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Surgeon: Silicone oil has advantages for some macular hole surgeries
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WAIKOLOA, Hawaii — The use of silicone oil in macular hole surgery has fallen out of favor in the United States, but in select cases it can be a useful and effective option, said Carl C. Claes, MD, of Belgium.
Dr. Claes made a case for the use of silicone oil here at Hawaii 2005, The Royal Hawaiian Eye Meeting.
“With silicone oil in the eye and a 30-gauge aspiration needle, you drain the [balanced salt solution] and the edges of the macular hole are pulled together,” Dr. Claes said. “Without even touching the hole you can close it — although you might have to repeat the maneuver several times.”
Dr. Claes said with silicone oil there is no need for patients to maintain special positions postoperatively, as is the case with gas tamponade. This is an important factor to consider when dealing with children, the elderly or the obese patient.
“Also, the patient can return to normal activity after surgery, it is more comfortable for monocular patients, and flying does not present a problem,” he said.
Dr. Claes and his colleagues have been able to streamline their approach to macular hole surgery with silicone oil. Originally, repairing a macular hole required first the performance of vitrectomy and the placement of a silicone oil tamponade, then removal of the silicone oil, followed by phacoemulsification. Now, he said, they do the vitrectomy, placement of the tamponade and phaco all in one step, followed by silicone oil removal after about 2 months.
He said the disadvantages of using silicone oil are the need for two surgeries and the high rate of cataract progression. He noted that he would use silicone oil only in larger or late-stage macular holes or in patients with high myopia. Otherwise he uses a gas tamponade.
He said while the oil is typically removed after 2 months, if the patient has a history of glaucoma, the oil should be removed sooner because of the chance of transient ocular hypertension.
He also noted that some patients have complained of floaters postoperatively due to oil emulsification in the eye.
“It’s not possible to remove all emulsifications, but if you do an extensive vitrectomy you can remove about 90%,” Dr. Claes said. He noted that regular needles are not adequate for draining the oil, so he uses a specially designed fine needle and ensures that the patient remains immobile.