Complications associated with the use of silicone oil in vitreoretinal surgery: A systemic review and meta‐analysis

Abstract

Silicone oil (SO) still represents the main choice for long‐term intraocular tamponade in complicated vitreoretinal surgery. This review compared the complications associated with the use of SO and other vitreous substitutes after pars plana vitrectomy in patients with different underlying diseases. Meta‐analysis was conducted in accordance with PRISMA guidelines. We retrieved randomized clinical trials (RCTs), retrospective case–control and cohort studies evaluating the risk of using SO, published between 1994 and 2020, conducting a computer‐based search of the following databases: PubMed, Web of Science, Scopus and Embase. Primary outcome was the rate of complications such as intraocular hypertension, retinal re‐detachment, unexpected vision loss or hypotony. Secondary outcome was to compare the rate of adverse events of different SO viscosities, especially emulsification. Forty‐three articles were included. There were significant differences in intraocular hypertension (p = 0.0002, OR = 1.66; 95% CI = 1.27–2.18) and the rate of retinal re‐detachment (p < 0.0009, OR = 0.65; 95% CI = 0.50–0.64) between SO and other agents, including placebo. However, there were no differences in other complication rates. Silicone oil (SO)‐emulsification rate was non‐significantly higher in low than high SO viscosity, and results from other complications were comparable in both groups. The high quality of most of the studies included in this study is noteworthy, which provides some certainty to the conclusions. Among them is the high variability of the SO residence time. The fact that ocular hypertension and not hypotension is related to SO use. A clear relationship is not found for the so‐called unexplained vision loss, which affects a significant percentage of eyes. Re‐detachment cases are less if SO is used and that surprisingly there does not seem to be a relationship in the percentage of emulsification between the low‐ and high‐viscosity silicones. All these data warrant more standardized prospective studies.

Vitamin D Receptor (VDR) Gene Polymorphisms Modify the Response to Vitamin D Supplementation: A Systematic Review and Meta-Analysis

“…As previously described [23][24][25], meta-analyses were carried out using RevMan 5.0 software [26]. The difference between baseline and post-supplementation status and their 95% confidence interval (CI) were estimated for each study.…”

Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade

“…In particular, higher η has been associated with increased resistance of SO to emulsifying in vitro, but also with more difficult surgical handling [ 40 ]. However, the relationship between higher η and decreased postoperative emulsification appears to be not supported by clinical studies [ 3 ]. It has to be noted that the nominal η refers to the dominant fraction of PDMS polymers of the desired length, but, despite post-synthesis purification processes, the final SO is a mixture of this fraction and a variable amount of siloxane chains of lower and higher MW [ 41 ].…”

“…Silicone oils have been traditionally used and have still an irreplaceable role in the surgical management of complex vitreoretinal diseases [ 2 ]. However, their use can be associated with potentially severe complications, whose pathogenetic mechanisms remain not fully understood [ 3 ]. Microstructural changes and clinically detectable alterations in the cornea and in the retina have been described after SO tamponade and indicated as SO-associated keratopathy and SO-associated retinopathy, respectively [ 3 , 4 , 5 , 6 ].…”

“…However, their use can be associated with potentially severe complications, whose pathogenetic mechanisms remain not fully understood [ 3 ]. Microstructural changes and clinically detectable alterations in the cornea and in the retina have been described after SO tamponade and indicated as SO-associated keratopathy and SO-associated retinopathy, respectively [ 3 , 4 , 5 , 6 ]. SO-associated keratopathy may ultimately lead to corneal decompensation and need of corneal transplant [ 4 , 7 ], whereas SO-associated retinal changes may result in impaired retinal function and are supposed to play a role in SO-related vision loss (SOVRL) [ 8 , 9 ].…”

Foldable Capsular Vitreous Body Implantation for Complicated Retinal Detachment Caused by Severe Ocular Trauma

“…In the former patient, this may eventually cause silicone oil dependence and produce various complications, such as intraocular hypertension, corneal degeneration, retinal redetachment, and silicone oil emulsification. 4 Patients who are not suitable for PPV or give up surgery will eventually experience atrophy of the eyeball, which affects appearance. Further negative psychological problems, such as low self-esteem, pessimism, and depression, will occur.…”