What is the retina?
The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.
What is retinal detachment?
When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture. Similarly, when the retina detaches the eye loses vision.
How is silicone oil used to repair retinal detachment?
Silicone oil is injected into the eye during vitrectomy surgery to hold the retina in place against the eye wall. It works by pushing and holding the retina in position from the inside. This is different from scleral buckle surgery in which the eye wall in indented to push it against the retina from the outside. Depending on the characteristics of a retinal detachment, during vitrectomy surgery silicone oil or gas may be used to hold the retina in place.
What are the advantages and disadvantages of silicone vs. gas to repair retinal detachment?
Various gas bubbles (air, SF6, or C3F8) are most frequently used hold the retina in position for healing after vitrectomy for retinal detachment repair. However, the effect of gas bubbles is temporary. Silicone oil may be used instead of a gas bubble (pneumatic retinopexy) for longer duration of action. Although gas has a higher surface tension with better ability to close retinal breaks, gas bubbles dissolve in the fluids of the eye and disappear over a period of days (air) to weeks (SF6 and C3F8). Silicone oil remains in the eye until it is removed with surgery in the operating room; it does not dissolve in the fluids of the eye. The long duration of effect with silicone oil makes it helpful when treating retinal detachments with inferior retinal breaks and with proliferative vitreoretinopathy. Silicone oil may also be used when a patient cannot stay in proper position, as is often required after retinal detachment surgery for proper healing with pneumatic retinopexy (gas injection). Head positioning is much less critical for success with silicone oil as compared to gas tamponade. Air travel is another reason silicone oil may be used over gas tamponade; there are no restrictions on air travel with silicone oil as there are with gas. As long as gas or silicone is in the eye, the vision is poor. The only way to remove silicone oil is with surgery in the operating room.
How long is silicone oil left in the eye?
Silicone oil may be left inside the eye for weeks, months, or years after surgical repair of retinal detachment. How long before surgical removal of silicone largely depends on the nature of the retinal detachment. The average duration of silicone oil retention in the eye is 3-4 months; however, some surgeons prefer to leave silicone in place for one year after repair of retinal detachment associated with scar tissue (proliferative vitreoretinopathy). In severe cases of retinal detachment, the only way to keep the retina attached is by leaving silicone oil in the eye permanently. Although this situation is not desirable, it may be necessary to retain silicone oil in the eye to preserve limited vision and keep the eye from shrinking and becoming deformed and/or painful from advanced scar tissue formation. When silicone oil is retained long-term inside the eye, periodic evaluation is needed to identify and treat late complications.
What complications are associated with silicone oil?
Although silicone oil may be the only way to successfully repair difficult retinal detachments, complications may occur. The most common side-effect with silicone oil is cataract formation. If a silicone lens implant is in the eye, the silicone oil may adhere to the lens implant and impair vision. Rarely, silicone oil may cause glaucoma (high pressure in the eye that can result in loss of vision if left untreated). This may be treated with eye drops, laser, or glaucoma surgery. Sometimes, it is necessary to remove and/or replace the silicone oil. In exceedingly rare cases, glaucoma may drive silicone oil from the eye through the optic nerve into the brain.
After many months to years, silicone oil may emulsify (break into tiny bubbles). These bubbles may then travel into the front of the eye and cause the cornea (the clear front window of the eye) to fog over. This may require removal/replacement of silicone and, rarely, corneal transplantation.
Severe complications from silicone oil are rare. The use of silicone oil may be the only hope of retaining vision and the eye in some cases. With routine exams and follow-up care, complications may be prevented or detected early, and managed appropriately.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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