Are there any risks or complications associated with silicone oil used as an intra‑ocular tamponade for retinal detachment?

Risks and Complications of Silicone Oil for Retinal Detachment

Yes, silicone oil tamponade carries significant risks including cataract formation (100% in phakic eyes), elevated intraocular pressure requiring treatment (12-40% of cases), oil emulsification (42-100% over time), and potential retinal redetachment (8-34% after oil removal), though it remains an effective treatment for complex retinal detachments when other tamponade agents are insufficient. 1, 2, 3

Major Complications During Silicone Oil Tamponade

Cataract Formation

• Cataract develops in 100% of phakic eyes following silicone oil tamponade, typically requiring surgical intervention 1, 2
• This is the most predictable long-term complication and should be discussed preoperatively with all phakic patients 1

Elevated Intraocular Pressure

• Elevated IOP requiring treatment occurs in 12-40% of cases, representing one of the most common complications 4, 1, 2
• Short-term IOP elevation (within 2 weeks) is common and usually transient 1
• Pupillary block glaucoma occurs in approximately 3% of cases, which is why inferior peripheral iridectomy is routinely recommended in aphakic eyes to prevent this complication 5, 2
• Closure of the inferior iridectomy occurs in 14% of cases, potentially leading to secondary angle closure 2

Silicone Oil Emulsification

• Oil emulsification occurs in 42-100% of cases within the first year, with universal occurrence by 1 year in some series 1, 2
• The physicochemical characteristics of the injected oil may influence the rate of emulsification 2

Corneal Complications

• Band keratopathy develops within 6 months in all corneas with oil-endothelial touch 2
• This emphasizes the importance of adequate fill and avoiding overfill that causes anterior migration 2

Retinal Redetachment Risks

During Silicone Oil Tamponade

• Recurrent detachment occurs in 12-22% of eyes while silicone oil remains in situ 4, 2
• The presence of retinal detachment at the time of planned oil removal is a critical negative prognostic factor 4, 3

After Silicone Oil Removal

• Overall redetachment rate after oil removal is 8-12% in eyes with completely attached retinas at the time of removal 3
• Redetachment rate increases dramatically to 34% in eyes with unstable or incompletely attached retinas at the time of oil removal 3
• If retinal detachment is present at oil removal, 88.2% will experience subsequent relapse, compared to only 14.2% if the retina is attached 4
• Longer duration of silicone oil tamponade and use of silicone oil (rather than air or gas) as post-removal tamponade are associated with lower redetachment rates 4

Other Significant Complications

Inflammatory and Proliferative Changes

• Mild anterior chamber inflammation occurs commonly in the short-term postoperative period 1
• Fibrous epiretinal and subretinal proliferations develop in 15% of cases 2
• Proliferative vitreoretinopathy occurs in 12.1% as a long-term complication 1

Additional Complications

• Ocular hypotony occurs in 9.1% of cases 1
• Pain develops in 5% of patients 2
• Subconjunctival oil deposits occur in 3% 2

Critical Management Considerations

Surgical Technique to Minimize Complications

• Meticulous sclerotomy closure with mattress sutures using long scleral passes is essential to prevent hypotony, one of the most common surgical complications 5, 6
• Complete peripheral vitreous removal and thorough treatment of all retinal breaks with laser or cryotherapy extending to the ora serrata reduces failure risk 6

Timing of Oil Removal

• The duration of silicone oil tamponade does not significantly affect redetachment rates in eyes with stable, attached retinas 3
• In eyes with retinal detachment at the time of planned oil removal, short-term tamponade should be avoided in favor of continued silicone oil 4
• Preoperative laser photocoagulation at the cerclage buckle and central to any local detachment significantly reduces redetachment rates (25% vs 53%) in unstable cases 3

Special Precautions

• Patients must avoid air travel and ascending to higher altitudes while silicone oil is present, as this can cause dangerous IOP elevation, arterial occlusion, or wound dehiscence 7
• Close IOP monitoring is mandatory, as elevated pressure can result in permanent vision loss, especially in glaucoma patients 7, 4

Visual Outcomes

• Despite high anatomic success rates (87.9-100% with one or two surgeries), functional visual outcomes are often disappointing, with only 19% achieving visual acuity of 0.05 or better in some series 4, 1, 8
• Mean visual acuity typically remains around 1.1 logarithm of minimum angle of resolution at all follow-up time points 4