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Purpose: This study evaluated the outcome of severely injured eyes treated with early primary vitrectomy with silicone oil filling., Methods: A total of 435 eye injuries, which required surgical intervention, were reviewed retrospectively. In 13 eyes (3%) pars plana vitrectomy and silicone oil filling were performed as primary surgical repair. Silicone oil filling was restricted to cases with laceration of the retina larger than 4 disc diameters (nine eyes), primary retinal detachment larger than two quadrants (two eyes) and/or persistent intrasurgical hemorrhage (12 eyes). All patients underwent surgery within 24 hours., Results: After a mean follow-up period of 28.7 months (range, 9-70 months), 11 eyes achieved a visual acuity ranging from 20/25 to 20/200. Silicone oil was removed in 11 of 13 eyes after 5.8 +/- 4.6 months. Recurrent proliferative vitreoretinopathy developed in two eyes., Conclusions: Silicone oil tamponade after early primary pars plana vitrectomy may be an alternative for primary repair after trauma, especially in severely injured eyes with retinal lacerations larger than 4 disc diameters, persistent intrasurgical bleeding, and/or primary retinal detachments.

Silicone oil is used in the treatment of complex retinal detachments, but late complications have been reported by many authors. Silicone oil removal (SOR) is therefore performed in order to reduce these complications. SOR was investigated in 63 consecutive cases. All these eyes had had a totally attached retina for at least 3 months before SOR was performed, there were no signs of traction or reproliferation, and the minimum vision was 4/200. The duration of silicone oil tamponade was less than 6 months in 13 eyes, 6-12 months in 18 and more than 1 year in 32 eyes. In post-traumatic and diabetic cases it was possible to remove silicone oil after 8 to 10 months and in PVR cases after 14 months. Redetachment of the retina was the most frequent complication of SOR, appearing in 18/63 eyes; 16 of them were refilled. In 9 eyes, the visual acuity present before silicone oil removal was reestablished. The redetachment rate was similar in PVR, diabetes and trauma cases and had no correlation with the duration of silicone oil tamponade. Increased intraocular pressure was observed in 13 eyes before SOR but it returned to normal levels afterwards in 8 cases without further surgery. The results of our study show that even if the indication is established very carefully, SOR results in a relatively high rate of complications, such as redetachment of the retina. Therefore every case undergoing this procedure must be evaluated in detail.

The authors discuss the pathogenesis and the method of treatment of a retinal detachment with a macular hole basing on personal material and a review of foreign literature. Personal material consists of 11 eyes in 10 patients operated upon in the University Ophthalmic Department in Munich in the period November 1988--April 1990. In all the cases the primary method of treatment based on vitrectomy performed through the pars plana with a gas tamponade. In 4 cases a reoperation with silicon oil tamponade was necessary. Anatomical reattachment of the retina was achieved in 9 among 11 treated eyes. In 10 cases the visual acuity was 1/50 or better. Five among them showed the visual acuity at last 0.1.

Three eyes with acute severe subretinal hemorrhages due to age-related macular degeneration were operated on by vitrectomy, retinotomy and subretinal lavage. It was possible to improve the visual acuity (VA) in case 1 from 20/500 preoperatively to 20/200 postoperatively; VA stayed the same for 16 months. In case 2 the VA was hand movements preoperatively, and postoperatively 20/200; after 18 months it was still 20/300. In case 3 VA was 20/400 preoperatively and 20/100 postoperatively; after 15 months it was 20/700. Even if this procedure cannot be recommended as routine, it can be considered in selected cases of subretinal hemorrhages no older than 1 week.

We report on a series of 135 consecutive cases of pars plana vitrectomy for proliferative diabetic retinopathy (average period of observation was 13 months). BSS was used in 69 eyes and silicone oil was used in 66 eyes as a vitreous substitute, the indications for silicone oil in these cases were the presence of several retinotomies or retinectomies as well as sharply increased risk for rebleeding. Postoperatively and after a minimum follow up of 6 months (55 eyes) the two groups with BSS or silicone oil achieved comparable functional results despite the different anatomical preoperative situation. Thus 18 out of 23 eyes of the silicone oil group, originally with detached macula and visual acuity of HM or FC, achieved a visual outcome of greater than = 0.02, showing the best postoperative result. In the BSS-group, with attached macula prior to the operation and same visual acuity, this result is attained by 27 out of 35 eyes. We interpret these figures as meaning, that silicone oil in proliferative diabetic retinopathy reduces some of the problems connected with more advanced retinal changes like retinal detachment and rebleeding thereby allowing a visual outcome which corresponds to the macular condition.

Silicone oil injection in conjunction with pars plana vitrectomy was carried out by five surgeons in 415 consecutive patients using the same surgical equipment, the same surgical techniques and the same highly purified silicone oil (viscosity, 5000 mPa.s). Indications for silicone oil injection after vitrectomy included advanced stages of proliferative vitreoretinopathy following rhegmatogenous retinal detachment (49%), severe proliferative diabetic retinopathy (38%), and proliferative vitreoretinopathy following retinal detachment due to ocular trauma (13%). Postoperative complications were noted in a 6- to 30-month follow-up period. Cataractous changes of varying degree were seen in all phakic eyes. Silicone oil entered the anterior chamber in 6% of all phakic and pseudophakic eyes. Subretinal silicone oil was noted in 4%. Other complications associated with the use of intravitreal silicone oil included biomicroscopically visible silicone oil emulsification (0.7%), keratopathy (5.5%), glaucoma (6%), closure of the inferior iridectomy (6%), and reproliferation of epiretinal and subretinal fibrous membranes (40%). We anticipate that the physico-chemical characteristics of the highly purified silicone oil (viscosity, 5000 mPa.s) and the routine performance of an inferior iridectomy in all aphakic eyes had a positive impact on the low incidence of silicone-oil-related complications such as emulsification, keratopathy and secondary glaucoma.