Author: Francisco Javier Valentín-Bravo (Spain)
Co-authors: Luis García-Onrubia, Cristina Andrés-Iglesias, Javier Martín-Vallejo, José Carlos Pastor-Jimeno, Ricardo Usategui-Martín, Salvador Pastor-Idoate
Purpose
Silicone oil (SO) still represents the main choice for long-term intraocular tamponade in complicated vitreoretinal surgery. This review compared the complications associated with the use of SO and other vitreous substitutes after pars plana vitrectomy in patients with different underlying diseases.
Setting/Venue
1. Department of Ophthalmology, University Clinical Hospital of Valladolid, Valladolid, Spain 2. Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 3. Faculty of Medicine. University of Valladolid, Valladolid, Spain 4. Department of Statistics. Faculty of Medicine. University of Salamanca. Salamanca Biomedical Research Institute (IBSAL), Salamanca, Spain. 5. Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III National Institute of Health, ISCIII, Madrid, Spain
Methods
This meta-analysis was conducted in accordance with the PRISMA guidelines. We retrieved retrospective case-control studies and randomized clinical trials (RCTs) evaluating the risk of SO published between 1994-2020, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus, and Embase. The primary outcome was the rate of complications such as intraocular hypertension, retinal re-detachment, unexpected vision loss, or hypotony. The secondary outcome was to compare the rate of adverse events of different SO viscosities, including particularly emulsification.
Results
Forty-two articles were included. There were significant differences in intraocular hypertension (P=0.0002, OR=1.66; 95% CI=1.27-2.18) and the rate of retinal re-detachment (P<0.0009, OR=0.65; 95% CI=0.50-0.64) between SO and other agents, including placebo. However, there were no differences in other complication rates. SO-emulsification rate is non-significantly higher in low than high SO viscosity and results from other complications were comparable in both groups.
Conlusions
The high quality of most of the studies included in this study is noteworthy, which provides some certainty to the conclusions. Among them, the high variability of the residence time of the SO. The fact that ocular hypertension and not hypotension are related to SO use. That a clear relationship is not found for the so-called unexplained vision loss, which affects a significant percentage of eyes. That the cases of re-detachment are less if SO is used and that surprisingly there does not seem to be a relationship in the percentage of emulsification between the low and high viscosity silicones. All these data warrant more standardized prospective studies.
Financial Disclosure
The author CAI receives funding from AJL Ophthalmic S.A. The authors JCP and CAI are members of the ISO Technical Committee involved in ISO 16672:2020 “Ophthalmic Implants – Ocular endotamponades”.
Comments
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