Our Summary

This paper discusses the use of Silicone oil (SO) in eye surgery. SO is used as a replacement for the vitreous, a jelly-like substance that fills most of the space in the eye. This is often used in operations to repair conditions like retinal detachments. However, this research highlights that there have been increasing reports of unexplained vision loss after the removal of the SO, and there’s currently no treatment for this.

The paper reviews existing literature on SO and its heavier variant, looking at their chemical and physical properties and the potential complications after surgery. These could include issues with the cornea (the clear front surface of the eye), glaucoma (a condition that damages the optic nerve), low eye pressure (hypotony), cataracts (clouding of the eye lens), and optic neuropathy (damage to the optic nerve).

It also discusses other surgical complications, such as using too much or too little SO, the SO moving or breaking down into smaller droplets, the SO sticking, and the worsening of retinal conditions.

The paper stresses that the decision to use SO should be based on the severity of the patient’s retinal disease and the surgeon’s experience. It also highlights the importance of continuing to search for safer alternatives to SO.

FAQs

  1. What are the potential complications related to the use of silicone oil as a vitreous substitute?
  2. What factors influence the decision to use silicone oil as a vitreous substitute in daily practice?
  3. What are some potential alternatives to silicone oil as a vitreous substitute?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vitrectomy is to be aware of the potential complications associated with the use of silicone oil as a vitreous substitute. These complications can include corneal decompensation, glaucoma, cataract, optic neuropathy, and unexplained visual loss after SO removal. It is important for patients to discuss these potential risks with their doctor and weigh the advantages and disadvantages of using silicone oil as a vitreous tamponade. Additionally, patients should follow their doctor’s postoperative instructions closely to minimize the risk of complications.

Suitable For

Patients who may be recommended vitrectomy include those with diabetic retinopathy, proliferative vitreoretinopathy, rhegmatogenous retinal detachment, and other severe retinal diseases. Surgeon experience and the severity of the condition are important factors to consider when deciding to use silicone oil as a vitreous substitute. It is important to be aware of the potential complications associated with silicone oil, such as corneal decompensation, glaucoma, hypotony, cataract, optic neuropathy, and unexplained visual loss. The pursuit of novel, safer vitreous substitutes is essential in order to minimize these complications.

Timeline

Before vitrectomy:

  1. Patient is diagnosed with a retinal condition such as diabetic retinopathy, proliferative vitreoretinopathy, or rhegmatogenous retinal detachment.
  2. Patient undergoes pre-operative evaluation and preparation for vitrectomy surgery.
  3. Surgeon discusses the risks and benefits of using silicone oil as a vitreous tamponade.
  4. Vitrectomy surgery is performed, and silicone oil is injected into the vitreous cavity to stabilize the retina.

After vitrectomy:

  1. Patient may experience postoperative complications such as corneal decompensation, glaucoma, hypotony, cataract, or optic neuropathy.
  2. Surgical complications such as over/underfilling of silicone oil, migration/emulsification of silicone oil, sticky silicone oil, or proliferative vitreoretinopathy may occur.
  3. Patient may have recurrent retinal detachments or unexplained visual loss after silicone oil removal.
  4. Surgeon may consider using alternative vitreous substitutes in future surgeries to minimize complications.
  5. The decision to use silicone oil as a vitreous substitute is based on the severity of the retinal disease and the surgeon’s experience.

What to Ask Your Doctor

  1. What are the potential complications associated with silicone oil as a vitreous tamponade?
  2. How common are complications such as glaucoma, cataract, or emulsification following vitrectomy with silicone oil?
  3. Are there any specific risk factors that may increase the likelihood of experiencing complications with silicone oil?
  4. What is the process for removing silicone oil from the eye, and what are the risks associated with this procedure?
  5. Are there any alternative vitreous substitutes available that may have lower risks of complications compared to silicone oil?
  6. How will you monitor for any potential complications following the vitrectomy procedure?
  7. What are the potential long-term effects of using silicone oil as a vitreous substitute?
  8. Are there any specific lifestyle changes or precautions I should take after undergoing a vitrectomy with silicone oil?
  9. What should I do if I experience any sudden changes in vision or other concerning symptoms after the vitrectomy procedure?
  10. Are there any ongoing research or clinical trials investigating new vitreous substitutes that may be safer or more effective than silicone oil?

Reference

Authors: Oliveira RA, Magalhaes Junior O, Rossi JPDS, Gonçalves LBM, Cavalcanti GNF, Maia A, Brant Fernandes RA, Farah ME, Maia M. Journal: Curr Eye Res. 2025 Apr;50(4):353-361. doi: 10.1080/02713683.2024.2409883. Epub 2024 Oct 9. PMID: 39382231