Successful Removal of Subretinal Silicone Oil Using a Vitreous Fluid Control Kit: A Case Report

Silicone oil (SO) is commonly used as a long-term intraocular tamponade in complex retinal detachment cases, but its use may lead to several complications, including glaucoma, keratopathy, cataract, and oil emulsification. Subretinal migration of SO is an uncommon but clinically significant event that can occur through pre-existing or iatrogenic retinal breaks or microscopic defects caused by repeated intraocular manipulation. We report a rare case of subretinal SO migration following pars plana vitrectomy (PPV) that was successfully managed using a direct intraocular approach with a vitreous fluid control (VFC) kit. A 48-year-old male patient presented with decreased vision in the left eye. Fundus examination revealed total rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Initial surgery involved scleral buckling and sulfur hexafluoride gas injection. Due to persistent subretinal fluid, a second PPV was performed with posterior vitreous detachment induction, removal of subretinal bands, PFCL injection, and SO tamponade. Seven days postoperatively, subretinal migration of SO was observed. A third PPV was performed to remove subretinal SO. A retinal incision was created at a location that allowed straight access via a nasal trocar. The 25G cutter failed to aspirate the SO; however, the VFC kit enabled successful removal. The retina remained attached postoperatively. SO removal and intraocular lens fixation were later performed without recurrence. This case demonstrates that strategic intraocular access using VFC-assisted aspiration can enable effective removal of subretinal SO while minimizing surgical damage and emphasizes the importance of careful planning during vitreoretinal surgery.