Changing attitudes in United States to use of intravitreal silicone

The use of intravitreal silicone oil injection to separate preretinal membranes from the retinal surface in proliferative vitreoretinopathy (PVR) was pioneered in the United States. The anatomical results obtained were encouraging but complications of cataract, glaucoma and keratopathy frequently occurred. This method was therefore discontinued in the United States once the techniques of pars plana vitrectomy and membrane dissection had been developed. More recently, however, it has become clear that in severe PVR treated by vitrectomy procedures, recurrent traction is almost inevitable and prolonged vitreous substitution is required to limit the associated retinal detachment. Silicone has been selectively re-introduced for this purpose. Improved techniques and oil removal in some cases have reduced the incidence of complications. Insoluble gases have also been widely used in the United States to achieve the same objective but have generally been found to be less effective. The comparative merits of these alternative forms of vitreous substitution remain controversial. A randomized clinical trial is currently being conducted in the United States to address this issue. The trial embodies features of multicenter clinical trials used successfully in other prospective clinical studies. Silicone oil is still used less frequently than in Europe or in Japan for the management of diabetic traction detachment and giant tears.