Macular hole surgery with silicone oil

Abstract

Purpose Macular hole surgery usually involves gas tamponade which necessitates a variable period of postoperative posturing in a face-down position. A number of patients find this difficult or impossible for medical or social reasons. This study reviews our experience of macular hole surgery using silicone oil tamponade with no restriction of posturing. Methods Sixteen consecutive cases of macular hole (stage III/IV) surgery where silicone oil was used for tamponade were reviewed. Group A patients were unable for medical or social reasons to maintain a facedown posture and Group B patients had previous failed surgery with gas tamponade. Results Anatomical closure of hole was achieved in 81% (13/16) of all cases and 88% (7/8) of cases with no previous surgery (Group A) with a mean follow-up of 7.5 months (range 4-24 months). Mean visual improvement (log MAR value of visual acuity) for Group A and Group B were 0.41 and 0.03, respectively. Conclusions The success rate of macular hole surgery using silicone oil as tamponade, in cases with no previous surgery, is comparable to that achieved when gas is used as tamponade. Although good anatomical success can be achieved in cases with previous failed surgery, the visual outcome is less rewarding. Silicone oil is an alternative to gas tamponade for macular hole surgery in patients who are unable or unwilling to posture. However, it has to be borne in mind that silicone oil tamponade is not without risks.

Successful Treatment of Persistent Macular Holes Using “Heavy Silicone Oil” as Intraocular Tamponade

“…The poor tamponade might be an explanation why visual recovery after silicone oil tamponade is less favorable than after gas tamponade. 2,12 In contrast, OCT images of the foveal region with HSO filling have shown no prefoveal interface. A good tamponade effect is exerted on the foveal region (Figs.…”

“…In these cases, surgical retreatment with silicone oil tamponade can lead to closure of the macular hole, but the visual outcome is less favorable. [2][3][4] We describe two patients in whom macular hole closure was not achieved after primary vitrectomy, peeling of the internal limiting membrane (ILM), and long-acting gas tamponade. We used "heavy silicone oil" (HSO) during a second surgical procedure that was removed after 3 months.…”

Heavy silicone oil (Densiron-68) for the treatment of persistent macular holes

“…Indeed standard silicone oil tamponade can also lead to closure of the MH, with a reported rate as high as 33% [37], but often does not achieve good functional results [14,38,39]. Moreover, the effectiveness of the silicone oil endotamponading of the posterior pole is still debatable [13][14][15].…”

1000 cSt silicone oil vs heavy silicone oil as intraocular tamponade in retinal detachment associated to myopic macular hole

“…Moreover, redetachment may still develop, and often multiple surgeries are required to achieve reattachment [1,4,9]. Silicone oil tamponade was introduced in macular hole surgery as an option for patients unable to maintain postoperative positioning, as required for gas-filled eyes [10][11][12]; it has also been suggested in the treatment of persistent idiopathic macular hole [13][14][15]. The use of silicone oil in RD associated to MMH has been proposed as a primary approach, with promising anatomical and functional results [16].…”