Abstract
Background/Objectives
The purpose of this study is to investigate whether history of silicone oil tamponade may predispose to the development of cystoid macular edema (CMO) following uneventful post-vitrectomy cataract surgery.
Subjects/Methods
This is a retrospective study that was conducted at a single academic institution. Records of patients who underwent pars plana vitrectomy (PPV) with or without silicone oil tamponade and subsequent cataract surgery between 2017–2020 were reviewed. Macular optical coherence tomography (OCT) findings up to 4 years after surgery were assessed.
Results
A total of 95 eyes were included. Forty-one eyes underwent cataract surgery and had a history of PPV with silicone oil tamponade (Group 1). Fifty-four eyes underwent cataract surgery by phacoemulsification and had a history of PPV with gas tamponade (Group 2). Average follow up time after cataract surgery was 41.1 months. In Group 1, the incidence of OCT-detected CMO was 39.0%, compared to 27.8% in Group 2 (p = 0.247). The incidence of clinically significant CMO in Group 1 was 22.0%, compared to 18.5% in Group 2 (p = 0.679). The duration of CMO was significantly longer in Group 1 (p = 0.041) and cases were less likely to resolve by the last follow up visit (p = 0.040).
Conclusions
The incidence of OCT-detected or clinically significant pseudophakic CMO is not significantly different between eyes with prior PPV with gas tamponade versus silicone oil tamponade. However, CMO after uneventful cataract surgery may have a prolonged course if there is history of silicone oil tamponade, requiring longer treatment.
Subject terms: Retinal diseases, Risk factors
Introduction
Pars plana vitrectomy (PPV) with silicone oil tamponade is considered to be a standard surgical approach for treating complex retinal detachments that may be associated with severe proliferative vitreoretinopathy (PVR), giant retinal tears, viral retinitis, or trauma [1]. Its properties as a chemically inert substance with high surface tension and viscosity allow it to coat the vitreous cavity for prolonged tamponade of retinal breaks and support of the retina [2]. In contrast to gas, which dissipates from the eye within several weeks, silicone oil usually remains in direct contact with the retina for a much longer period of time. In the context of severe PVR, long-acting tamponade with silicone oil has improved visual outcomes and rates of macular attachment when compared to tamponade with short-acting gas such as sulfur hexafluoride, and similar outcomes when compared to tamponade with longer-acting gas such as perfluoropropane [3]. The optimal duration of tamponade under oil is debated and varies depending on the clinical context and surgeon judgment.
Intraocular silicone oil may precipitate anterior segment complications that preclude optimal visual potential, and so its use is intended to be temporary. Lens changes can occur in the setting of high oxygen tension during vitrectomy, oxidative stress due to oil-lenticular contact, and impairment of normal metabolic exchange [4, 5]. The risk of cataract formation is as high as 100% after silicone oil tamponade, and the rate of cataract development is proportional to the duration of retained oil [6]. The risk of cataract formation after vitrectomy with gas tamponade is also significant and reported to be as high as 84–98% [7, 8]. Thus, PPV with either gas or silicone oil tamponade in phakic eyes oftentimes requires subsequent cataract surgery for optimal visual function [6, 9].
As one of the most common complications of cataract surgery, pseudophakic cystoid macular edema (pCMO) may limit visual outcomes even after successful retinal reattachment and cataract removal [10]. According to a few reports on cataract surgery outcomes in this subset of patients, the risk of developing clinically significant, acute onset CMO varies from 4–13% [11, 12]. There are a number of factors that predispose to pCMO such as intraoperative surgical complications, history of uveitis, and retinal vascular disease [13]. In the setting of uneventful cataract surgery and absence of inflammatory ocular comorbidities, our prior study found that history of PPV with gas tamponade was associated with increased incidence of developing CMO [12]. The purpose of this study was to assess whether history of vitrectomy with silicone oil tamponade may increase the risk of pseudophakic CMO after cataract surgery compared to gas tamponade.
Materials (subjects) and methods
Study design
This study was conducted with permission by the institutional review board. Electronic health records (EHR) of patients with history of pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with or without silicone oil tamponade and subsequently underwent cataract surgery by phacoemulsification between 2017–2020 at the New York Eye and Ear Infirmary of Mount Sinai were reviewed. All patients were followed with routine spectral domain optical coherence tomography (SD-OCT) studies. Baseline OCT studies were taken after retinal detachment repair but prior to cataract surgery. Only subjects with at least 3 months of postoperative follow up were included. Exclusion criteria included history of diabetes, uveitis, inflammatory retinal vascular disease, advanced age-related macular degeneration (AMD), intraocular infection, aphakia, and myopic retinoschisis. Cases with intraoperative complications precluding intraocular lens placement in the bag, significant iris trauma, posterior capsule rupture, retained lens particles, and vitreous loss or prolapse were also excluded. Data on patient demographics, comorbidities, clinical exam findings, treatments, and SD-OCT studies up to 4 years after surgery were recorded.
The primary outcome measures were incidence of development and duration of pseudophakic cystoid macular edema (pCMO). A retina specialist who was blinded to patient surgical history confirmed all cases of OCT-detected macular edema. CMO was considered clinically significant if there was worsened best-corrected visual acuity (BCVA) concomitant with evidence of CMO on OCT, and was considered resolved when BCVA was achieved in conjunction with absence of cystoid changes on imaging. The cases of CMO were classified as acute (occurring <3 months after cataract extraction and with duration <6 months), chronic (persisting >6 months), and late onset (starting >3 months after cataract extraction) [13].
Surgical techniques
Subjects in Group 1 underwent either primary vitrectomy with the use of silicone oil tamponade or combination PPV with silicone oil tamponade and scleral buckle. Subjects in Group 2 underwent either primary PPV with gas tamponade or combination PPV with gas tamponade and scleral buckle. Intraoperative procedures are detailed in Table 1. All eyes in Group 1 and Group 2 underwent cataract surgery by standardized, small-incision phacoemulsification with in-the-bag IOL implantation. Cataract extraction was performed alone or as a combined PPV and phacoemulsification surgery with silicone oil removal. All patients were treated postoperatively with topical steroid and fluoroquinolone antibiotic with or without an NSAID based on surgeon preference, and the regimen was titrated based on postoperative course.
Table 1.
Pars plana vitrectomy characteristics and complications.
| Group 1 | Group 2 | P-value | |
|---|---|---|---|
| PPV-CEIOL interval, days | 226.9 ± 191.8 | 403.6 ± 428.9 | 0.016a |
| CEIOL/SOR concurrent | 310.5 ± 216 | 0.357a | |
| Surgical approach | 0.004b | ||
| PPV, % | 53.7 (22/41) | 81.5 (44/54) | |
| PPV + SB, % | 46.3 (19/41) | 18.5 (10/54) | |
| Prior pneumatic retinopexy, % | 17.1 (7/41) | 5.6 (3/54) | 0.095c |
| Macula off, % | 82.9 (34/41) | 33.3 (18/54) | <0.001a |
| Duration of tamponade, days | 296 ± 209 | ||
| Other intraoperative procedures, % | |||
| PFCL injection | 46.3 (19/41) | 59.2 (32/54) | 0.211b |
| Endolaser | 100.0 (41/41) | 100.0 (54/54) | |
| Membrane peel | 46.3 (19/41) | 14.8 (8/54) | <0.001b |
| ILM removal | 44.9 (2/41) | 5.6 (3/54) | 1.0c |
| Retinectomy | 12.2 (5/41) | 0.0 (0/54) | 0.034c |
| PPV complications, % | |||
| PVR | 29.3 (12/41) | 1.9 (1/54) | <0.001b |
| Re-detachment | 24.4 (10/41) | 1.9 (1/54) | <0.001c |
| Preoperative ERM | 36.6 (15/41) | 13.0 (7/54) | 0.007b |
CEIOL cataract extraction with intraocular lens placement, SOR silicone oil removal, SB scleral buckle, PFCL perfluorocarbon liquid, ILM internal limiting membrane, ERM epiretinal membrane.
aStudent’s T test.
bχ2-test.
cFisher’s exact test.
Statistical analysis
Patient demographics and baseline clinical characteristics including IOP and BCVA converted to logarithm of the minimal angle of resolution (LogMAR) scale were compared with the student’s t test for numerical variables with normal distribution and the χ2-test for categorical variables. The non-parametric Mann–Whitney U test was used to compare data that were not normally distributed. For outcomes measures, incidence of pseudophakic CMO was compared between groups using a two proportion Z-test, and duration of CMO in days was reported as mean ± standard deviation. Severity of macular edema was assessed by the change in OCT macular thickness in μm, which was calculated as the difference between maximum thickness and baseline thickness. For comparisons between groups, a two-sided p ≤ 0.05-decision rule was established a priori as the rejection criterion.
Results
Baseline patient and eye characteristics
A total of 95 eyes were included in the study with an average follow up time of 40.6 months after cataract surgery. Group 1 consisted of 41 eyes from 40 patients that underwent PPV with silicone oil tamponade, and Group 2 consisted of 54 eyes from 51 patients that underwent PPV with gas tamponade. Baseline demographics and characteristics are summarized in Table 2. There were no significant differences between subjects in Group 1 and Group 2 with regards to sex or medical comorbidities. Average age was significantly lower in Group 1 compared to Group 2 (p = 0.015). Preoperative BCVA before PPV was similar between groups (p = 0.137). Preoperative LogMAR BCVA before cataract extraction was 1.3 (Snellen equivalent 20/400) in Group 1 and 0.7 (Snellen equivalent 20/100) in Group 2 (p < 0.001). Baseline average OCT macular thickness was 274 μm in Group 1 and 284 μm in Group 2 (p = 0.241). In Group 1, 83% of subjects underwent initial PPV for macula-off retinal detachment, compared to 33% in Group 2 (p < 0.001).
Table 2.
Demographics and baseline eye characteristics.
| Group 1 (n = 41) | Group 2 (n = 54) | P-value | |
|---|---|---|---|
| Age, years (mean ± SD) | 52.0 ± 14.9 | 57.7 ± 8.1 | 0.015a |
| Female, patients (%) | 22.0 (9/41) | 40.7 (22/54) | 0.053b |
| Medical comorbidities, (%) | |||
| Hypertension | 24.4 (10/41) | 25.9 (14/54) | 0.447b |
| Hyperlipidaemia | 22.0 (9/41) | 20.4 (11/54) | 0.851b |
| HIV | 2.4 (1/41) | 3.7 (2/54) | |
| Laterality, right eye (%) | 36.6 (15/41) | 55.6 (30/54) | 0.066b |
| Ocular comorbidities (n) | |||
| Glaucoma | 3 | 2 | |
| Strabismus | 4 | ||
| Keratoconus | 1 | ||
| History of trauma | 4 | ||
| Retinal comorbidities | |||
| ARMD | 1 | ||
| Macular hole | 1 | 1 | |
| Retinopathy of prematurity | 1 | ||
| Prior ocular surgery (n) | |||
| Strabismus surgery | 3 | ||
| LASIK | 1 | 6 | |
| Pre-PPV BCVA (LogMAR ± SD) | 1.5 ± 0.9 | 1.2 ± 0.8 | 0.136c |
| Pre-Phaco BCVA (LogMAR ± SD) | 1.3 ± 0.7 | 0.7 ± 0.4 | <0.001c |
| IOP (mmHg ± SD) | 12.6 ± 4.4 | 14.3 ± 3.6 | 0.051a |
| OCT thickness (μm ± SD) | 274.4 ± 47.4 | 284.4 ± 34.2 | 0.241a |
PPV pars plana vitrectomy, SO silicone oil, SD standard deviation, ARMD age-related macular degeneration, LASIK laser-assisted in situ keratomileusis, BCVA best-corrected visual acuity, IOP intraocular pressure, OCT optical coherence tomography.
aStudent’s T test.
bχ2-test.
cMann-Whitney U test.
Surgical procedures and complications
All study subjects underwent uncomplicated cataract surgery by phacoemulsification with intraocular lens (IOL) placement in the bag. For surgical approach, 22 of 41 eyes in Group 1 underwent primary PPV only, while 19 of 41 eyes underwent combined PPV and scleral buckle. There were 44 of 54 eyes in Group 2 that underwent primary PPV, while 10 of 54 eyes underwent combined PPV and scleral buckle. In Group 1, 20 of 41 eyes had combined cataract extraction and silicone oil removal in the same surgical session. Intraoperative procedures performed during vitrectomy are detailed in Table 1. The average duration of silicone oil tamponade was 296 ± 209 days, and four eyes had retained silicone oil at last follow up. Ten eyes in Group 1 suffered the complication of re-detachment after PPV, compared to one eye in Group 2 (p < 0.001). Six eyes in Group 1 underwent subsequent vitrectomy with silicone oil tamponade only after a primary vitrectomy with gas tamponade failed due to re-detachment. 37% of eyes in Group 1 and 13% of eyes in Group 2 developed OCT-detectable epiretinal membrane (ERM) following PPV but prior to cataract surgery (p = 0.007). All eyes received topical steroid and fluoroquinolone antibiotic as part of the immediate postoperative regimen, with 37% of eyes in Group 1 and 44% in Group 2 additionally receiving topical NSAID drops (p = 0.441).
Outcomes
Primary outcomes and CMO characteristics are detailed in Table 3. The incidence of OCT-detected CMO in Group 1 was 39.0% compared to 27.8% in Group 2 (p = 0.247). The incidence of clinically significant CMO in Group 1 was 22.0% compared to 18.5% in Group 2 (p = 0.679). Average duration of macular edema was 179.1 ± 141.6 and 89.5 ± 54.3 days in Group 1 and Group 2, respectively (p = 0.041). For eyes that developed CMO, mean change in OCT macular thickness from baseline was 149.1 ± 124.0 μm in Group 1 and 91.6 ± 58.6 μm in Group 2 (p = 0.092). In Group 1, 12.5% of CMO cases were associated with subretinal fluid, compared to 20% in Group 2. The onset of OCT-detected CMO was a median of 69.0 (16–100) days from cataract surgery for Group 1, and 47.0 (27.5–105) days from cataract surgery for Group 2. Of eyes with OCT-detected CMO, 50.0%% in Group 1 and 66.7% of cases in Group 2 were classified as acute. The estimated post-hoc power for detecting a difference in incidence of CMO between Group 1 and Group 2 was 21.1%.
Table 3.
Pseudophakic cystoid macular edema characteristics and treatment.
| Group 1 | Group 2 | P-value | |
|---|---|---|---|
| Incidence (OCT), % | 39.0 (16/41) | 27.8 (15/54) | 0.247a |
| CEIOL/SOR concurrent, % | 25.0 (5/20) | 0.072a | |
| Incidence (CSME), % | 22.0 (9/41) | 18.5 (10/54) | 0.679a |
| CEIOL/SOR concurrent, % | 15.0 (3/20) | 0.294a | |
| Duration, days ± SD | 179.1 ± 141.6 | 89.5 ± 54.3 | 0.041b |
| CEIOL/SOR concurrent, days | 110.3 ± 57.3 | 0.524a | |
| Postoperative topical regimen | |||
| Steroid + fluoroquinolone antibiotic | 100.0 (41/41) | 100.0 (54/54) | |
| NSAID | 36.6 (15/41) | 44.4 (24/54) | 0.441a |
| Onset from CEIOL, median days (IQR) | 69.0 (16–100) | 47.0 (27.5–105) | |
| ME prior to CEIOL, % | 6.3 (1/16) | 19.4 (2/15) | |
| Classificationd, % | |||
| Acute | 50.0 (8/16) | 66.7 (10/15) | 0.347a |
| Late onset | 18.8 (3/16) | 20.0 (3/15) | |
| Chronic | 25.0 (4/16) | 6.7 (1/15) | |
| Chronic and late onset | 6.3 (1/16) | 0.0 (1/15) | |
| Recurrent | 6.3 (1/16) | 6.7 (1/15) | |
| Subretinal fluid, % | 12.5 (2/16) | 20.0 (3/15) | |
| Retained silicone oil | 31.3 (5/16) | ||
| OCT thickness, μm ± SD | |||
| Min | 282.8 ± 52.9 | 291.8 ± 57.0 | |
| Max | 412.9 ± 106.5 | 373.6 ± 70.2 | |
| Change in thickness | 149.1 ± 124.0 | 91.6 ± 58.6 | 0.092b |
| Topical treatment only, % | 62.5 (11/16) | 80.0 (12/15) | |
| Steroid only | 25.0 (5/16) | 6.7 (1/15) | |
| NSAID only | 0.0 (0/16) | 26.7 (4/15) | |
| Both | 37.5 (6/16) | 46.7 (7/15) | |
| Topical and intravitreal steroid, % | 6.3 (1/16) | 0.0 (0/15) | |
| No treatment, % | 25.0 (4/16) | 20.0 (3/15) | |
| CMO resolved by last follow up | 62.5 (10/16) | 93.3 (14/15) | 0.040a |
| Last follow up BCVA, LogMAR ± SD | 0.6 ± 0.5 | 0.2 ± 0.2 | <0.001c |
OCT optical coherence tomography, CSME clinically significant macular edema, SD standard deviation, PPV pars plana vitrectomy, CEIOL cataract extraction with intraocular lens placement, BCVA best-corrected visual acuity.
aχ2-test.
bStudent’s T test.
cMann–Whitney U test.
dCMO cases were classified as follows: acute (occurring <3 months after cataract extraction and with duration <6 months); chronic (persisting >6 months); late onset (starting >3 months after cataract extraction).
For subjects in Group 1, 25% of eyes that underwent combined cataract surgery and silicone oil removal developed OCT-detectable CMO, compared to 52% of eyes that had separate surgeries (p = 0.072). Average duration of macular edema was 110.3 ± 57.3 days in eyes that underwent combined cataract surgery and silicone oil removal, compared to 200.9 ± 165.1 days in eyes that had separate surgery (p = 0.162). There was no difference in the duration of silicone oil tamponade for eyes that did and did not develop CMO (p = 0.769), which was an average of 308 ± 252 days and 288 ± 181 days, respectively (p = 0.769).
For eyes in Group 1 that developed CMO, 62.5% were treated topically with steroid drops, NSAID drops, or a combination, while 25% of cases were observed. There was one case that required intravitreal steroid injection for recalcitrant macular edema. For eyes in Group 2 that developed CMO, 80.0% were treated topically and 20% were observed. No eyes required intravitreal therapy. 62.5% of CMO cases in Group 1 and 93.3% of cases in Group 2 were resolved by the last follow up visit. At last follow-up, the average LogMAR BCVA was 0.6 (Snellen equivalent 20/80) in Group 1 and 0.3 (Snellen equivalent 20/30) in Group 2 (p = 0.027).
Discussion
Pseudophakic CMO is generally a self-limited complication of cataract surgery, but there can be significant visual morbidity when uncontrolled or comorbid with other retinal pathologies [11]. The incidence of OCT-detected CMO after cataract surgery was 39% in eyes with a history of PPV with silicone oil tamponade compared to 28% in eyes with history of PPV with gas tamponade (p = 0.247). Although the incidence was not statistically different, the duration of pCMO was longer in eyes that had silicone oil tamponade (p = 0.041) and CMO was less likely to resolve by the last follow up visit (p = 0.040). As other known risk factors for pCMO such as retinal vascular disease, uveitis, and intraoperative complications were controlled for [13], inherent differences between vitrectomy with gas versus silicone oil, such as duration of tamponade and severity of pathology will be discussed.
While CMO is a known complication of vitrectomy with silicone oil tamponade, our study demonstrates that the risk increases dramatically after cataract surgery. A prior study found that the incidence of postoperative CMO after PPV with silicone oil tamponade for an average of 276 days was as high as 36.2% prior to oil removal [14]. In eyes with retinal detachment complicated by PVR grade C that received silicone oil tamponade for an average of 29.1 months, CMO occurred in 17% of cases after oil removal [15]. Other studies with shorter durations of tamponade found incidences of 1.6–3% [16, 17]. Lens status was not controlled for in these studies, thus it is unclear if cases of postoperative CMO may have also included pCMO. In contrast, all subjects in our study were phakic at the time of the first vitrectomy. The average duration of tamponade was 286 days, and only one subject (2.4%) developed CMO prior to cataract extraction. After cataract surgery, the risk of developing CMO jumped to 39%. Our findings suggest that PPV with silicone oil tamponade is associated with a low risk of post-vitrectomy CMO prior to cataract surgery, but a significant risk of pseudophakic CMO that is comparable to the incidence in subjects with a history of PPV with gas tamponade.
Although we did not find a statistically different incidence of pCMO associated with silicone oil tamponade compared to gas tamponade, there may be some component of silicone oil in situ or history of it that predisposes to longer duration of CMO. The causes of CMO associated with intraocular silicone oil are uncertain, especially as the general pathogenesis of CMO is still unresolved. One explanation for postoperative CMO involves compromise of the blood-retinal barrier from cytotoxic insults due to iatrogenic damage and upregulated inflammatory mediators [18]. Silicone oil injection could further alter the intraocular inflammatory state, given that concentrated levels of interleukin-6 and growth factors are detectable in vivo in the retro-oil space [19]. Prolonged local stress to the macula and eventual neuronal cell death is another explanation for the propensity to develop fluid accumulation [20]. A few mechanisms have been proposed for how silicone oil may precipitate retinal damage, including mechanical stress of the oil bubble and indirect cytotoxicity to retinal ganglion cells (RGC) [21, 22]. OCT studies in cases of potential toxicity have previously demonstrated perifoveal RGC layer thinning up to six months after vitrectomy with silicone oil in situ. Given that there is a notable risk of CMO in subjects with a history of silicone oil tamponade that appears to increase dramatically after cataract surgery, there are likely multiple and compounding causative factors involved.
The use of silicone oil during repair of retinal detachment indicates more challenging retinal pathology that could also relate to the propensity for developing CMO. One retrospective study assessed the risk factors associated with CMO after RRD repair [7]. Total number of surgeries, surgical approach of vitrectomy with scleral buckle, use of silicone oil tamponade, rates of grade C proliferative vitreoretinopathy (PVR) and retinectomy, and macula-off detachment were all significant risks, although all lost significance after adjusting for total number of surgeries. Due to the retrospective design of our investigation, these factors were notable differences between the two study groups. Significantly more subjects who underwent PPV with silicone oil tamponade received combined vitrectomy with scleral buckle, had PVR and required retinectomy, presented with macula-off detachments and suffered the complication of re-detachment. Our study was not designed to parse which of these components may be independent risk factors. Thus, although silicone oil tamponade was associated with a high incidence of pCMO and increased duration compared to gas tamponade, it may not be an independent risk because it often comes hand-in-hand with greater underlying retinal pathology and surgical complexity.
Earlier removal of silicone oil when prudent to do so may be beneficial for limiting macular complications. Some authors suggest that the duration of silicone oil tamponade appears to correlate with the risk of developing postoperative CMO [14]. In pseudophakic eyes, silicone oil in situ was associated with macular disturbances, including a 13% incidence of CMO [23]. All cases resolved spontaneously after the oil was removed. In our study of phakic eyes, five of the 16 subjects developing macular edema had retained oil at the time of edema occurrence. Another investigation of macular microstructure before and after silicone oil removal found that OCT-detected CMO occurred in 19.6% of subjects while under oil [24]. After oil removal combined with membrane peeling when indicated, BCVA improved significantly in conjunction with decreased intraretinal cystic changes and decreased central foveal thickness on OCT. There were no recurrences of CMO described after silicone oil removal, but the baseline lens status of these cases and whether they also underwent phacoemulsification at the time of oil removal is unclear.
In addition to earlier silicone oil removal, concurrent cataract surgery may also be advantageous. One study of patients with stable retinal pathology found that combined cataract surgery and silicone oil removal resulted in quicker visual rehabilitation and similar final visual outcomes compared to cataract surgery and oil removal in separate surgical sessions [25]. Complication rates were also similar and there were no cases of clinically detectable pCMO. In our study, 25% of subjects that underwent combined cataract surgery and silicone oil removal developed OCT-detectable CMO with an average duration of 110 days. In contrast, 52% of subjects that underwent separate surgeries developed CMO with an average duration of 201 days. While our study numbers are small and these differences did not reach statistical significance (p = 0.072; 0.162), the trends suggest that early and judicious silicone oil removal with consideration of combined cataract extraction may be prudent to consider in this subset of patients with high risk of pCMO.
To our knowledge, this is the first study to directly compare the incidence of pCMO after uncomplicated cataract surgery in eyes that previously underwent PPV with silicone oil tamponade versus gas tamponade. While the incidence of pCMO was not statically different, silicone oil tamponade was associated with longer duration of pCMO, lower likelihood of resolution on topical therapy, and poorer final visual outcome. Although chronic macular edema may lead to irreversible retinal damage that affects visual function [26], the difference in visual outcome likely reflects more severe underlying retinal pathology, as eyes receiving silicone oil had worse baseline BCVA and were more likely to have undergone surgery for macula-off detachment.
Silicone oil tamponade is often used in the repair of complex retinal detachments, for which the prognosis is oftentimes uncertain. Thus, anticipating the propensity for pCMO in this subset of patients is important for patient counseling and guiding treatment approach. Our study is limited by its retrospective design and thus inability to control for factors such as surgical frequency and complexity of retinal pathology. However, the characteristics of our patient sample are representative of the wide clinical spectrum seen at our academic center. Future prospective studies would better evaluate the optimal medical therapy for treating pCMO in this population of patients and the potential benefit of shorter tamponade duration or combined cataract surgical approach.
Summary
What was known before
There is a high risk of cataract formation after vitrectomy with silicone oil tamponade.
Vitrectomy in phakic eyes oftentimes requires subsequent cataract surgery for optimal visual outcome.
Prior vitrectomy is associated with an increased risk of pseudophakic cystoid macular edema, which may limit visual outcome even after successful retinal reattachment. and cataract removal.
What this study adds
Silicone oil tamponade is used in the repair of complex RDs, for which the prognosis is oftentimes uncertain; thus, anticipating the propensity for pseudophakic cystoid macular edema in this subset of patients is important for patient counseling.
Patients with history of rhegmatogenous retinal detachment repaired with pars plana vitrectomy and silicone oil tamponade have a significant risk of developing pCMO that may be longer in duration and more recalcitrant to topical therapy.
Author contributions
GL was responsible for research conception and design, extracting data, interpreting results, and providing feedback and critical revision of the report. JD was responsible for extracting and analyzing data, interpreting results, writing the report, and revision of the report.
Data availability
The data that support the findings of this study are available on request from the corresponding author, JD.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author, JD.