14.3.3 Complications Related to Silicone Oil Use

•High IOP (see above).

•Cataract (see Table 14.3).

–In diabetics, cataract development appears to be delayed.

•Silicone oil prolapse into the AC. This may occur:

–Intraoperatively because of weak/torn zonules, more commonly in highly myopic eyes.

–Intraoperatively because of overfill.

–Postoperatively if the oil is being pushed forward by detaching21 retina (see Fig. 35.4) or, less commonly, a severe hemorrhage.

Pearl

If at the follow-up visit the surgeon finds in the AC silicone oil that was not there at the last visit, he must first determine whether RD is developing.

•Silicone oil under the retina if the retina detaches and the traction forces tear it.

– The typical appearance of such a tear is one of a characteristically oval shape

(see Fig. 14.4). It is rather large and centrally located.

• Hyperopic shift in the phakic or pseudophakic eye, ~ + 5 D.22

•Band keratopathy if the silicone oil is in almost constant or recurring contact with the endothelium for extended periods of time.

–This is caused by calcium-hydroxyapatite deposition in the superficial corneal layers. Paradoxically, if the AC is completely filled with silicone oil (the

Fig. 14.4 Secondary tractional retinal tear under silicone oil. The shape of the tear is typical, almost pathognomonic: it is oval and often follows the course of the nerve fibers in the area

21If the retina tears and the silicone oil enters the subretinal space, there may be no oil prolapse into the AC at all or the progression of the prolapse is halted.

22In the aphakic eye, a similar-sized decrease in the corrective diopter power is seen due to the shape of the oil bulge; in a myopic eye, the myopic correction will be reduced.