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Outcomes of Complex Retinal Detachment Repair Using 1000- vs 5000-Centistoke Silicone Oil
Ingrid U. Scott, MD, MPH;
Harry W. Flynn, Jr, MD;
Timothy G. Murray, MD;
William E. Smiddy, MD;
Janet L. Davis, MD;
William J. Feuer, MS
Arch Ophthalmol. 2005;123:473-478.
ABSTRACT
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Objective To compare anatomic and visual acuity outcomes, as well as complication rates, after retinal detachment repair using 1000- vs 5000-centistoke silicone oil.
Methods Records of all patients who underwent retinal detachment repair with silicone oil at one institution between January 1, 1995, and December 31, 2000, were reviewed. Anatomic outcomes included retinal redetachment and macula-off retinal redetachment. Visual acuity outcomes included ambulatory vision ( 5/200) and change in visual acuity from preoperative examination. Complications included rates of secondary intraocular pressure elevation, hypotony, corneal opacification, cataract, and oil emulsification. Outcomes were assessed at 1 week, 1 month, 3 months, 6 months, and 1 year.
Results The study included 82 eyes that underwent retinal detachment repair with 1000-centistoke silicone oil and 243 eyes that underwent retinal detachment repair with 5000-centistoke silicone oil. Demographic characteristics, cause of retinal detachment, and preoperative ocular characteristics were similar in the 2 groups. There was no significant difference in the rate of retinal redetachment at each of the follow-up intervals investigated. The cumulative retinal detachment rate was also similar between the 2 groups except among trauma cases, for which 1000-centistoke silicone oil was associated with a higher cumulative redetachment rate (P<.001). There was no significant difference between the groups with respect to (1) change in visual acuity from preoperatively to 6 months postoperatively and (2) the proportion of patients who achieved ambulatory vision at each of the follow-up intervals investigated. Rates of elevated intraocular pressure, hypotony, corneal abnormality, cataract, and silicone oil emulsification were similar in the 2 groups.
Conclusions Anatomic and visual acuity outcomes, as well as complication rates, were similar in both groups; retinal reattachment and ambulatory vision were achieved in most eyes regardless of oil viscosity.
INTRODUCTION
Silicone oil was first reported for the treatment of retinal detachment in 19621 and has been used increasingly as a retinal tamponade in the management of complex retinal detachments associated with cytomegalovirus necrotizing retinitis,2-11 proliferative diabetic retinopathy,12-18 giant retinal tears,19-28 proliferative vitreoretinopathy,29-37 and ocular trauma.38-45 The National Eye Institute Silicone Study demonstrated the superiority of 1000-centistoke silicone oil compared with sulfur hexafluoride, and its comparability with perfluoropropane, for the treatment of complex retinal detachment associated with advanced proliferative vitreoretinopathy.46-48 Several other publications have also reported outcomes after the use of 1000-centistoke silicone oil during retinal detachment repair.49-51 To our knowledge, and based on a literature search of the MEDLINE database, there has been no published report comparing the outcomes and complication rates after the use of 1000- vs 5000-centistoke silicone oil retinal tamponade during retinal detachment repair.
The purpose of the present study was to compare anatomic and visual acuity outcomes, as well as complication rates, after retinal detachment repair using 1000- vs 5000-centistoke silicone oil.
METHODS
Medical records of all patients who underwent retinal detachment repair with 1000- or 5000-centistoke silicone oil at Bascom Palmer Eye Institute, Miami, Fla, between January 1, 1995, and December 31, 2000, were reviewed (informed consent was not required for this retrospective chart study). During this period, either 1000- or 5000-centistoke silicone oil (but not both) was available at Bascom Palmer Eye Institute at any one time; thus, there was no selection bias in terms of which type of oil was used. Surgeons had no proprietary interest in either product.
In general, operative procedures consisted of pars plana vitrectomy, relief of epiretinal traction, retinal reattachment by fluid-air exchange, simultaneous internal drainage of subretinal fluid, and cryopexy or laser photocoagulation. Fluid-silicone exchange and/or perfluorocarbon liquids were used in selected cases. The vitreous cavity was filled with silicone oil to the iris plane. An inferior iridectomy was usually performed in aphakic eyes and occasionally in pseudophakic eyes. Eyes without cytomegalovirus necrotizing retinitis were usually treated with scleral buckling if a scleral buckle was not already present. Phakic eyes without cytomegalovirus necrotizing retinitis frequently underwent lensectomy.
For the purposes of this study, a change in visual acuity was defined as a change of at least 0.3 logMAR (logarithm of the minimum angle of resolution) units; this represents a doubling (visual worsening) or halving (visual improvement) of the minimum angle resolvable. Ambulatory vision was defined as a visual acuity of 5/200 or better. Elevated intraocular pressure (IOP) was defined as an IOP greater than 25 mm Hg; hypotony was defined as an IOP less than 5 mm Hg. Corneal abnormality included corneal abrasion, corneal edema, corneal scar, and band keratopathy.
Interval level variables were compared with the 2-sample 2-sided t test. Categorical variables were compared with Fisher exact test or the  2 test. The exact permutation 2 test was used when small expected values were encountered. Cumulative rates of retinal redetachment and silicone oil removal were calculated with Kaplan-Meier time-to-failure methods and compared with the log-rank test; Cox proportional hazards survival regression was used to perform multivariate adjustments of time-to-failure data. Rates of complications and visual outcomes were also presented for uniform follow-up visits (1 week, 1 month, 3 months, 6 months, and 1 year). These rates were calculated as ordinary percentages of the number of cases available at each visit and compared with Fisher exact test or, as documented in the text and tables, with logistic regression to adjust for the cause of retinal detachment.
RESULTS
The study included 82 eyes that underwent retinal detachment repair with 1000-centistoke silicone oil and 243 eyes that underwent retinal detachment repair with 5000-centistoke silicone oil. There were no significant differences between the 2 groups in terms of demographic characteristics or cause of retinal detachment (Table 1). Preoperative ocular characteristics were similar between the 2 groups except for a higher proportion of patients with preexisting glaucoma in the 1000-centistoke silicone oil group (Table 2). There was no significant difference between the groups in baseline visual acuity (Table 3). A relaxing retinectomy (an indicator of the complexity of retinal detachment) was performed in 17% of eyes in the 1000-centistoke silicone oil group and 18% in the 5000-centistoke group (P >.99).
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Table 1. Patient Characteristics
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Table 2. Preoperative Ocular Characteristics
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Table 3. Baseline Visual Acuity by Type of Oil and Cause of Retinal Detachment
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There was no significant difference in the rate of retinal redetachment at each of the follow-up intervals investigated (Table 4). The cumulative retinal detachment rate was also similar between the 2 groups except among trauma cases, for which 1000-centistoke silicone oil was associated with a higher cumulative redetachment rate (P<.001) (Table 5). If retinal redetachment occurred, it was more likely to be macula-off in the 5000-centistoke silicone oil group (Table 6). The cumulative proportion of patients who had their silicone oil removed by 6 months was 20% in the 1000-centistoke silicone oil group and 19% in the 5000-centistoke group; at 1 year, these cumulative percentages were 38% and 41%, respectively (P = .71, log-rank test).
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Table 4. Retinal Redetachment Rates by Type of Oil and Length of Follow-up
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Table 5. Cumulative Retinal Redetachment Rate by Type of Oil and Cause of Original Retinal Detachment
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Table 6. Macula-Off Retinal Redetachment Rates by Type of Oil and Follow-up Visit
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There was no significant difference between the groups with respect to change in visual acuity preoperatively compared with 6 months postoperatively (Table 7). There was also no significant difference between the groups with respect to the proportion of patients who achieved ambulatory vision at each of the follow-up intervals (Table 8). There was no significant difference between the groups in the rates of elevated IOP, hypotony, corneal abnormality, or new cataract at each of the follow-up intervals analyzed except for elevated IOP at 6 months (higher rate in the 1000-centistoke group) and corneal abnormality at 1 year (higher in the 5000-centistoke group) (Table 8). Silicone oil emulsification was noted in 3 patients (4%) in the 1000-centistoke group and 4 patients (2%) in the 5000-centistoke group (P = .37).
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Table 7. Change in Visual Acuity by Type of Oil and Cause of Retinal Detachment at 6 Months of Follow-up
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Table 8. Outcomes by Follow-up Visit
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COMMENT
Silicone oil is commonly used for the repair of complex retinal detachments, but published data on outcomes of such surgery are limited primarily to patients treated with 1000-centistoke silicone oil.46-51 Although 1000- and 5000-centistoke silicone oil are similar in terms of surface tension (21.2 dynes/cm and 21.3 dynes/cm, respectively) and specific gravity (0.971 and 0.973, respectively), they differ significantly in terms of molecular weight (25 000 and 50 000, respectively).52 Higher-viscosity silicone oil has been reported to have a lower tendency to emulsify.53-57 Although the emulsification rates in the present series were not significantly different between the 2 groups, the emulsification rates observed in both groups in the present retrospective study were low; a prospective study with gonioscopy performed at follow-up visits may show higher emulsification rates and may demonstrate a significant difference between the groups.
Results of the present study indicate that anatomic and visual acuity outcomes were similar between the 2 groups. Retinal reattachment and ambulatory vision were achieved in most eyes in both groups at each follow-up interval investigated, with the retina completely attached in approximately 80% of eyes in each group at 1 year and ambulatory vision achieved in approximately 60% in each group at 1 year.
Complication rates were also similar with each type of silicone oil. The proportion of patients with elevated IOP at 6 months was significantly higher in the 1000-centistoke group, and the proportion of patients with corneal abnormality at 1 year was significantly higher in the 5000-centistoke group. Because these 2 findings were in opposite directions with respect to the type of oil used and were not consistent throughout follow-up, they do not appear to represent clinically significant differences between the 2 types of oil.
The decision of which type of silicone oil to use may depend on surgeon preference. For example, 1000-centistoke silicone oil is easier and faster to inject and to remove from the eye, while a more complete fill of the vitreous cavity with silicone oil may be easier to achieve when 5000-centistoke silicone oil is used (because there may be less egress of 5000- compared with 1000-centistoke silicone oil through the sclerotomy sites during sclerotomy closure).
In summary, there were no significant differences between the 2 groups with respect to anatomic and visual acuity outcomes, as well as complication rates. Retinal reattachment and ambulatory vision were achieved in most eyes undergoing complex retinal detachment repair with either 1000- or 5000-centistoke silicone oil.
AUTHOR INFORMATION
Correspondence: Ingrid U. Scott, MD, MPH, Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136 (iscott{at}bpei.med.miami.edu).
Submitted for Publication: March 6, 2004; final revision received June 29, 2004; accepted July 16, 2004.
Funding/Support: This study was supported in part by Research to Prevent Blindness Inc, New York, NY.
Financial Disclosure: None.
Author Affiliations: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Fla.
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