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Purpose: To compare the efficacy and safety of pars plana vitrectomy (PPV) with silicone oil compared to gas tamponade for uncomplicated rhegmatogenous retinal detachment (RRD)., Design: Systematic review and meta-analysis., Methods: A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to September 2023 for comparative studies evaluating the efficacy and safety of PPV with either silicone oil or gas tamponade in the setting of uncomplicated RRD. Our primary outcome was best-corrected visual acuity at the last study observation. Secondary outcomes included the rates of retinal reattachment, retinal thickness, and the incidence of adverse events. We performed a meta-analysis using a random-effects model., Results: Nine observational studies reporting on 491 RRD eyes were included. The mean best-corrected visual acuity at the last study observation was significantly better in the gas tamponade group than in the silicone oil group (weighted mean difference [WMD] = 0.17 logMAR, 95% confidence interval [CI] = [0.06, 0.27], P = .002). Rates of primary retinal reattachment were similar between the silicone oil and gas tamponade groups (P = .89). The ganglion cell layer was significantly thinner in the silicone oil group compared to the gas tamponade group (WMD =-3.70 µm, 95% CI = [-5.87, -1.53, P = .0008), as was the inner plexiform layer (WMD = -2.45, 95% CI = [-4.50, -0.40], P = .02) and outer nuclear layer (WMD = -11.74 µm, 95% CI = [-18.39, -5.10], P = .0005)., Conclusions: PPV with gas tamponade was associated with better functional outcomes compared to PPV with silicone oil, although both tamponades yielded comparable primary reattachment rates. The absence of randomized trials and the potential for selection bias underscore the importance of further investigation in diverse patient populations., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to compare the clinical efficacy of foldable capsular vitreous body (FCVB) filled with either light or heavy silicone oil and the incidence of complications after their implantation for the treatment of severe ocular trauma and silicone oil-dependent eyes., Methods: FCVB filled with either light (n = 16) or heavy (n = 8) silicone oil was implanted in 24 patients. During the 12-month follow-up period, the intraocular pressure, final best-corrected visual acuity, retinal reattachment condition, position of the FCVB, and complications were assessed., Results: All surgeries were performed without issue. There was no significant difference in preoperative and postoperative best-corrected visual acuity between the two groups. A significant improvement in the intraocular pressure was observed after surgery in both the light silicone oil (P = 0.029) and heavy silicone oil (P = 0.035) groups. None of the patients developed displacement or prolapse of the FCVB. The most common early and late postoperative complications were postoperative hemorrhage (33.3%) and corneal opacification (50%), respectively., Conclusions: FCVB filled with heavy silicone oil can be used as a supplemental therapy for patients who have lost the anterior segment of their eye, have lesions of the inferior retina, or cannot maintain the prone position for various reasons., Translational Relevance: Implantation of FCVB combined with heavy silicone oil compensates for the shortcomings of this with light silicone oil, providing patients with more personalized treatment.

Purpose: To report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors., Methods: Retrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes., Results: The median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06)., Conclusion: A retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate., Trial Registration Number: ID NCT05647928 (12th April 2022)., (© 2024. The Author(s).)

It is over 60 years since Paul Cibis et al. reported the experimental use of liquid silicone in the surgical management of retinal detachment. Initial experiences were complicated by significant side-effects associated with the impurities in the non-medical grade commercial silicone oils deployed at the time. These were substantially reduced (but not eliminated) by the adoption of refined high-viscosity medical grade silicone oils. Two of the major complications associated with silicone tamponade are (i) the variability of focus due to its movement and higher refractive index, and (ii) progressive emulsification, particularly with low viscosity oils. This article reviews recent and ongoing research on the causes of emulsification of intra-ocular silicone oil to understand the causes better and thereby reduce this risk, especially for those eyes where permanent tamponade is the only current option for retaining vision., (© 2024. The Author(s).)

Purpose: A complication of using silicone oil as an intraocular endotamponade is its adhesion to intraocular lenses (IOLs). Forward light scattering is a measure to quantify the optical disturbance caused by adherent oil droplets. We tested the straylight caused by silicone oil adhesion to different IOLs and examined whether an approved cleaning solution, F4H5, reverses the induced straylight., Design: An experimental study., Methods: Two hydrophobic acrylic IOL models and 1 hydrophilic model with a hydrophobic surface (n = 8 per model: 24 lenses) had straylight measured before contact with silicone oils, providing a baseline for subsequent testing: 12 lenses with lighter-than-water silicone oil (Siluron 2000) and 12 with heavier-than-water oil (Densiron 68). The final measurement was performed after cleansing with F4H5 when we used scanning electron and light microscopy to detect surface changes., Results: Straylight was majorly increased in IOLs with adherent silicone oil (baseline vs adherent oil median 3.1 [2.1, 3.9] and 39.7 [22.7, 87.8] deg 2 /sr, respectively; P < .001). No difference was seen between heavier- and lighter-than-water silicone oils. Between IOL types, induced straylight varied significantly, with 1 hydrophobic model reaching the highest average straylight. F4H5 significantly reduced straylight values in all IOL types (median 9.4 [5.4, 13.8] deg 2 /sr). The microscopy revealed surface changes on the IOLs even after cleaning., Conclusions: Silicone oil adhesion to IOLs can induce amounts of straylight known to cause severe optical disturbance. F4H5 cleansing solution reversed straylight values to only slightly increased values. We found no difference in straylight formation between the lighter- and heavier-than-water silicone oils., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To describe the findings of Multicolour® imaging (MCI) in the presence of residual emulsified silicone oil (SiO) droplets., Case Report: A 62-year-old man had previously undergone surgery for a traumatic retinal detachment in the left eye, followed by SiO removal a few years ago. His presenting visual acuity was 6/60 in the left eye and intraocular pressure was 12 mm Hg. Clinical examination revealed the presence of emulsified residual SiO droplets in the vitreous cavity, 'inverse hyperoleon' at the posterior pole and pathological myopia. Retinal findings were documented using optical coherence tomography (OCT), fundus autofluorescence (FAF), and MCI on the Spectralis (Heidelberg, Germany) machine., Results: On OCT, the emulsified SiO droplets in the preretinal and intraretinal layers appeared as multiple hyperreflective dots with no underlying shadowing trapped beneath the residual posterior hyaloid or preretinal membrane in the region of the posterior staphyloma. Residual emulsified silicon oil on the retinal surface appeared to have greenish hue on the composite multicolour image and was hyperreflective on individual blue and green reflectance images and dark and hyporeflective on the infrared reflectance image. The SiO droplets appeared dark and were difficult to identify on the short wavelength FAF image., Conclusion: To the best of our knowledge, this case report describes the MCI findings in emulsified SiO droplets for the first time., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/objectives: The purpose of this study is to investigate whether history of silicone oil tamponade may predispose to the development of cystoid macular edema (CMO) following uneventful post-vitrectomy cataract surgery., Subjects/methods: This is a retrospective study that was conducted at a single academic institution. Records of patients who underwent pars plana vitrectomy (PPV) with or without silicone oil tamponade and subsequent cataract surgery between 2017-2020 were reviewed. Macular optical coherence tomography (OCT) findings up to 4 years after surgery were assessed., Results: A total of 95 eyes were included. Forty-one eyes underwent cataract surgery and had a history of PPV with silicone oil tamponade (Group 1). Fifty-four eyes underwent cataract surgery by phacoemulsification and had a history of PPV with gas tamponade (Group 2). Average follow up time after cataract surgery was 41.1 months. In Group 1, the incidence of OCT-detected CMO was 39.0%, compared to 27.8% in Group 2 (p = 0.247). The incidence of clinically significant CMO in Group 1 was 22.0%, compared to 18.5% in Group 2 (p = 0.679). The duration of CMO was significantly longer in Group 1 (p = 0.041) and cases were less likely to resolve by the last follow up visit (p = 0.040)., Conclusions: The incidence of OCT-detected or clinically significant pseudophakic CMO is not significantly different between eyes with prior PPV with gas tamponade versus silicone oil tamponade. However, CMO after uneventful cataract surgery may have a prolonged course if there is history of silicone oil tamponade, requiring longer treatment., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To clarify the postoperative incidence of macular edema in patients undergoing surgery to repair rhegmatogenous retinal detachment and identify the associated risk factors., Methods: In this prospective, observational study, 79 patients who underwent surgery to correct rhegmatogenous retinal detachment using pars plana vitrectomy with silicone oil injection were analyzed. Patients were followed up postoperatively at 7, 30, 90, 180, and 365 days. At each visit, optical coherence tomography was performed to assess the presence or absence of macular edema. were analyzed as possible risk factors for macular edema: age, sex, macular status (attached or detached), presence of vitreoretinal proliferation, history of previous intraocular surgery, reported time of symptoms suggestive of rhegmatogenous retinal detachment up to the date of surgery, and the surgical modality performed., Results: The 1-year macular edema prevalence rate was 26.6%. In the adjusted analysis, older patients had a higher risk of macular edema, and each 1-year increase in age increased the risk of macular edema by 6% (95% confidence interval = 1.00-1.12). The macular status, vitreoretinal proliferation, the surgical technique used, prior intraocular surgery, and the intraocular lens status were not identified as risk factors. However, the incidence of macular edema increased up to 180 days after surgery, peaking at 10.6%, and then decreased until 365 days after surgery., Conclusion: Macular edema was a common complication after surgery to treat rhegmatogenous retinal detachment, with its incidence peaking between 30 and 180 days after surgery. Age was an important risk factor for macular edema in this cohort.

Purpose: To study the incidence of macular edema (ME), ocular hypertension (OHT), emulsification and migration to the anterior chamber (AC) of silicone oil (SO) in patients after complex retina surgery, stratified by SO type., Methods: Retrospective, cohort study. Patients who underwent retina surgery with SO injection and extraction in our center were included. We compared the complication rates of ME, OHT, emulsification and migration to the AS according to SO type (1300cSt, 5700cSt and heavy SO). Data on age, sex, emulsification time, duration of the tamponade, previous retina surgeries and diagnosis were also gathered and included in a multivariate analysis., Results: We included 163 patients (mean age of 64.8 years; mean duration of the tamponade: 11 months). Rates of emulsification, ME, OHT and SO migration to the AC were similar in all groups ( p  = 0.998, 0.668, 0.915 and 0.360). ME was the most frequent complication (33.3-47.8%), which resolved after SO extraction in 77.6% of cases. The majority of cases with OHT persisted (61.7%). Emulsification was related to younger age (OR 0.94) and longer duration of the tamponade (OR 1.04). The odds of SO migration to the AC increased with emulsification (OR 2.78), recurrent retinal detachment (OR 0.99) and aphakia (OR 4.05)., Conclusions: We propose SO extraction as the preferred treatment for ME during SO tamponade. SO extraction should be performed sooner in younger patients to avoid emulsification. In selected patients, we suggest a longer duration of the tamponade up to 11 months with a reasonable safety profile, regardless of the SO type., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Puropse: Aqueous misdirection syndrome (AMS) is an aggressive post-operative glaucoma unresponsive to conventional measures with grave outcomes. In this report, we describe a rare case of AMS following silicon oil removal in a vitrectomized eye., Methods: A diabetic patient with tractional retinal detachment underwent pars plana vitrectomy with silicon oil injection. Following retinal reattachment, silicon oil removal was performed at three months. Post oil removal she developed increased intraocular pressure with shallowing of both the peripheral and central anterior chamber suggestive of AMS., Results: Initial medical management with anti-glaucoma medications and cycloplegics was not beneficial. A pars plana lensectomy with complete anterior hyaloidectomy along with a surgical peripheral iridectomy helped relieve the aqueous misdirection., Conclusion: AMS can rarely occur following vitrectomy and is likely secondary to intact anterior hyaloid. Lensectomy along with zonulo-hyaloido-iridectomy is essential. This report highlights the occurrence of this rare complication and its effective management., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To describe a case of concurrent rhegmatogenous retinal detachment, choroidal detachment, and macular hole (RRD-CD-MH) formation in a patient after uncomplicated cataract extraction and intraocular lens implantation (CEIOL). In addition, we summarize the previously reported cases of RRD-CD-MH in the literature., Methods: Interventional case report and literature review., Results: A 71-year-old white man without relevant medical or ocular history underwent an uncomplicated CEIOL. He presented with counting fingers vision and intraocular pressure of 5 mmHg after 3 weeks. On dilated fundus examination, multiple superior tears and total RRD with a serous CD was evident. Intraoperatively, a full-thickness MH was identified. The patient underwent routine RRD and MH repair, with instillation of 1,000 centistoke silicone oil (SiO). The retina successfully re-attached, the CD resolved, and the intraocular pressure normalized; however, the MH did not initially close. The SiO was removed approximately 4 months later and, while the MH remained open, the patient's vision improved to 20/80. Approximately three years after the surgical repair, the MH closed spontaneously, and the vision remained at 20/80., Conclusion: Our patient developed an RRD-CD-MH after uncomplicated CEIOL. The MH displayed delayed closure. The vision improved after surgical repair, and remained stable in the long term.

Aim: To report silicone oil tamponade induced vasculitis in the early post operative period - a rare manifestation of 'Toxic Posterior Segment Syndrome' after pars plana vitrectomy for rhegmatogenous retinal detachment., Case Description: A 50-year-old gentleman presented with vasculitis after a pars plana vitrectomy with silicone oil tamponade on the first post-operative day. He was started on oral steroids (1 mg/ kg) tapered sequentially every week. All signs of vasculitis resolved over a period of one month after which the silicone oil was removed. The patient maintained a visual acuity of 20/90 even after 3 months. There was no recurrence of vasculitis observed thereafter., Conclusion: Silicone oil induced vasculitis is a rarely described entity, especially as a manifestation of toxic posterior segment syndrome. This differential must be kept in mind even on the first post-operative day in cases where silicone oil has been used for tamponade., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The migration of silicone oil into the suprachoroidal region is a rare complication of vitrectomy. A 70-year-old man was admitted to our ocular oncology unit with a choroidal elevation in the nasal area, as well as signs of pars plana vitrectomy surgery performed about 5 years ago for retinal detachment. The patient underwent ocular ultrasound, visual field test, fluorangiography, and magnetic resonance imaging, which led to the diagnosis of silicone oil migration in the suprachoroidal space. Silicone oil may move into the suprachoroidal area, mimicking choroidal neoformation. It is important to have a comprehensive diagnosis and then set up the appropriate treatment. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:104-108.] .

Silicone oil (SO) is used as an intraocular tamponade after complex vitreoretinal surgeries because of its properties such as transparency, inertness, high surface tension, and interfacial tension with water. The only disadvantage of SO tamponade is the need for a second surgery for its removal. However, there is a risk of ocular hypotony soon after the removal of the infusion cannula, especially in retinal vascular conditions, such as diabetic retinopathy. We hereby present a silicone oil removal (SOR) technique using a 30 G needle that prevents intraocular hypotony during SOR., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Background: To discuss the efficacy of an inferior implant of XEN 63 gel stent in a patient with refractory glaucoma after trabeculectomy failure and vitreoretinal surgery with silicone oil tamponade., Case Description: We report the case of a 73-year-old man with a history of refractory open glaucoma with trabeculectomy failure. He experienced recurrent retinal detachments with silicone oil tamponade, with uncontrolled intra-ocular pressure (IOP) after silicone oil removal. Due to the presence of oil emulsion in the anterior chamber, the chosen location for XEN 63 implantation was the infero-temporal quadrant. Mild hyphema and vitreous hemorrhage were seen post-operatively, but were self-limiting. At week 1, the intraocular pressure was 8 mmHg with a well-formed bleb seen in anterior segment optical coherence tomography (AS-OCT). At 6 month follow up, the patient maintained a IOP of 12 mmHg without topical hypotensive drugs. Slit lamp examination revealed a widespread, developed bleb with no signs of inflammation., Conclusion: In this case of refractory glaucoma in a vitrectomized eye with previous oil tamponade, the inferior placement of the XEN 63 gel stent delivered an adequate intraocular pressure even at 6-months follow up, with a diffuse functional infero-nasal bleb seen with AS-OCT., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: Recently, intravitreal pegcetacoplan became the first drug to gain US Food and Drug Administration approval for the treatment of geographic atrophy associated with nonexudative age-related macular degeneration, but the administration of this medication may be associated with unanticipated posttreatment complications., Objective: To assess the prevalence of presumed silicone oil droplets in the vitreous cavity after intravitreal injection of pegcetacoplan., Design, Setting, and Participants: This case series study involved a retrospective record review of all 55 patients treated with intravitreal pegcetacoplan, 0.1 mL in 150-mg/mL solution, between March 24 and June 5, 2023, at a single specialty retina practice. All injections were done using needles from the kit supplied by Apellis Pharmaceuticals on a 1-mL McKesson Luer lock syringe., Main Outcomes and Measures: The presence or absence of presumed silicone bubbles detected during dilated biomicroscopic fundus examination and/or on color fundus photographs, the presence or absence of symptoms, change in visual acuity, and/or increase in intraocular pressure., Results: A total of 62 intravitreal pegcetacoplan injections were given to 55 patients (mean [SD] age, 83.8 [7.8] years; 33 women [60%]) from March 24 to June 5, 2023. Of the 55 patients, 16 (29%; mean [SD] age, 83.8 [7.4] years; 9 women [56%]) had presumed intravitreal silicone droplets discovered 2 to 4 weeks after treatment, 3 of which were documented on color fundus photographs. Of the 16 patients, 14 (88%) were symptomatic for new floaters that they described as persistent, while 2 (13%) were asymptomatic. There were no signs of inflammation or infection, no increases in intraocular pressure, and no changes in visual acuity for all 16 patients., Conclusions and Relevance: A substantial percentage of patients had symptomatic floaters from presumed intravitreal silicone oil droplets after injections of pegcetacoplan using a McKesson 1-mL Luer lock syringe. These findings support consideration of informing patients of this potential adverse effect, avoiding use of the McKesson syringe, and considering use of silicone-free syringes for pegcetacoplan injections.

Background: To report a case in which silicone oil accidentally entered Berger's space (BS) after vitrectomy and to explore the effective treatments and possible etiological mechanisms., Case Presentation: A 68-year-old male underwent vitrectomy and silicone oil injection for the treatment of retinal detachment (RD) in the right eye. Six months later, we noticed an unexpected lens-like round translucent substance located behind the posterior lens capsule and diagnosed it as BS filled by silicone oil. Subsequently, we conducted vitrectomy and the drainage of the silicone oil in BS in the second surgery. A 3-month follow-up showed significant anatomic recovery and visual recovery., Conclusions: Our case report presents a patient with silicone oil entering BS after vitrectomy and provides photographs of BS from a relatively unique perspective. Furthermore, we illustrate the surgical treatment procedure and reveal the possible etiology and prevention method of silicon oil entering BS, which will provide good insights for clinical diagnosis and treatment., (© 2023. The Author(s).)

Purpose: To report a new photographic macular feature identified on multimodal imaging in eyes with silicone oil in situ., Methods: Retrospective, observational case series of three eyes of three patients., Results: Two eyes had undergone initial vitrectomy for vitreous hemorrhage with fibrovascular membranes causing tractional retinal detachments secondary to retinovascular occlusion. One eye had further vitrectomy for rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. All three eyes had multiple, discrete, coarse, hyperreflective deposits at the silicone oil-retina interface on optical coherence tomography macular scans, with increased reflectivity from the inner retinal layers. On multicolor and infrared images, these preretinal deposits produced hyporeflective darker spots giving a quasi-pitting appearance of the retinal surface against glossy bright reflection from silicone oil, thus simulating an appearance of ‟a strawberry." These deposits are causing inverse pitting of the oil bubble. On blue autoflourescence imaging, the preretinal deposits caused hypoautoflourescence. Partial silicone oil emulsification was seen superiorly in two of these patients with a different clinical and optical coherence tomography appearance from these hyperreflective macular deposits., Conclusion: We describe a new distinctive ‟Strawberry Retina" appearance identified on multicolor and infrared macular images associated with hyperreflective, coarse deposits at the silicone oil-retina interface.

Background/aims: This study investigated the risk factors for epiretinal membrane (ERM) in eyes with primary rhegmatogenous retinal detachment (RRD) that received silicone oil (SO) tamponade., Methods: This retrospective analysis included 1140 patients (1140 eyes) with RRD who underwent primary vitrectomy and SO tamponade. The prevalence of ERM was estimated and possible risk factors (eg, type 2 diabetes, proliferative vitreoretinopathy (PVR), SO tamponade time (SOTT), photocoagulation, vitreous haemorrhage, choroidal detachment, cryotherapy and retinal tear size) were analysed via multiple logistic regression., Results: The prevalence of ERM was 12.3% (140/1140), and the accuracy of preoperative ERM diagnosis was 40.5%. Multivariate logistic regression analysis showed that risk factors for ERM in eyes with SO tamponade included preoperative PVR (OR=4.336, 95% CI 2.533 to 7.424, p<0.001), type 2 diabetes (OR=3.996, 95% CI 2.013 to 7.932, p<0.001), photocoagulation energy (OR=1.785, 95% CI 1.306 to 2.439, p<0.001) and SOTT (OR=1.523, 95% CI 1.261 to 1.840, p<0.001). No statistically significant associations were observed between the incidence of ERM and other risk factors. Preoperative PVR showed the strongest association with risk of ERM. The risk of ERM was positively associated with SOTT, photocoagulation energy and preoperative PVR grade., Conclusion: In eyes with RRD that received SO tamponade, the prevalence of ERM was 12.3%, while the accuracy of preoperative ERM diagnosis was low. Preoperative PVR, type 2 diabetes, photocoagulation energy and SOTT were the main risk factors for ERM., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To explore the presence of residual emulsified silicone oil (SO) droplets in patients with rhegmatogenous retinal detachment (RRD) and their possible risk factors., Methods: Patients who underwent primary pars plana vitrectomy with SO injection for RRD and SO removal at the same eye centre were included. Approximately 10 weeks after SO removal, B-scan ultrasonography was performed, and using ImageJ, the silicone oil index (SOI) was measured, and its possible correlations with other clinical factors were explored., Results: A total of 101 eyes were included. Residual SO particles were found in all the patients (100%), and the mean SOI was 4.04% ± 5.16% (range 0.06%-19.88%). Multiple linear regression revealed that, among all the clinical factors, axial length (AL) and ocular hypertension (intraocular pressure (IOP) > 21 mmHg or the use of antiglaucoma medications) before SO removal were positively and significantly associated with the SOI (all P < 0.05). Patients with ocular hypertension after SO removal had a higher SOI, a longer SO duration, a higher IOP before SO removal and a longer AL than those without (all P < 0.05)., Conclusions: Patients with a larger AL and higher IOP before SO removal were more prone to have more residual SO droplets, which might in turn lead to an elevated IOP. In these eyes, thorough irrigation or repeated fluid-air exchange might be necessary., (© 2022. The Author(s).)

Purpose: Presumed silicone oil-related retinal toxicity causes central vision loss with a reported incidence of 1-33% in the first month after oil removal and 10% in the first six months of having silicone oil in-situ. This report examines local rates in a tertiary hospital that manages many geographically distanced patients. A miniature literature review, audit and case series are presented., Methods: A retrospective audit of all patients who underwent a 'removal of silicone oil' surgery at the Royal Brisbane and Women's Hospital between 2016 and 2021. Inclusion criteria were that the oil was inserted for primary or recurrent rhegmatogenous retinal detachment. Visual acuity was analysed at presentation, at 1 and 3 months of oil in-situ, preoperatively to removal of oil and up to 6 months after oil removal. Ocular coherence tomographic parameters were examined at each time interval, including nerve fibre layer (NFL) and ganglion cell layer and inner plexiform layer (GCL + IPL) thicknesses in the 3 mm parafoveal zone, presence of inner retinal microcystic changes or intraretinal silicone oil globules. Patients were identified who had unexplained vision loss of two or more Snellen lines. Further analysis and case review were performed., Results and Conclusions: Between January 2016 and May 2021, 101 patients met the inclusion criteria. Three patients had significant and unexplained visual loss. They are presented in this paper. Presumed silicone oil toxicity is an increasingly recognised and potentially devastating phenomenon that vitreo-retinal surgeons should be wary of. Patients should be specifically consented for it and hospitals should perform local auditing to determine their own rates and inform this discussion., (© 2022. Crown.)

Objective: This study aimed to evaluate the clinical efficacy and safety of foldable capsular vitreous body (FCVB) implant surgery in silicone oil-dependent eyes., Methods: A total of 22 participants with silicone oil-dependent eyes who received treatment with FCVB implant surgery between January 2019 and June 2020 were included in this retrospective study. The intraocular pressure (IOP), best-corrected visual acuity (BCVA), demographic data, and any recorded complications were evaluated., Results: The postoperative IOP (12.73±4.20 mmHg) was significantly improved (P=0.03) compared to the preoperative IOP (10.23±3.69 mmHg) (the main endpoint). There was no significant difference (P=0.33) in the final BCVA preoperation and 3rd month postoperation (the secondary endpoint). The most common postoperative complication was hyphema. Other common postoperative complications included corneal opacity, a shallow anterior chamber, and a low IOP., Conclusion: FCVB implant surgery is a safe and effective method for treating silicone oil-dependent eyes; however, attention should be paid to the prevention and timely treatment of complications., (© 2023. Huazhong University of Science and Technology.)

A man in his 50s underwent vitrectomy surgery for a macular off retinal detachment which was complicated by intraoperative hypotony and suprachoroidal haemorrhage, resulting in the use of silicone oil tamponade. Postoperatively, several retained cysts of fluid were seen underneath the retina, one of which was large and close to the macular. Imaging was used to determine that this was likely retained silicone oil. Given the potential of migration to the macular and retinal toxicity, the decision was made to remove the larger oil bubbles under the retina. We explain how the oil may have got under the retina in this unusual case, how we dealt with it and discuss other cases of different substances under the retina and their appearance on ocular imaging., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To describe intraocular clouding of silicone oil in the absence of emulsification., Methods: Retrospective observational case series of patients who received silicone oil injections and developed silicone oil discoloration without emulsification after pars plana vitrectomy. Clinical examinations and physicochemical analyses were performed to find out the common cause for the opaque oil., Results: Thirteen patients developed silicone oil discoloration after pars plana vitrectomy. It could be traced down that all patients had received silicone oil from one respective production batch. The silicone oil was removed as soon as possible after the changes were detected (range, 8-16 weeks). Gas chromatography flame ionization detector, size exclusion chromatography, and high-performance liquid chromatography analysis showed the absence of low-molecular-weight compounds in the opaque lot. Thermogravimetric analysis revealed the opaque lot was more temperature stable. During the follow-ups, no obvious retinal toxicity could be observed and best-recorded visual acuity improved considerably in 12 patients and was only limited by the underlying retinal pathologic conditions., Conclusion: This is the first report on opacification of intraocular silicone oil without emulsification. This discoloration of silicone oil may disturb vision and prevent proper fundus examination; however, it seems to be a nontoxic phenomenon without serious long-term consequences.

Purpose: Silicone oil (SO) is commonly used for tamponade purposes in retinal detachment (RD) surgery, but the long-term visual prognosis after removal of the oil, and in particular, what is known about the recurrence of RD after SO removal, remains unclear. The purpose of this study is to evaluate the long-term vision prognosis after SO removal, and to understand the frequency and characteristics of RD recurrence., Methods: We retrospectively reviewed the medical charts of 1017 eyes of patients with a diagnosis of RD who had a pars plana vitrectomy with SO tamponade between January 2009 and December 2018. Best-corrected visual acuity (BCVA) was obatained before and after vitrectomy and also at the last visit. After SO removal, the group who showed improvement in visual acuity and the group who did not were compared. The anatomical results were compared between the group in which the retina was detached again after SO removal and the group in which the retina was not detached. To determine whether the duration of SO tamponade affects RD recurrence, further analysis was performed by dividing subgroups according to SO tamponade duration. RD recurrence, visual acuity, SO tamponade period were investigated., Results: Mean follow-up period was 56.65 ± 72.02 months. An average SO tamponade period was 6.68 ± 11.39 months. The average logMAR BCVA was 1.75 ± 0.91 before SO injection, 1.60 ± 0.75 before SO removal and 1.29 ± 0.96 after the removal. After SO removal, 926 of the 1017 (91.1%) patients had well attached retina without recurrence. There was no significant difference in visual acuity before SO removal in re-detachment group compared to no re-detachment group, but visual acuity of re-detachment group was worse than no re-detachment group after SO removal (p<0.001). The SO tamponade period in the group with improved vision after SO removal was 5.09 ± 9.87 months, and the period was significantly shorter than the 9.09 ± 13.05 months in the group not showing vision recovery (p = 0.005). The occurrence of corneal opacity was significantly higher in the group with SO over 6 months, than those of the two groups with SO tamponade duration of less than 3 months and between 3 and 6 months (p = 0.038). The longest tamponade group showed the worst final vision after SO removal (p<0.001)., Conclusion: The prognosis for final vision is generally good when performing surgery using SO in RD, but considering the complications that arise after surgery, long-term retention of SO is not recommended and the timing of SO removal should be considered., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Our aim was to determine the various risk factors for secondary ocular hypertension (OHT) following pars plana vitrectomy (PPV) with silicone oil (SO) injection., Methods: A prospective cohort study was performed on 46 eyes of 42 patients who underwent PPV with SO injection under a single surgeon between January 2020 and July 2021. Complete ophthalmological examination including gonioscopy and Goldmann applanation tonometry was performed preoperatively and on three postoperative visits, that is, day 7, day 30, and day 90. Axial length and lens thickness were measured at baseline using immersion A-scan. Anterior segment optical coherence tomography (OCT) was used for measuring anterior chamber depth (ACD) at baseline and at 3 months., Results: There was a statistically significant increase in intraocular pressure (IOP) (>21 mmHg) on day 7 (4.70 ± 7.754 mmHg), day 30 (5.24 ± 7.481 mmHg), and day 90 (2.39 ± 5.659 mmHg) (P<0.01 for all). Age <50 years, rhegmatogenous retinal detachment (RRD), and pseudophakia had a strong association with short-term OHT on day 7. Preexisting glaucoma was the only independent risk factor for long-term OHT (day 90). Higher baseline IOP and SO emulsification also contributed to long-term OHT., Conclusion: There was a statistically significant elevation in IOP at all postoperative visits. Short-term OHT was associated with younger age (<50 years), RRD, and pseudophakia. Patients with emulsified SO in the anterior chamber, higher baseline IOP, and preexisting glaucoma were at higher risk for long-term OHT., Competing Interests: None

Silicone oil insertion is a common modality in vitreoretinal surgeries after ocular perforating injury. It needs surgical removal after several months. Extraocular silicone oil migration to orbit and eyelid is uncommon complication. We reports a case of silicone oil migration to orbit and eyelid. A 41-year-old male presented with left upper eyelid swelling following silicone oil injection 3 years before admission. Orbital computed tomography scan showed multiple high-density well-defined masses in vitreous, left upper eyelid and orbit. We diagnosed the patient with orbital and eyelid mass, meanwhile, speculated mechanical ptosis. Excision of orbital and eyelid masses were performed. Cystic spaces with delicate fibrous wall and small vessels, and clear fluid in cyst were discovered on histologic examination. The patient was followed up after 1 week. The left upper eyelid slightly depressed and the mechanical ptosis was significantly improved.

In this chapter, we describe a clinically relevant inducible and reversible ocular hypertension glaucoma model, which mimics the secondary glaucoma that can be a postoperative complication when silicone oil (SO) is used as a tamponade agent in human vitreoretinal surgery. First, we detail the procedures for generating SO-induced ocular hypertension (SOHU) in mouse and describe the two variations of this model that simulate common but distinct glaucoma types. We also describe separately the related procedures for measuring IOP and removing SO to return IOP to normal. Lastly, we describe the extension of the SOHU model in nonhuman primate (NHP), which recapitulates the severe neurodegeneration of acute human glaucoma but with unique dynamic changes of IOP due to the tolerance of the NHP ciliary body. The SOHU glaucoma model is, therefore, suitable for assessing experimental therapies for neuroprotection and regeneration, with or without treatment to lower IOP (SO removal), and consequently for translating relevant findings into novel and effective clinical treatments for glaucoma and other neurodegenerations. This model is straightforward, does not require special equipment or repetitive procedures, closely simulates clinical situations, and may be applicable to diverse animal species although minor modifications may be required., (© 2023. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

In this article, we answered the questions in Lei Gao et al.'s comments on the "effects of refractive accommodation on subfoveal choroidal thickness in silicone oil-filled eyes" one by one., (© 2022. The Author(s).)

Background: Phacoemulsification has been the mainstay method for extracapsular cataract extraction surgery in the anterior segment; for cases of posterior drop of lens fragments into the vitreous, a posterior segment phacoemulsification instrument (fragmatome; Alcon, Inc., Fort Worth, TX) can be employed to remove the dislocated lens materials. Studies have reported on thermal injury to the cornea during phacmoemulsification of the anterior segment. However, few studies have investigated thermal burn in the simultaneous sclera and eyelid induced by the fragmatome. Currently, there is no reports and lack of optimal strategy for the management of nucleus drop in a vitreous cavity filled with silicon oil., Case Presentation: We present the case of a 53-year-old male patient with a thermal burn wound on the upper eyelid and sclera following phacoemulsification for a dropped lens in a silicone oil-filled vitreous. We further designed an experiment to verify our hypothesis that thermal injury could be induced by the high temperature of the metal tip during phacoemulsification in silicone oil. In our experiment, during 420 s of continuous ultrasonic wave, the temperature of the fragmatome tip in the balanced salt solution (BSS) increased from 22.0 to 24.0 ºC, while the temperature of the fragmatome tip in the silicone oil group increased from 22.0 to 43.0 ºC., Conclusions: The temperature of the fragmatome tip increased significantly in silicone oil compared to BSS in the experiment. Thus, physicians should be aware of possible thermal complications when using fragmatome in eyes filled with silicone oil., (© 2022. The Author(s).)

Competing Interests: The authors have no conflicts of interest to declare.

Objective: To illustrate the complications in subjects who experienced posterior vitrectomy and internal tamponade with silicone oil. Design: Prospective, observational, longitudinal, descriptive, series of cases. Material and methods: Patients who underwent posterior vitrectomy and internal tamponade with silicone oil of 1000 centistokes, from April to October 2021, were considered. All subjects included in the study had a complete ophthalmic examination pre and postoperatively on first day, first week and 1 to 6 months, and were assessed the best corrected visual acuity, ocular tension (raised > 21 mmHg, hypotony < 5 mmHg), emulsification, keratopathy, cataracts and posterior pole. Results: 40 eyes of 40 patients were considered; twenty women and 20 men, with an average age of 63 years (range 46 to 77 years). Conclusions: Complications are brief, treated medically or surgically, with better prognosis., (#x00A9; The Authors.Romanian Society of Ophthalmology.)

Background: Silicon oil is an important adjunct for achieving internal tamponade in the treatment of retinal detachment. Silicone oil tamponade often leads to narrowing of the angle and development of adhesions between the iris and anterior chamber angle structures, with consequential elevation of the intraocular pressure. The video showcases the management of these challenging scenarios., Purpose: To highlight the management of early synechial closures due to silicon oil tamponade., Synopsis: The video highlights the management of early synechial closure following silicon oil tamponade. Surgical pupilloplasty has been demonstrated to break the peripheral anterior synechias on intraoperative gonioscopy as well as on anterior segment optical coherence tomography (AS-OCT). Performing pupilloplasty in the early phase of development of peripheral anterior synechias (PAS) helps to break the existing synechias and prevent angle closure and sequential deterioration of vision., Highlights: Surgical pupilloplasty helps to relieve the post silicon oil-induced secondary angle closure glaucoma by breaking the peripheral anterior synechias and significantly opening the anterior chamber angles., Online Video Link: https://youtu.be/xe2NGlhPBF4., Competing Interests: None