This study investigates if heavy silicone oil (HSO) is associated with better outcomes than standard silicone oil (SO) as a tamponade agent in the repair of primary inferior rhegmatogenous retinal detachments (RRD).
Methods
Pubmed, Embase, and Scopus were searched on 4 December 2024 for randomized clinical trials, cohort studies, or case-control studies that compared HSO to SO in patients with primary inferior RRD and reported postsurgical visual acuity (VA) or primary anatomical success defined as retinal reattachment rates after silicone oil removal.
Results
The analysis included three studies with 529 eyes in the analysis of primary anatomical success and 590 eyes in the analysis of postsurgical visual acuity. The meta-analysis of anatomical success showed a statistically significant difference in the HSO group compared to the SO group, favoring HSO (RR = 1.25; 95% CI: 1.12–1.39; P < 0.0001). The meta-analysis of postoperative visual acuity yielded no statistically significant differences between the HSO group compared to the SO group (WMD = −0.01; 95% CI: −0.28–0.25; P = 0.93).
Conclusion
This meta-analysis of one RCT and two observational studies found low-certainty evidence that suggests a higher rate of primary anatomical success in primary inferior RRDs using HSO as a tamponade agent compared with SO. More studies are required to bolster the strength of this conclusion.
SinghAKGlaserBMLemorM, et al.Gravity-dependent distribution of retinal pigment epithelial cells dispersed into the vitreous cavity. Retina1986; 6: 77–80. doi:https://doi.org/10.1097/00006982-198600620-00002
4.
BarcaFCaporossiTRizzoS. Silicone oil: different physical properties and clinical applications. Biomed Res Int2014; 2014: 502143. doi:https://doi.org/10.1155/2014/502143
5.
VaziriKSchwartzSGKishorKS, et al.Tamponade in the surgical management of retinal detachment. Clin Ophthalmol2016; 10: 471–476. doi:https://doi.org/10.2147/OPTH.S98529
6.
KontosATeeJStuartA, et al.Duration of intraocular gases following vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol2017; 255: 231–236. doi:https://doi.org/10.1007/s00417-016-3438-3
7.
TavaresRLPNóbregaMJNóbregaFAJ, et al.Timing and outcomes after silicone oil removal in proliferative vitreoretinopathy: a retrospective clinical series. Int J Retina Vitreous2015; 1: 2. doi:https://doi.org/10.1186/s40942-015-0002-y
8.
PrazeresJMagalhãesOJrLucattoLF, et al.Heavy silicone oil as a long-term endotamponade agent for complicated retinal detachments. Biomed Res Int2014; 2014: 136031. doi:https://doi.org/10.1155/2014/136031
HeimannHStapplerTWongD. Heavy tamponade 1: a review of indications, use, and complications. Eye (Lond)2008; 22: 1342–1359. doi:https://doi.org/10.1038/eye.2008.61
11.
RussoAMorescalchiFDonatiS, et al.Heavy and standard silicone oil: intraocular inflammation. Int Ophthalmol2018; 38: 855–867. doi:https://doi.org/10.1007/s10792-017-0489-3
12.
MorescalchiFCostagliolaCDuseS, et al.Heavy silicone oil and intraocular inflammation. Biomed Res Int2014; 2014: 574825. doi:https://doi.org/10.1155/2014/574825
13.
KocakIKocH. Comparison of Densiron 68 and 1 000 cSt silicone oil in the management of rhegmatogenous retinal detachment with inferior breaks. Int J Ophthalmol2013; 6: 81–84. doi:https://doi.org/10.3980/j.issn.2222-3959.2013.01.17
14.
HerbrigESandnerDEngelmannK. Anatomical and functional results of endotamponade with heavy silicone oil – Densiron 68 – in complicated retinal detachment. Ophthalmic Res2007; 39: 198–206. doi:https://doi.org/10.1159/000104681
15.
TzoumasNYorstonDLaidlawDAH, et al.; British and Eire Association of Vitreoretinal Surgeons and European Society of Retina Specialists Retinal Detachment Outcomes Group. Improved outcomes with heavy silicone oil in complex primary retinal detachment: a large multicenter matched cohort study. Ophthalmology2024; 131: 731–740. doi:https://doi.org/10.1016/j.ophtha.2023.12.016
16.
LefebvreCGlanvilleJBriscoeS, et al. Chapter 4: Searching for and selecting studies [last updated March 2025]. In: Higgins JPT, Thomas J, Chandler J, et al. (eds). Cochrane Handbook for Systematic Reviews of Interventions version 6.5.1 Cochrane, 2025. Available from cochrane.org/handbook.
17.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J2021; 372: n71. doi:https://doi.org/10.1136/bmj.n71
18.
SterneJAHernánMAReevesBC, et al.ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Br Med J2016; 355: i4919. doi:https://doi.org/10.1136/bmj.i4919
19.
SterneJACSavovićJPageMJ, et al.Rob 2: a revised tool for assessing the risk of bias in randomized trials. Br Med J2019; 366: l4898. doi:https://doi.org/10.1136/bmj.l4898
20.
GuyattGHOxmanADVistGE, et al.GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Br Med J2008; 336: 924–926. doi:https://doi.org/10.1136/bmj.39489.470347.AD
21.
WanXWangWLiuJ, et al.Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol2014; 14: 135. doi:https://doi.org/10.1186/1471-2288-14-135
22.
The Cochrane Collaboration. 2020. Review Manager (RevMan). Version (5.4). Available at revman.cochrane.org
23.
PageMJHigginsJSterneJAC2024Chapter 13: Assessing risk of bias due to missing evidence in a meta-analysis [last updated August 2024]. In: Higgins JPT, Thomas J, Chandler J, et al. (eds). Cochrane Handbook for Systematic Reviews of Interventions version 6.5. Cochrane, 2024. Available from cochrane.org/handbook.
24.
MoherDLiberatiATetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6: e1000097. doi:https://doi.org/10.1371/journal.pmed.1000097
GisquetCNdiayeNCDubrouxC, et al.Retinal redetachment after silicone oil removal: a risk factor analysis. BMC Ophthalmol2024; 24: 346. doi:https://doi.org/10.1186/s12886-024-03618-z
27.
GuberJBentivoglioMValmaggiaC, et al.Predictive risk factors for retinal redetachment following uncomplicated pars plana vitrectomy for primary rhegmatogenous retinal detachment. J Clin Med.2020; 9: 4037. doi:https://doi.org/10.3390/jcm9124037
28.
CarlàMMMateoCGiannuzziF, et al.Heavy silicone oil tamponade in retinal detachment surgery: a systematic review and single-arm meta-analysis on Densiron 68 and Oxane HD. AJO Int.2024; 1: 100055. doi:https://doi.org/10.1016/j.ajoint.2024.100055
29.
MoussaGTadrosMCh’ngSW, et al.Outcomes of heavy silicone oil (Densiron) compared to silicone oil in primary rhegmatogenous retinal detachment: a multivariable regression model. Int J Retin Vitr2022; 8: 61. doi:https://doi.org/10.1186/s40942-022-00413-0
30.
XiangJFanJWangJ. Risk factors for proliferative vitreoretinopathy after retinal detachment surgery: a systematic review and meta-analysis. PLoS One2023; 18: e0292698. doi:https://doi.org/10.1371/journal.pone.0292698
31.
StenzECYuHJShahAR, et al.Outcomes of eyes undergoing multiple surgical interventions after failure of primary rhegmatogenous retinal detachment repair. Ophthalmol Retina2022; 6: 339–346. doi:https://doi.org/10.1016/j.oret.2022.01.007
32.
JoussenAMRizzoSKirchhofB, et al.Heavy silicone oil versus standard silicone oil as vitreous tamponade in inferior PVR (HSO study): interim analysis. Acta Ophthalmol2011; 89: e483–e489. doi:https://doi.org/10.1111/j.1755-3768.2011.02139.x
33.
WickhamLTranosPHiscottP, et al.The use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol2010; 248: 1225–1231. doi:https://doi.org/10.1007/s00417-010-1358-1
34.
GirsangWSariDCRSrigutomoW, et al.Concept and application of relaxing radial retinectomy for retinal detachment with advanced proliferative vitreo-retinopathy. Int J Retina Vitreous2020; 6: 46. doi:https://doi.org/10.1186/s40942-020-00251-y
35.
MendesTSGomesAMVRochaBS, et al.Evaluation of retinectomy in the treatment of severe proliferative vitreoretinopathy. Int J Retin Vitr2015; 1: 17. doi:https://doi.org/10.1186/s40942-015-0018-3
36.
WickhamLConnorMAylwardGW. Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle?Br J Ophthalmol2004; 88: 1376–1379.
37.
VickersAJ. The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: a simulation study. BMC Med Res Methodol.2001; 1: 6. doi:https://doi.org/10.1186/1471-2288-1-6
38.
FunatsuRTerasakiHKoriyamaC, et al.Silicone oil versus gas tamponade for primary rhegmatogenous retinal detachment treated successfully with a propensity score analysis: japan Retinal Detachment Registry. Br J Ophthalmol2022; 106: 1044–1050. doi:https://doi.org/10.1136/bjophthalmol-2021-319876
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