patient. Microscopic emulsion was found in 20 patients.

This surgical technique is longer and more invasive than simple passive ablation. However, complementary procedures could decrease the risk of recurrent retinal detachment and provide better visual rehabilitation. Better silicone oil removal seems to limit residual emulsion.

Active drainage with air-fluid exchange for silicone oil removal is an interesting procedure. It could reduce short- and medium-term silicone oil complications in vitreoretinal surgery and increase the final visual outcome. However, a prospective comparative and randomized study is necessary to confirm our results.