Clinical Outcomes After Intraocular Silicone Oil Removal and Analysis of Its Prognostic Factors

Soo Young Kim; Jung Yeong Jeong; Sang Joon Lee; Shin Dong Kim

doi:10.3341/jkos.2009.50.12.1809

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Kim, Jeong, Lee, and Kim: Clinical Outcomes After Intraocular Silicone Oil Removal and Analysis of Its Prognostic Factors

Original Article

J Korean Ophthalmol Soc 2009;50(12):1809-1816.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.12.1809

Clinical Outcomes After Intraocular Silicone Oil Removal and Analysis of Its Prognostic Factors

Soo Young Kim, MD¹, Jung Yeong Jeong, MD², Sang Joon Lee, MD¹, Shin Dong Kim, MD¹

¹Department of Ophthalmology, Kosin University, College of Medicine, Busan, Korea

²Salang-gadeuk Eye Clinic, Busan, Korea

Address reprint requests to Shin Dong Kim, MD, Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine #34 Amnam-dong, Seo-gu, Busan 602-702, Korea Tel: 82-51-990-6140, Fax: 82-51-990-3026, E-mail: shdkim@ns.kosinmed.or.kr

Received 6 March 2009 Accepted 17 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the factors influencing clinical outcome after removal of intraocular silicone oil and the relationship of the factors to the postoperative visual prognosis.

Methods

The authors retrospectively analyzed clinical outcomes related to 76 patients (79 eyes) who underwent silicone oil tamponade. Prognostic factors were as follows: age, underlying pathologies, systemic diseases, range and type of retinal detachment (RD), type of RD, number of retinal tears, macular and lens status, and types of operation. The influence of these factors on visual acuity and anatomical success rates were studied.

Results

The 79 eyes that underwent silicone oil removal had preoperative diagnoses as follows: proliferative diabetic retinopathy in 32 eyes, primary rhegmatogenous RD in 12 eyes, RD with an intraocular foreign body in nine eyes, traumatic RD in eight eyes, RD with a macular hole in six eyes, RD development after other surgeries in six eyes, RD with endophthalmitis in three eyes, and RD with high myopia in three eyes. Anatomical success was achieved in 59 eyes (74.7%) after silicone oil removal. Thirty-two eyes (40.5%) had an increase in visual acuity, 28 eyes (35.4%) showed no changes and 19 eyes (24.1%) showed deteriorated conditions after silicone oil removal. The number of surgeries was an important factor related to anatomical and functional success rate. Postoperative visual improvement was observed when the number of surgeries was greater than two and in groups with no macular holes or degenerations.

Conclusions

When considering prognostic factors for silicone oil removal, reducing complications and retinal redetachment after silicone oil removal may be helpful.

Keywords: Retinal redetachment, Silicone oil, Silicone oil removal, Vitrectomy

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Table 1.

Preoperative diagnosis at initial silicone oil injection

Diagnosis	No. of eyes (%)
PDR^*	32 (40.5)
Primary RRD^†	12 (15.2)
RD^‡ with IOFB^§	9 (11.4)
Traumatic RD^‡	8 (10.1)
RD^‡ with macular hole	6 (7.6)
RD^‡ developed after other surgeries	6 (7.6)
RD^‡ with endophthalmitis	3 (3.8)
RD^‡ with high myopia	3 (3.8)
Total	79 (100.0)

^* PDR=proliferative diabetic retinopathy

^† RRD=rhegmatogenous retinal detachment

^‡ RD=retinal detachment

^§ IOFB=intraocular foreign body.

Table 2.

Complications associated with silicone oil tamponade

Complications	No. of eyes (%)
Cataract	9^* (42.9)
Keratopathy	5 (6.3)
Secondary glaucoma	6 (7.6)
Silicone oil in anterior chamber	1 (1.3)
Emulsification	1 (1.3)

N=79; phakic eyes (21)+aphakic and pseudophakic eyes (58)

^* 9 of 21 phakic eyes (42.9%=9/21).

Table 3.

Variables influencing postoperative anatomical results

Variables	Anatomical success: eyes (%)		Total	p-value
Variables	Success	Failure	Total	p-value
Age				0.478
≤45	30 (71.4)	12 (28.6)	42
>45	29 (78.4)	8 (21.6)	37
SiO^* retained period (months)				0.669
≤1.5	16 (72.7)	6 (28.3)	22
1.5< ～ >3.0	30 (78.9)	8 (21.1)	38
≥3.0	13 (68.4)	6 (31.6)	19
Number of operation				0.008^††
≤2	32 (88.9)	4 (11.1)	36
>2	27 (62.8)	16 (37.2)	43
Lens status				0.213
Phakia	15 (71.4)	6 (28.6)	21
Aphakia	23 (67.6)	11 (32.4)	34
Pseudophakia	21 (87.5)	3 (12.5)	24
Type of RD^†				0.562
RRD^‡	29 (72.5)	11 (27.5)	40
TRD^§	24 (77.4)	7 (22.6)	31
XRD^∏	2 (100.0)	0 (0.0)	2
Macular hole				0.974
Yes	12 (75.0)	4 (25.0)	16
No	57 (90.5)	6 (9.5)	63
Number of retinal tears				0.332
Multiple or giant tears	28 (70.5)	12 (30.0)	40
One or not found	31 (79.5)	8 (20.5)	39
Diabetes				0.401
Yes	27 (79.4)	7 (20.6)	34
No	32 (71.1)	13 (28.9)	45
Diabetic renal failure				0.269
Yes	10 (62.5)	6 (37.5)	16
No	49 (77.8)	14 (22.2)	63
Scleral buckling				0.688
Yes	35 (59.3)	24 (40.7)	59
No	10 (50.0)	10 (50.0)	20
Preoperative diagnosis
PDR^＃	24 (75.0)	8 (25.0)	32
Primary RRD^‡	10 (83.3)	2 (16.7)	12
RD with IOFB^**	7 (77.8)	2 (22.2)	9
TRD^§	7 (77.8)	2 (22.2)	8
RD^† with macular hole	4 (66.7)	2 (33.3)	6
RD^† developed after other surgeries	4 (66.7)	2 (33.3)	6
RD^† with endopthalmitis	2 (66.7)	1 (33.3)	3
RD^† with myopia	2 (66.7)	1 (33.3)	3

^* SiO=silicone oil

^† RD=retinal detachment

^‡ RRD=rhegmatogenous retinal detachment

^§ TRD=tractional retinal detachment

^∏ XRD =exudative retinal detachment

^＃ PDR=proliferative diabetic retinopathy

^** IOFB=intraocular foreign body

^†† Significant difference between the two groups by Pearson x² test.

Table 4.

Variables influencing postoperative functional results

Variables	Functional success: eyes (%)			Total	p-value
Variables	Improve	No change	Worse	Total	p-value
Age					0.114
≤45	14 (33.3)	15 (35.7)	13 (21.0)	42
>45	17 (46.0)	14 (37.8)	6 (16.2)	37
SiO^* retained period (months)					0.199
≤1.5	12 (54.5)	4 (18.2)	6 (27.3)	22
1.5< ～ >3.0	13 (34.2)	18 (47.4)	7 (18.4)	38
≥3.0	7 (36.8)	6 (31.6)	6 (31.6)	19
Number of operation					0.008^††
≤2	17 (47.2)	13 (36.1)	6 (16.7)	36
>2	15 (34.9)	15 (34.9)	13 (30.2)	43
Lens status					0.217
Phakia	7 (33.3)	8 (38.1)	6 (28.6)	21
Aphakia	11 (32.4)	13 (38.2)	10 (29.4)	34
Pseudophakia	14 (58.3)	7 (29.2)	3 (12.5)	24
Type of RD^†					0.731
RRD^‡	16 (40.0)	16 (40.0)	8 (20.0)	40
TRD^§	12 (38.7)	9 (29.0)	10 (32.3)	31
XRD^∏	2 (100.0)	0 (0.0)	0 (0.0)	2
Macular hole or degeneration					0.390
Yes	5 (31.3)	8 (50.0)	3 (18.7)	16
No	27 (42.9)	20 (31.7)	16 (25.4)	63
Number of retinal tears					0.154
Multiple or giant tears	20 (50.0)	12 (30.0)	8 (20.0)	40
One or not found	12 (30.8)	16 (41.0)	11 (28.2)	39
Diabetes					0.401
Yes	15 (44.1)	8 (23.5)	11 (32.4)	34
No	17 (37.8)	20 (44.4)	8 (17.8)	45
Diabetic renal failure					0.134
Yes	7 (43.8)	4 (25.0)	5 (31.2)	16
No	25 (39.7)	24 (38.1)	14 (22.2)	63
Scleral buckling					0.527
Yes	24 (40.7)	22 (37.3)	13 (22.0)	59
No	8 (40.0)	6 (30.0)	6 (30.0)	20
Preoperative diagnosis
PDR^＃	13 (40.6)	9 (28.1)	10 (31.3)	32
Primary RRD^‡	3 (25.0)	7 (58.3)	2 (16.7)	12
RD^† with IOFB^**	3 (33.3)	3 (33.3)	3 (33.3)	9
TRD^§	3 (33.3)	4 (44.5)	1 (11.2)	9
RD^† with macular hole	3 (50.0)	3 (50.0)	0 (0.0)	6
RD^† developed after other surgeries	3 (50.0)	1 (16.7)	2 (33.3)	6
RD^† with endopthalmitis	2 (66.7)	1 (33.3)	0 (0.0)	3
RD^† with myopia	1 (33.3)	1 (33.3)	1 (33.3)	3