Silicone Oil Use in Primary Diabetic Vitrectomy

Despite advances in vitreoretinal surgery for the treatment of severe proliferative diabetic retinopathy (PDR), serious postoperative complications, such as recurrent retinal detachment (RD), neovascular glaucoma (NVG), and hypotony with subsequent phthisis bulbi, may lead to many cases that are unsalvageable (Shen and Yang, Eur J Ophthalmol 17:954–960, 2007; Chen et al., Graefes Arch Clin Exp Ophthalmol, 2023; Eliott et al., Retina. Philadelphia, PA: Elsevier Mosby 2438–2442, 2006). Although some of the complications may be reversed by the use of long-term silicone oil (SO) tamponade, SO itself may cause adverse effects, such as severe preretinal proliferation, high intraocular pressure (IOP), and emulsification, requiring eventual SO removal (Shen and Yang, Eur J Ophthalmol 17:954–960, 2007; Tsui et al., Eye (Lond) 34:2307–2314, 2020). The use of SO in DVs has been a controversial issue. The indications and time of its removal have not reached a general consensus among retinal surgeons. Early removal may avoid possible oil-related complications (Shen and Yang, Eur J Ophthalmol 17:954–960, 2007; Tsui et al., Eye (Lond) 34:2307–2314, 2020; Yeo et al., Ophthalmology 94:1109–1113, 1987, Scott et al., Am J Ophthalmol 130:745–750, 2000); however, premature SO removal may increase the possibility of recurrent vitreous hemorrhage (VH), recurrent RD, and phthisis bulbi (Shen and Yang, Eur J Ophthalmol 17:954–960, 2007; Tsui et al., Eye (Lond). 34:2307–2314, 2020; McCuen and Rinkoff, Arch Ophthalmol 107:677–682, 1989; Heimann et al., Graefes Arch Clin Exp Ophthalmol 227:152–156, 1989). Furthermore, the removal of SO may increase the risk of sudden visual loss in rare cases. In this chapter, we discuss the indications and complications of SO tamponade and removal, as well as the proper duration of SO removal.