Silicone oil (Polydimethylsiloxanes) is an artificial liquid that injected into the vitreous cavity with the aim of restoring intraocular pressure and provides intraocular tamponade in vitreoretinal surgery. Silicone oil has a combination of physical and chemical properties. Physical parameters which affects the function of silicone oil, namely specific gravity, buoyancy, surface tension, and viscosity. Indications of using silicone oil are retinal detachment with proliferative vitreoretinopathy, giant retinal tears, severe proliferative diabetic retinopathy, macular hole, retinal detachment due to viral retinitis, complicated pediatric retinal detachment, retinal detachment associated with choroidal coloboma, retinal detachment due to trauma, and endophthalmitis. Complications of using silicone oil are silicone oil entry in subconjunctival space and anterior chamber, glaucoma, chronic hypotony, cataract formation, recurrent retinal detachment, emulsification, and keratopathy. Management of complications using silicone oil depends on the types of complications that occur.

1. THE MANAGEMENT OF SILICONE OIL
COMPLICATION
POST VITRECTOMY
Vitreoretina Subdivision
Department of Ophthalmology
Medical Faculty of Andalas University/ DR. M. Djamil Hospital
Padang
2021
Meironi Waimir
Literatur Review

2. INTRODUCTION
 An artificial liquid  a tamponade agent in vitreoretinal surgery  retinal
detachment.
 Injected into the vitreous cavity  restoring intraocular pressure and providing
intraocular tamponade.
Polydimethylsiloxanes (Silicone oil)
 Silicone oil (SO) has a long enough retinal tamponade effect  long time attached
retinal adhesions and overcomes the presence of preretinal traction forces.

3. INTRODUCTION
Better control
retinal manipulation
during surgery.
Can be used for a
longer period.
Emulsification,
cataracts,
glaucoma,
keratopathy, etc.
Advantages
Disadvantages

4. CHARACTERISTICS OF TAMPONADE SILICONE OIL
Maintain
adhesion
between the
retina and the
RPE
Chemical
Properties
Physical
Properties:
Specific gravity,
Buoyancy,
Surface tension,
Viscosity
 SO is an important component in vitreoretinal surgery.

5. PHYSICAL PROPERTIES OF SILICONE OIL
1. Specific Gravity
Specific gravity explain why the intraocular tamponade sinks or floats in the
aqueous humor.
• SG 0.975 g/ml
• Float to the highest point in
the vitreous cavity.
• Superior tamponade.
SO with SG smaller
than water
• SG 1.060 g/ml
• Lower point than the vitreous
fluid.
• Inferior tamponade.
• Combination of silicone oil
with "heavy fluid"
perfluorohexyloctane (F6H8).
SO with SG
greater than water

6. PHYSICAL PROPERTIES OF SILICONE OIL
2. Buoyancy
Silicone oil floats in the vitreous cavity and has an upward force.
 In SO, the "pressing" force  relatively small  its specific gravity is almost the same as
the aqueous humor.

7. PHYSICAL PROPERTIES OF SILICONE OIL
3. Surface Tension
Difference between the intermolecular forces of two liquids and is responsible for the
shape of the liquid bubble.
 Factors that can affect the surface tension of SO bubbles after injected into the eyes.
- Viscosity: the higher the viscosity, the higher the surface tension.
- Viscoelastic solutions, blood, proteins, lipids, and ionized solutions  lowering
surface tension  emulsification.

8. PHYSICAL PROPERTIES OF SILICONE OIL
Modification of the traction vector by intraocular SO bubbles.
Intraocular SO bubbles reduce radial traction to the retina.
Surface Tension

9. PHYSICAL PROPERTIES OF SILICONE OIL
4. Viscosity
The consistency of SO  called in Centistokes (cSt) units.
 Related to the length of the polymer chain.
 Available from 1000 cSt to 5000 cSt.
 SO resistance breaking into droplets depending on
the viscosity.
 The less viscous the substance  the lower energy
required to disperse large bubbles into tiny droplets.

10. CHEMICAL PROPERTIES OF SILICONE OIL
Has a shorter
polymer chain 
more watery.
Colorless and does
not mix with
intraocular blood.
The vitreous cavity
media become
clearer 
visualization of the
fundus after
surgery is better.
 SO  A group of polymer compounds and hydrophobic monomers consisting of silicon-oxygen
bonds  organosiloxans.
 A linear chain of siloxane repeating units (–Si – O) and various side chains (radical side groups).

11. CHEMICAL PROPERTIES OF SILICONE OIL
Composition of Silicone Oil and Other Tamponade Agents.

12. INDICATIONS OF SILICONE OIL TAMPONADE
Retinal Detachment with Proliferative Vitreoretinopathy
Giant Retinal Tears
Severe Proliferative Diabetic Retinopathy
Macular Hole
Viral retinitis
Complex Retinal Detachment in Children
Retinal Detachment Associated With Choroid Coloboma
Trauma
Endoftalmitis

13. INDICATIONS OF SILICONE OIL TAMPONADE
Retinal Detachment with Proliferative Vitreoretinopathy
• Relative indication  still controversial.
• Surgeon's preference, the patient's ability to adhere postoperative procedures, and the
need for air travel immediately after surgery.
Giant Retinal Tears
• SO  unwind the retinal fold and as internal tamponade agent.
• The surgical principle  repair the retinal detachment without slipping or exposing a large
area of ​​the RPE.
• Exchange of PFCL-silicone oil reduces the risk of slippage during processing exchange.

14. INDICATIONS OF SILICONE OIL TAMPONADE
Severe Proliferative Diabetic Retinopathy
• SO occupies vitreous cavity  limiting all dissolved oxygen in the anterior segment 
prevent vascular proliferative factors from the posterior to the anterior segment.
Macular Hole
• The use of SO  still controversial.
• Many vitreoretinal surgeons prefer gas  have a higher superficial tension and better
buoyancy and didn't need a second operation to remove it.
• Considered for them who need to travel by air immediately after surgery.

15. INDICATIONS OF SILICONE OIL TAMPONADE
Viral Retinitis
•Retinal detachment associated with viral retinitis  diffuse and high risk of redetachment.
•Cytomegalovirus (CMV) retinitis or acute retinal necrosis (ARN).
•Azen et al  prospective observational multicenter study
•Success rate on CMV-related retinal detachment at 6 months after surgery  78%.
•Retinal detachment associated with ARN  100%
Complex Retinal Detachment in Children
• Retinal detachment trauma-related, retinopathy of prematurity, congenitals abnormalities
such as coloboma or optic disc pit.

16. INDICATIONS OF SILICONE OIL TAMPONADE
Retinal Detachment Associated With Choroid Coloboma
• Incidence of 23-42%.
• Pal et al, reported retinal attachment levels  88.1% at 6 months. From 21 cases that
underwent the SO removal, only two experienced redetachment.
Trauma
• SO internal tamponade  flatten the retina, maintain retina attach, avoid phthysis and
prevent bleeding and PVR formation.
Endoftalmitis
• SO has antimicrobial activity.
• Azad et al  Comparing the effect of vitrectomy with or without tamponade SO
posttraumatic endophthalmitis. In the case of using silicone oil, vision achieved 20/200 or
better in 58% of cases (seven of 12 patients).

17. INJECTION OF SILICONE OIL
 Modern vitrectomy system.
 Injection and evacuation of SO  a syringe connected to the pump  controlled
with the foot-pedal.
 Injection  pneumatically or manually pump.
 Automatic infusion pump  faster and easier to control with foot-pedal.
 Disadvantage  there is no mechanism pressure feedback  risk of over or
underfill.

18. INJECTION OF SILICONE OIL
 There are 3 surgical techniques to inject SO into the eye:
1. Fluid-silicone exchange,
2. Air-silicone exchange,
3. Perfluorocarbon liquid (PFCL)-silicone exchange.
 Air-silicone exchange  better than PFCL-silicone
exchange, because presence of a retinotomy or anterior
break.
 Photocoagulation endolasers should be performed for closing
all retinal breaks.

19. INJECTION OF SILICONE OIL
 If a relaxation retinotomy has been applied or the
retinal break is anterior  direct exchange PFCL and
silicone oil.
 The "overfilling" technique of the PFCL during exchange
of PFCL-silicone oil  very effective removes all the
aqueous from the vitreous and prevent slippage.
 The "sandwich" technique  after overfilling PFCL, the
vitreous is filled with silicone oil from the anterior

20. SILICONE OIL REMOVAL
 Standard three ports pars plana vitrectomy.
 After the silicone oil bubble was evacuated  fluid-air
exchange to remove every drop of silicone oil.
 In the case of emulsified drop in AC  removal through
a small corneal incision to minimize risk of
postoperative complications.

21. SILICONE OIL COMPLICATIONS AND MANAGEMENT
Silicone Oil in the Subconjunctiva
Silicone Oil in the Anterior Chamber
Silicone Oil Induced Glaucoma
Chronic Hypotony
Cataract Formation
Recurrent Retinal Detachment
Emulsification
Kerathopathy

22. Silicone Oil in the Subconjunctiva
 Causes granuloma formation  cosmetic problems.
 Prevention  with good sclera coverage using a small
gauge vitrectomy and good mattress suture.
 Management:
 Observation  if the cosmetic appearance
acceptable to the patient.
 Surgical  making a small incision in the
conjunctiva.

23. Silicone Oil in the Anterior Chamber
 The barrier at lens-iris diaphragm  inadequate to stop SO migrating into AC  aphakia,
zonular dehiscence, blockage of inferior peripheral iridectomy, or a break in the posterior
capsule.
 Overfilling of SO.
• Pupil can be mid-dilated with an increase in IOP,
• Corneal edema  if SO is later removed.

24. Silicone Oil Induced Glaucoma
 The early onset of raised IOP  Pupil block glaucoma, inflammation,
overfill SO and pre-existing glaucoma.
 The late onset of raised IOP  infiltration trabecular meshwork by silicone
bubbles, chronic inflammation and trabeculitis, sinechia angle closure,
rubeosis iridis, migration of emulsified SO into AC and/or idiopathic open
angle glaucoma.

25. Silicone Oil Induced Glaucoma
 Pupillary block glaucoma occurs in aphakic eye.
 Early postoperative period where peripheral iridectomy is nonfunction the aqueous will
accumulates behind the iris and forces bubbles of SO through pupil  Pupillary block occurs
when there is progression.
 Management:
Inferior peripheral iridectomy  YAG laser or surgery.
Blockage by fibrin  injection of tissue plasminogen activator (tPA) into the AC.

26. Silicone Oil Induced Glaucoma
 Raised IOP due to overfill of SO
 Aphakic eye  the shallow AC indicates the secondary angle closure.
 Pseudophakic or phakic eyes  SO enter front of the crystalline or intraocular lens through the
pupil herniation.
 Management:
Aphakic eye  SO removal through a corneal incision or pars plana.
Pseudophakic eyes or phakic  SO removal and reinjection.

27. Silicone Oil Induced Glaucoma
 Pre-existing glaucoma
 This patient presented with a normal IOP and found a retinal detachment  When the retina
is reattached, secondary glaucoma will be evident.
 Secondary open angle glaucoma
 Mechanical blockage trabecular meshwork, or trabeculitis induced by emulsified SO.
 Management:
 Anti-glaucoma drugs  initials therapy.
 Glaucoma drainage device.
 Trabeculectomy is not a therapeutic option.

28. Silicone Oil Induced Glaucoma
Silicone Study
• 8% of cases underwent SO
tamponade  glaucoma at
36 months follow-up.
Al-Jazzaf et al
• Incidence of secondary
glaucoma  11% from 450
eyes undergoing vitrectomy
and SO tamponade.
• From 51 eyes that
developed secondary
glaucoma  78% (40 eyes)
successfully treated with
anti glaucoma drugs, 22%
(11 eyes) required a
glaucoma drainage device.
Budenz et al
• 51 cases of secondary
glaucoma because SO
tamponade.
• Three options: SO removal
only, glaucoma drainage
device alone, and combined
glaucoma drainage device
with SO removal.
• All approaches  effective
in lower IOP, but risk of
uncontrolled IOP more
occur with SO removal
alone.

29. Chronic Hypotony
 Postoperative late onset  IOP ≤5 mmHg.
 Low IOP  combination of uvealscleral outflow increased and reduced production.
 Silicone Study  prevalence of chronic hypotony after vitrectomy with tamponade SO
was 18% at 36 months.
 Management:
 Long-term complications  SO removal.
 Operation with excision and dissection of membrane over the ciliary body.

30. Cataract Formation
 Metabolic exchange in the posterior capsule and direct toxicity.
 Vacuole formation occurs in the posterior part of the lens  Posterior subcapsular
cataract or nuclear sclerosis.
 SO removal is useful in minimizing the risk of cataract formation.
 Management:
Phacoemulsification and implantation intraocular lens in the bag.

31. Recurrent Retinal Detachment
 A missed retinal break  recurrent retinal detachment either with SO in situ or
after SO removal.
 A little underfill SO will leave an untamponade retinal area.
 Management:
 Laidlaw et al  Laser 360° before SO removal can reduce the risk redetachment.
 Laser 360° as prophylaxis in high risk patients can be considered.

32. Emulsification
 Emulsification occurs when surface energies droplets
are reduced in the presence of surfactants 
Dispersion of SO from large bubbles into droplets.
 Emulsification can occur 1 week to several months
after operation.
 Broad emulsification  “inverse hypopyon”
(Hyperoleon).

33. Kerathopathy
 Prolonged use of SO  Contact SO and corneal endothelium.
 Silicone Study  rate of keratopathy was 27% at 24 months follow-up.
 Management:
 Removing SO as soon as practical.
 EDTA chelation is the first line therapy.
 Keratoplasty can be considered on cases involving large cornea.

34. CONCLUSION
Silicone oil (Polydimethylsiloxanes) is an artificial liquid that injected into the
vitreous cavity with the aim of restoring intraocular pressure and provides
intraocular tamponade in vitreoretinal surgery.
Silicone oil has a combination of physical and chemical properties. Physical
parameters which affects the function of silicone oil, namely specific gravity,
buoyancy, surface tension, and viscosity.

35. CONCLUSION
Indications of using silicone oil are retinal detachment with proliferative
vitreoretinopathy, giant retinal tears, severe proliferative diabetic retinopathy,
macular hole, retinal detachment due to viral retinitis, complicated pediatric retinal
detachment, retinal detachment associated with choroidal coloboma, retinal
detachment due to trauma, and endophthalmitis.
Complications of using silicone oil are silicone oil entry in subconjunctival space and
anterior chamber, glaucoma, chronic hypotony, cataract formation, recurrent retinal
detachment, emulsification, and keratopathy.
Management of complications using silicone oil depends on the types of
complications that occur.

36. THANK YOU