[Long-term outcome after silicone oil removal]

In order to reduce the incidence of postoperative complications in silicone-filled eyes, many authors recommend that silicone oil should be removed from the eye as soon as a stable retinal situation is achieved. Even in the eyes with completely attached retina and a clinically stable situation there is a risk of retinal redetachment and other complications after silicone oil removal. In a retrospective study we analyzed 324 cases after silicone oil removal regarding the postoperative redetachment rate and risk of complications from this procedure. The indication for primary surgery was retinal detachment with PVR in 167 (51.5%) cases, proliferative diabetic retinopathy in 87 cases (26.8%), complications of penetrating ocular injuries in 48 cases (14.8%), giant tear retinal detachment in 9 cases (2.7%) and retinal detachment with a central hole in 13 cases (4%). At the time of silicone oil removal retina was completely attached in 277 eyes. Local retinal redetachment central to the encircling band existed in 47 eyes at the time of silicone removal. Follow-up time ranged from 6-63 months. Silicone oil removal was combined with a cataract operation in 42 cases (12.9%), penetrating keratoplasty in 9 cases (2.8%) and membrane peeling in 54 eyes (16.7). In the postoperative period the retina detached in 39 (12%) eyes. In the eyes with preoperatively completely attached retinas, redetachment occurred in 23 eyes (8%), whereas in the group of eyes with an unstable preoperative retinal situation, the retina redetached in 16 eyes (34%). The duration of the silicone oil tamponade had no effect on the redetachment rate. In the group of eyes with an unstable preoperative retinal situation, preoperative laser photocoagulation at the cerelage buckle, as well as central to the local detachment, reduced the incidence of redetachment after silicone oil removal significantly (25% vs. 53%). In the group of eyes with a preoperatively stable retinal situation, this effect was not significant. Our results show that in eyes with completely attached retinas, the risk of complications and redetachment after silicone oil removal is relatively low. In selected cases, even in eyes with incompletely attached retinas, silicone oil could be removed. Nevertheless, a relatively high risk of postoperative complications has to be taken into consideration. In eyes with an incompletely attached retina, preoperative laser photocoagulation at the cerclage buckle, as well as central to the local redetachment significantly reduced the incidence of redetachment after silicone oil removal.