Silicone Oil for Retinal Detachments

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Silicone Oil for Retinal Detachments

Silicone oil is often used to repair recurrent and complicated retinal detachments. Intraocular gas is often used primarily, but silicone oil is often very useful.

Silicone oil is used for recurrent retinal detachments or complicated retinal detachments including PVR (proliferative vitreoretinopathy).  It can be a valuable tool to prevent blindness.

Most retinal detachments are caused by a retinal tear, or hole, in the retina.  In either case, this allows for communication between the vitreous cavity and the potential space underneath the retina.  Fluid may leave the vitreous and accumulate underneath the retina, causing a rhegmatogenous retinal detachment (rhegma = with a hole).

A vitrectomy with gas with or without a scleral buckle are common ways to surgically repair retinal detachments.

Recurrent Retinal Detachments

Occasionally, a retina can redetach and usually shortly after the first surgery.  Common reasons include an additional retinal tear, or, it is conceivable that an extra tear(s) was overlooked and not treated.

Options include repeating the vitrectomy with gas and possibly adding a scleral buckle if one is not present.  This usually does the trick.

Recurrent Detachments and PVR

Repeated retinal detachments due to additional tears usually persuades me to consider using silicone oil to fix the detachment.  In addition, a condition called proliferative vitreoretinopathy (PVR) often requires using silicone oil.

PVR can cause retinal detachments as membranes (scar tissue) form on the surface of the retina and start to pull.  This pulling can cause multiple retinal tears.

How Intraocular Gas Fixes Retinal Detachments

Intraocular gas works by “plugging” the retinal tears or retinal holes.  The gas bubble, when properly positioned against the tear/hole, prevents fluid from getting underneath the retina causing a recurrent detachment. As the gas is absorbed, the bubble will become so small that any untreated or new hole will be uncovered.  Thus, the retina can detach again.

How Silicone Oil Repairs Retinal Detachments

Think of silicone oil as a non-absorbable gas bubble.  Since the silicone oil is not absorbed, it stays large enough to always cover the holes.  This makes it highly unlikely that a redetachment can occur.

Is Intraocular Gas Better than Silicone Oil

Normally, intraocular gas is preferred as it eventually absorbs after reattaching the retina.  A separate procedure is not required to remove the gas.

Silicone oil does require removal and the vision is usually poor with the oil in the eye, however, when warranted, the oil is likely to prevent re-detachment.

What Does This Mean?

Silicone oil is a great tool to repair retinal detachments.  Repeated operations can be mentally straining and can be a hardship on the patient and family.  Also, with each new detachment, the likelihood of permanent vision loss increases, thus, the fewer detachments the better.

Too many retinal physicians, using silicone oil is a last resort to keeping the retina attached.  Often doctors wait until the retina has detached 3-4 times before considering oil (in fairness, I used to be one of them).

My belief is that oil should be used earlier to stop the vicious cycle of re-detachment and re-operation.  By preventing recurrent detachments, the vision can be better preserved in these complicated cases.

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Randall Wong, M.D.
Randall Wong, M.D.
As a retina specialist, I've been very successful with my websites to educate my patients about what I do professionally. I am a father of five, have a passion for SEO, love Dunkin' Donuts and don't care for Starbucks coffee, love tennis, but only like to watch golf. I'm a huge youth ice hockey supporter and love Labrador retrievers.
Comments
  • Dave December 20, 2011 at 7:29 pm

    Your post is exactly where I’m at Doc! Two operations, the second with silicone oil and the scleral buckle resulted in PVR. After 4 months however, everything is stable, ( very limited peripheral vision,) so we’ve decided to go in again in January to remove the scar tissue, leaving the oil in there.

    I understand that the success rate for this process is about 1 out of 3, but that’s more than a decent chance to get at least some useful vision out if my eye!

    Wish me luck!

  • david December 20, 2011 at 7:53 pm

    My eye Dr. attached my retina to scar tissue twice and it detached both times. The 3rd operation the Dr. attached it and it now has oil in the eye. Could the retina detach again after the oil is removed. And is it normal for a Dr. to reattach the retina to scar tissue?

    • Randall V. Wong, M.D. December 21, 2011 at 2:24 pm

      Dear David,

      The retina can absolutely detach again when the oil is removed. I don’t really understand your question re: reattaching the retina to scar tissue.

      Write back!

      Happy Holidays!

      r

  • Patrice Steffee December 20, 2011 at 9:47 pm

    Thank you for all of your information regarding retinal detachment and especially this one regarding using Silicone Oil. It makes me hopeful that my last surgery with Silicone Oil will be successful although I suspect if it is not I will not be able to go through an eighth retinal surgery.
    Repeated etinal surgery is so difficult physically and emotionally that it really helps being able to find such great information as you provide .

    • Randall V. Wong, M.D. December 21, 2011 at 2:23 pm

      Dear Patrice,

      Thank you for your kind words. Best of luck with surgery.

      Happy Holidays.

      r

  • Job December 21, 2011 at 6:58 am

    Thanks for this information. I have just had a 4th operation! there was repeated detachment, redness tears, and dischrge! What is scaring?

    • Randall V. Wong, M.D. December 21, 2011 at 2:21 pm

      Job,

      Do you mean scar tissue?

      It’s a poor description of “membranes” or a layer of tissue that lines the surface of the retina and then contracts…pulling the retina off and causing tears.

      Randy

  • Optometrist Scottsdale December 21, 2011 at 8:30 am

    Thanks for keeping the information coming.

  • Laura January 9, 2012 at 1:52 am

    Hi Dr Wong,
    I am 2 mo. post silicone oil placement for 3rd retinal detachment with development of PVR and macular pucker – all having occurred in last 4 mo. The oil is now leaking to front of eye causing severe eye pain and extremely high pressure. I was put back on multiple eye drops to control pressure and surgery is scheduled to take oil out. My eye is aphakic from last surgery. Any ideas why the oil is leaking now? Is this uncommon ? Any thoughts or advice would be appreciated.

    • Randall V. Wong, M.D. January 9, 2012 at 11:34 am

      Dear Laura,

      Not an uncommon issue. With no lens, there is no physical barrier for the oil migrating forward although the oil usually prefers to stay in one uniform glob (fancy word!).

      There may also be too much oil, bad head positioning, etc. I’d have to examine you.

      I hope you find resolution quickly.

      Randy

  • Kaushik January 12, 2012 at 1:26 am

    Dear Dr Randall,

    After having silicone oil for over eight months, it was removed on 3rd January. The eye was filled with air bubble. After 8 days the bubble has become very small. However, my vision is very very faint. Glare is there in sunshine but contrast sensitivity is very poor. Is it normal? How long it would take to have reasonable vision?

    • Randall V. Wong, M.D. January 19, 2012 at 7:55 pm

      Hope you have improved by now, but an eye with recently removed silicone may take a while to settle. I also can’t really address your other symptoms…there are too many factors causing glare.

      Randy

  • Kaushik January 21, 2012 at 7:09 am

    The vision has come but hazy. Moreover, if i stay out in the bright day light for sometime everything becomes dark inside room and takes 8 to 10 hours to recover. I wonder why?

  • Gerhard January 27, 2012 at 4:12 am

    I had an eye(left) injury when I was 5 years old. After many operations, new lenses etc, I had a rather big retinal detachment about a year ago. My doctor attached the retina succesfully and put silicone oil in to stabilize it. It worked very well, although he was not in favour of the silicone. A year after the operation he removed the silicone and replaced it with gas. Unfortunately the gas did not work and he had to put the silicone back. My eye pressure has been very high ever since, around 38! I’m taking drops to lower the pressure, but the doctor is worried that the increase pressure from the silicone will damage my optical nerve. I would like to hear your comments on this please. Thanks

    • Randall V. Wong, M.D. February 1, 2012 at 11:43 am

      Dear Gerhard,

      Not sure why he would associate high pressure with silicone oil. Perhaps too much oil?

      I think he was saying that he is concerned about the high pressure damaging the optic nerve.

      Randy

  • Shawna January 27, 2012 at 5:42 pm

    My neighbor has had silicone in his eye now for about a year and 1/2, maybe less. According to his doctor the silicone is starting to separate and they want to remove the silicone and replace it with gas. My neighbor is 75 years old. The questions I have are 1) how long is the gas suppose to last? 2) why not put in new silicone? 3) We live at an elevation of 4500. His surgery is out of town at sea elevation. The doctor wants to keep him there for 5 days after the surgery because of the difference in elevation. Would it be better to have the operation locally to avoid the elevation difference?

    • Randall V. Wong, M.D. February 1, 2012 at 11:46 am

      Dear Shawna,

      1. The gas will last 2-4 weeks, but it depends upon the type of gas and the concentration of the gas. It varies from surgeon to surgeon.

      2. I, too, would probably vote for gas, but you’d have to ask his doctor why he prefers removing the oil and replacing with gas.

      3. If you can find a retina surgeon at your location/altitude. You are correct.

      r

  • Susan February 14, 2012 at 9:33 am

    I just had surgery to remove oil after 3 months..after the 3rd detachment. An air bubble was place in my eye and is now going down and being absorbed. The vision above the line seems very blurry, which he told me it would be for a few months. My pupil has been dialated since the first surgery and has not come down at all..seems like it will be permanent. He told me it can be fixed by cataract surgeons, but I am terrified of having anyone do anything else. How poor will vision be after the 3 surgeries for detachment? Will it be blurry forever..or will a new RX for glasses help? Thanks for you comments.

    • Randall V. Wong, M.D. February 15, 2012 at 9:03 am

      Susan,

      I suggest you wait until ALL the gas is gone before trying to determine your eventual vision.

      There are so many factors affecting your vision right now. Light bounces off the gas bubble inside your eye and can significantly reduce your vision.

      Your surgeon is the best fit to answer the question about glasses.

      Randy

  • hazel February 14, 2012 at 12:01 pm

    dear dr wong. could you possibly say how long i can expect to wait for good vision after the silicone oil and cataract was removed from my eye.after pretty severe problems with giant tears and holes. colours are still very weird centrally with bad eye,everyone has greyish blue faces and the colour red disappears or goes a weird brown colour. also looking any distance seems like i still have the cataract. the surgeon did have difficulty with the placing the lens and it took a lot longer than i was told but the retina is still attached. also does lattice degeneration in my good eye mean that i will get a detachment on that one. he has sealed around it with laser .i have so many bits of oil floating round in my eye it’s like its raining and i’m a bit frustrated as i expected it to be a quicker result than this. thank you so much for a great site and your kindness. hazel

  • Susan February 15, 2012 at 11:25 am

    Dear Doctor Randy:

    Thank you for your advice.. Do you have any opinion about the dilated pupil issue? Would having that repaired effect the retina or be a high risk factor in another detachment? Thanks so much for your kindness.

  • Laurie Muir March 29, 2012 at 5:58 am

    Dear Dr I have found some inner peace from finally finding your blog.

    In Nov last year flying into LAX on my way home to Thailand developed my second detachment in 6 years in same eye – left eye – not being able to stay in LA for a month and wanting to fly home I elected to have oil put in my eye.

    Now 4 months post op I find my central vision has develop some sort of fuzziness and although not noticed earlier the color and brightness seems to have slightly diminished compared to my good eye.

    I have seen 3 retinal specialists 1 said the fuzziness was caused by an edema and the other 2 said I didnt have an edema but could not explain or have an answer for the fuzziness in my central vision – they performed 2 separate OCT’s and both were compared and last 2 specialist ruling out no edema.

    My question that I am seeking an answers too is what is the fuzziness and why would my eye brightness and colour be diminishing

    In my first detachment the doctor waited too long and it detached over the macula I recovered with a little damaged and distortion to my central vision but the fuzziness I gave now is accross the entire macula.

    Sorry and one last thing, if I close my eye and open suddenly I see what I can only describe as sparks not flashes representing the patch that is fuzzy but it disappears immediately.

    OCTs show retina attached in macula as I thought sparks were it detaching in the centre.

    Any help would be very much welcomed.

    • Randall V. Wong, M.D. April 4, 2012 at 7:28 am

      Dear Laurie,

      I can only guess that you have an ERM, macular edema or cataract as the most likely causes of the blurred vision. These are only guesses as I can’t examine you. I have no idea about the sparks you mention other than perhaps it’s due to the oil stimulating (by moving) a poorly functioning macula?

      Randy

  • wee-Victor April 6, 2012 at 5:19 am

    Dear Dr Randy
    I just had my silicon oil removal after my retinal detachment surgery 4 months ago. I also did a cataract on the same eye at the same time. Its now more than a week and the doctor said my retina looks fine. But I got thousands of fish eyes and sometime debris in my vision. Occasionaly I also experience a few light flashes (maybe after exposure to strong lights?) . Is this normal? I am worried about a re-detachment.

    Victor

    • Randall V. Wong, M.D. April 8, 2012 at 5:50 pm

      Unfortunately, we always have to worry about retinal detachment and your symptoms can’t let me know one way or the other. The best way to know is obviously have your doctor examine you.

      Randy

  • josephine April 23, 2012 at 8:38 am

    i did an operation for retinal detachment in 2009 july with silicon oil.and still today i have,nt removed the oil.last week i started to see greenish and blue things with the eye and also a little bit of bubbles .does it mean the retina is off again?pls help as i am worried

    • Randall V. Wong, M.D. April 23, 2012 at 6:56 pm

      Dear Josephine,

      I have no way of knowing. It is possible you have detached again (worst case scenario) but only because there is a change in your vision and not because you describe the “greenish and blue things” so well.

      Go see your doc.

      r

  • Maggie April 25, 2012 at 2:27 am

    Hello
    What a great informative and easy to understand blog!
    I had retinal detachment surgery a month ago [reattachment/vitrector/silicone oil insertion].
    I want to fly to the UK from Oz in 5 months time. Has anyone flown long haul eg Australia to UK and had problems with eyeball pain etc?
    Can you fly 1 month long haul following removal of silicone oil?
    Spoken to a few people and they said they thought their eyeball was going to burst…eeek!
    Thanks for any ideas/suggestions.
    Maggie

    • Randall V. Wong, M.D. April 25, 2012 at 11:39 am

      Dear Maggie,

      In my opinion, flying with or without silicone oil should not matter. Gas volume, however, responds to great changes in atmospheric pressure and is usually a contraindication to flying.

      Randy

  • maggie July 9, 2012 at 11:58 pm

    Hello again Dr Wong,
    It’s nearly 4 months since my RD surgery rt eye [silicone oil and scleral buckle]. In the last month in the evenings/night time I have double vision if both of my eyes are open, but not if I close one.
    Also, my right eye looks smaller than my left eye – will this improve? I am quite conscious of it when talking to people.
    Many thanks for any insights. Maggie

    • Randall V. Wong, M.D. July 19, 2012 at 1:19 pm

      Dear Maggie,

      If the double vision is recent, have you considered the possibility of a cataract? It doesn’t really cause true double vision, but does cause problems often described as “double.” An epiretinal membrane could also cause similar issues. Either way, you should ask your own doc who can at least examine you.

      The smaller right eye may be due to the trauma of the surgery (loss of fat in the eye socket is common, there is less tissue “pushing” the eye forward and the eye ends up sitting deeper in the eye socket and the lid droops down a bit more), or, you could have ptosis (droopy lid) as a result of the surgery.

      Your doc should be able to sort this out.

      r

  • Mike July 15, 2012 at 10:27 am

    Great blog, thanks Dr Randy.
    I have had the silicone oil in for a week now, after 4 retina ops in the past 5 months… Hopefully no.5 using oil has it all sorted!
    Ref flying, the advice I have been given is it is ok to fly long haul with the oil, do you see any issue in flying regularly whilst it is in?
    Ref PVR does the oil stop this, reduce it or no effect? Any other way to stop this other than cleaning out?
    Thanks
    Mike (Singapore)

    • Randall V. Wong, M.D. July 19, 2012 at 1:27 pm

      Dear Mike,

      I agree. No problem with flying with the oil.

      My opinion about PVR. It is active for a finite period (say for a few months). The idea of the oil is to keep you attached during this “active” period.

      Randy (Hello from Virgin America Flight to Los Angeles – wifi!)

  • maggie August 6, 2012 at 8:13 am

    Hi Dr Randy
    Post visit to my surgeon and you are spot on! The oil has caused a cataract so am now on the waiting list for removal of oil and insertion of new lens.
    Thank you again
    Maggie

  • Sridhar Dawadi August 6, 2012 at 5:21 pm

    Hi Doc,
    This Blog has good info. I got my first eye surgery done 1 week ago with silicone oil. I can’t see any thing with my left eye. It’s foggy….my Doc said, I might neet to go thru another surgery after 3 or 4 months for replacing my lens. Will my vision be foggy all thru or will I be getting some glacess to focuse my vision properly. Generally after how many days I should return to my normal activity?

    Please let me know…
    Thanks for taking the time to reply to patients like me… 🙂

    • Randall V. Wong, M.D. August 17, 2012 at 9:43 am

      Dear Sridhar,

      Everything you state sounds normal. I usually allow my patients to return to work within a week.

      Randy

  • Jen August 25, 2012 at 9:04 am

    Dear Dr Wong, I have been reading the blogs and different stories about retinal detachments from people all over! I too have had a horrible 8 months of vision. I am 47 years old, a mom and a pediatric nurse. We have a great very busy life. I had a pvd with some bleeding/tears in Dec of 2011. Had a vitrectomy with gas bubble and laser which failed. Next a sceral buckle more laser, vitrectomy and longer acting gas. This lasted about 6 weeks. My eye surgeon shunted me off to a new surgeon in different city as he was going on vacation. ( my retina had detached and I had developed a cataract which he failed to report to me.) I had fremoval of the cataract, vitrectomy, flattening of scar tissue, repair of detachment,laser and insertion of oil. The oil stayed in for almost 6 months. Vision is crappy with some periperal vision lost. Just before my oil removal I had developed another tear shich he lasered before surgery. Had surgery Aug 8th, the next day at my postop check I had another tear near that same area, which he lasered in office.I am praying that this is the final surgery. I am so very healthy other than being highly mioptic, so this has been so frustrating. I have not been able to do my normal exercise program and am gettting all out of shape! Also I forgot to mention I have latice degeneration in both eyes and my good eye has been lasered prophylactically. All of this recent work has been done in Portland Maine. Do you think I should get another opinion at Mass eye and ear? my surgeon came from there originally. I am so young and I have a ton that I want to still do in my lifetime!!! Thanks so much for your blog and time!

    • Randall V. Wong, M.D. August 28, 2012 at 8:14 am

      Dear Jen,

      Unless there is another surgeon in your area, I might suggest you go to Mass Eye and Ear as I think you need a second opinion.

      Your course seems unusually complicated.

      Fairfax, Va. is just outside of Washington DC!

      Good luck.

      r

  • Nina August 28, 2012 at 10:07 am

    Dear Dr Wong

    I found your website whilst searching on the internet and thought I would drop you an email.

    My son has had a virus (herpetic) in his optic nerve which has resulted in acute retinal necrosis, retinal tear/detachment and after a series of vitrectomies and other operations (including cataract) he now has silicone oil which has done an excellent job of keeping his retina in place. The oil has been in place for about 16 months, but his consultant is concerned that the cornea might be becoming irritated by the oil. He is using a low dose of steroid drops which seems to have stopped the discomfort he was feeling. He has very limited vision in this eye now, although recently he feels there may have been some improvement.

    The care he has received has been excellent but I would be grateful for any information that you may have regarding silicone oil and long term use; or any information about any of the problems he has had. I don’t know if there is any research currently being under-taken in the States with stem cells and retinal re-growth or any pioneering treatment that I would be able to investigate?
    Have you heard of any a treatment where a gas bubble is inserted between the silicone oil and the cornea to reduce irritation?

    I would be very grateful if you would be able to help. My son is only 14 and I would like to feel that I am doing all I can to help him.

    Thank you for your time,

    Best wishes

    Nina

    • Randall V. Wong, M.D. August 28, 2012 at 11:51 am

      Dear Nina,

      My experience, and I stress my experience, with silicone oil and corneal clouding is that oil may be physically touching the cornea. Usually the oil stays behind the iris and poses no problem whatsoever to the cornea.

      On the other hand, I don’t know if the herpetic infection involved the cornea….probably not.

      I would recommend getting an evaluation from a corneal specialist, but in the back of your mind, consider oil removal if that is the ultimate culprit. You may want to seek the opinion of another retinal specialist regarding possible removal.

      I am not aware of any long term gas bubble treatment as the gas, regardless of type, will be absorbed. Perhaps if this has been suggested then the oil is actually in contact with the cornea.

      Nothing on stem cells on the horizon in this scenario.

      Randy

  • Sheila September 1, 2012 at 12:27 am

    Dear Dr Wong,

    I am a 46 year female which before my nightmare began had 20/16 vision in my left eye. Let me start from the very beginning. I had Lasik 20 years ago at Kremer Laser Institute in both eyes and enjoyed 17 years of good vision until I developed a cataract in my left eye. I had a new lens put in and was seeing 20/20 but lost all my close vision, I can live with that. Three years later my retina detached and I had surgery at Bascom Palmer in Miami,FL to correct it with the two top retina surgeons there. They used gas and a sclera buckle to repair. After the first time it re-detached from scar tissue. After the second time they said I did not position myself correctly (face down) and it lifted with fluid seeping under the retina. The third surgery was done and silicone oil put in. After the third surgery I got a corneal infection which took 4 months to clear up. Here I am 2 1/2 years later still using antibiotic drops and they are scared to remove the oil because of re-detachment and the possibility of the eye becoming atrophic. I have an oil bubble in the front of my eye which is visible to the naked eye. I have constant pain in and around the eye with extreme dryness. I still have a tear duct plug in which they say will help with the tears but doesn’t. I have to use artificial tears every 10 minutes just to relive the dryness. I have had my eye checked and I do not have any infections to date, just redness due to all the surgeries, some cornea damage and pain. Is there any new vitreous fluids substitutes any where in the world? I would travel to China to sort this mess out. I guess my question is is it worth it to try removing the oil? I would be happy if I got 20/50 vision again and not expecting 20/20. Is there anything else besides serum tears that will help heal my dry eye?

    Thank you so much,

    Sheila

    • Randall V. Wong, M.D. September 3, 2012 at 9:46 am

      Dear Sheila,

      I’d consult the corneal specialist again. The problem may have stemmed from the infection and the issue is not looking for a vitreous substitute. I also wonder if there is too much oil causing some the corneal damage (another question for the corneal person).

      Sorry.

      r

  • stephen mclaughlin September 16, 2012 at 3:47 pm

    how long does silcone last if placed in the bottom part of your eye i had surg when i was 7 im 46 now my question is can silcone lAST 39 years can it still be in my eye after that many years thanks your sincerely stephen mclaughlin

    • Randall V. Wong, M.D. September 25, 2012 at 9:05 pm

      Stephen,

      Don’t really remember when silicone oil was first introduced to eye surgery. In theory, I believe silicone oil may last indefinitely. Are you sure?

      r

  • David Andrew Brown October 3, 2012 at 3:31 pm

    hi doctor Wong
    i had complicated retinal detachment 2008 ,after a cateract op went wrong ,i have had silicon oil in my eye since, when i look straight ahead my vision is blurred but when iface down my vision is brilliant,my periphial is ok to.just wondering if to have silicon removed altogether,ive read many articles on silicon removal with a 100 or so patients but they seem to have had their oil in for 23 months max and a certain percentage had redetachments.. i suppose it depends on whats happening within the eye, am i getting corneal damage , oil emulsification, or optic nerve damage,
    Very concerned as my job is Hgv driver,and my medical is coming up

    • Randall V. Wong, M.D. October 10, 2012 at 10:33 pm

      Dear David,

      Unfortunately, your history is the best prognostic indicator of your eventual vision…not the story of 100 other patients with oil. The reason is that the timing of implementing oil varies so much…some surgeons too late, some surgeons not so late.

      One promising note is that your vision is “brilliant” when face down.

      I can’t make a comment as I can’t examine you…but your surgeon can and push him for answers!

      Best of luck.

      r

  • Brian Ni November 18, 2012 at 6:23 pm

    How Silicone Oil Repairs Retinal Detachments

    Think of silicone oil as a non-absorbable gas bubble. Since the silicone oil is not absorbed, it stays large enough to always cover the holes. This makes it highly unlikely that a redetachment can occur. Too many retinal physicians, using silicone oil is a last resort to keeping the retina attached.

    Q: What about: The macular hole and peripheral retina are not fully covered by the silicone oil procedure?

    • Randall V. Wong, M.D. November 21, 2012 at 8:22 am

      Dear Brian,

      There was a study several years ago where silicone oil was indeed used for macular hole surgery. You are right, in theory, the most peripheral retina may be difficult to have covered. This is especially true for the retina at “6 o’clock.”

      r

  • Ikram November 21, 2012 at 5:22 am

    Hi Doctor Wong,

    I am 31 years old. My eye sight started weakening since he age of 12. At age of 26 I was diagnosed with cataract in both eyes, My Doc initially delayed cataract removal since it was not causing major hindrance to vision. i am also high Myopic. Doc performed cataract operation first in left eye and the in right eye with a gap of one year. I was doing quite well, until 6 months ago, I had a retinal detachment in right eye, though it was operated for cataract later than the left eye.
    I was operated for retinal detachment with silicon oil in my eye. Doc said they will remove after 6 months to one year initially, but few days back I had a “Facial Paralysis” on the left side (a mild stroke but on the other side, NOT on the retinal detachment operated side of eye, I am on steroids treatment for a week now and recovering).
    My eye specialist told me that Oil in the eye has started “Emulsification” , i am not sure what is this process and he needs to remove it now. Oil has already been in the eye for 5 months and he gave me appointment next moth for removal of silicon oil, means Oil will be completing 6 months till then.
    1.My Question is that what is the effect of facial paralysis on retinal detachment or silicon oil removal surgery.
    2.Also This was my first surgery for Retinal detachment but doc preferred to do it with silicon oil. Why?
    3.Doc described Rhegmatogenous retinal detachment type for my case.
    4.What is the emulsification of oil, what can it cause to eye and is how much should doctor wait for silicon oil removal if Oil starts emulsification.
    5. Will doc prefer to insert Gas after silicon Oil removal or not.
    6. What is average recovery time after the silicon oil removal.
    7. Is the silicon Oil removal surgery complicated like retinal detachment surgery less critical.

    Sorry for so many questions.

    Thanks alot for such a nice and informative website.

    Regards

    Ikram

    • Randall V. Wong, M.D. November 21, 2012 at 8:32 am

      Ikram,

      1. None.
      2. I don’t know, you’d need to ask him/her for the specific reasons. Perhaps it was long standing or you had evidence of PVR?
      3. Maybe very complicated by multiple holes. Again, this is a great question for your doctor.
      4. Emulsification: oil breaking down.
      5. Don’t know. Ask.
      6. Depends upon gas used, if any.
      7. In my experience, oil removal is easy.

      Thanks for the remarks about the site.

      r

  • Shalin Mehta January 18, 2013 at 4:56 am

    Dear Dr. Wong,
    My father (who resides in India) is affected by retinopathy and retinal traction. I have been trying to educate myself about the treatment options so that I can assist him in making meaningful decisions.

    He has only one functional eye on which vitrectotomy and silicon oil placement were performed 3 months ago. The oil had stabilized his retina until now and his intraocular pressure was under control.

    But, after particularly cold winter in India and being outside during a local festival, his IOP increased > 50. He has been given Mannitol IV two times over 4 days now to relieve the pressure. His doctor is going to remove the oil in couple of days.

    I have following questions, and will be grateful for your insights.
    1. can silicon oil emulsification cause sudden increase in IOP?
    1. can cold weather induce emulsification of silicon oil and elevate IOP?
    2. can sneezing hard due to cold affect silicon oil distribution in eye and elevate IOP?
    3. After removal of silicon oil, how long does it take to regain ambulatory vision? After vitrectomy, the recovery lasted for 10 days or so during which oil drops needed to be administered. My father gained ambulatory vision in about a month.

    Lastly, I want to thank you for the great service you are doing to community at large by allowing them to write to you.

    • Randall V. Wong, M.D. January 23, 2013 at 1:55 pm

      Dear Shalin,

      1. Usually not
      2. No
      3. No
      4. Depends upon the vision before the oil was inserted. Your doctor should be able to tell if there is likely improvement within a week or two.

      Thanks for the support and kind remarks!

      Randy

    • Randall V. Wong, M.D. January 23, 2013 at 1:56 pm

      Dear Shalin,

      Is your dad diabetic? I would think the diabetic retinopathy is likely to cause the IOP changes, but ask his doc.

      r

  • Shalin Mehta January 23, 2013 at 2:43 pm

    Dear Dr. Wong,
    Thank you for your views. My father has diabetic retinopathy. He has been affected by chronic glaucoma since many years, but this was the first episode of acute glaucoma as far as I can recall; so I wanted to understand what may be underlying cause. After examination, his doctor did laser iridectomy, which has helped so far and we have postponed removal of silicone oil.

    Shalin

    • Randall V. Wong, M.D. February 2, 2013 at 4:08 am

      Dear Shalin,

      Laser iridectomy, in this specific case, may be due to the silicone oil blocking the pupil. Aqueous humor is then prevented from moving to the front of the eye and can’t leave the eye….thus, the pressure increases.

      r

  • Michael May 9, 2013 at 9:15 pm

    Dr Wong:

    I recently underwent a third vitrectomy since early March. Following the first reattachment, PVR formation caused subsequent detachments in early April (4 weeks after the original surgery), and then again at the end of April (2 1/2 weeks after the second operation). In operation #2, I received a scleral buckle. This last time, I had a small part of the bottom of my retina cut away (where the scarring was forming), and received silicone oil. A one-week followup showed the retina reattachment is holding well and there is no sign of new scarring.

    I’m in a waiting period now — but wonder how soon PVR would be noticeable if it were to return? I have an opportunity to fly to Washington for a conference in two weeks, and I’m nervous about being out of town if I’m likely to have another detachment. My doctor says I shouldn’t worry about going — as a detachment will occur whether I travel or not if it’s going to happen. If it happens in Washington, he says I could be seen there (or I could try to rebook an immediate flight home).

    So I’m wondering if I am needlessly worrying about a recurrence, or if it’s a wiser course to stay closer to home and my usual medical care for the next couple of months?

    Thanks.

  • Sean May 29, 2013 at 9:58 am

    Dr Wong,

    I did retinal detachment surgery and cataract in the same time before 3 years (28/08/2010) by silicone oil, then after four months the oil removed (25/12/2010), but there were still some small bubbles of oil in the eye the eye was good around 17mmHg but after one year the pressure of my eye increased around 24mmHg and some doctors told me maybe due to the oil bubbles i am using now COSPOT drops and the eye pressure become normal around 17mmHg …
    i am confused shall i do another surgery to remove the remaining small bubbles or no need .. to be honest with you some doctors told me no need and some of them they told me do it?
    is there any risk to keep these small bubbles forever?

    Br,Sean

    • Randall V. Wong, M.D. June 4, 2013 at 2:37 pm

      Sean,

      Silicone oil should not react with the tissues in the eye. I doubt small bubble could be directly causing an increase in your eye pressure.

      I don’t think there is any long term risk with the small bubbles.

      Randy
      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, Virginia
      http://www.RetinaEyeDoctor.com

  • Luis June 12, 2013 at 2:53 am

    Hello Doctor
    I had etinal detachment surgury with buckle and bubble then has a lower detachment oil used still in attached. I’m having surgury to remove oil that’s beer. In since 2010 I’m nervous about it and concerned about recovery period time etc. I want to do because vision with oil is not clear no lens in either. Please share your words of wisdom as to what to expect with oil removal and possible outcomes
    Thanks

    • Randall V. Wong, M.D. June 12, 2013 at 10:09 am

      Luis,

      I personally hate removing oil due to the possibility of recurrent retinal detachment. I estimate there is about a 50% chance of this happening. I usually pretreat the retina with laser about 1 month prior to the anticipated removal….to reduce the chances of redetachment.

      Randy

  • Addie Reed June 16, 2013 at 3:55 pm

    Hi there, My husband on May13 2003 had a gas bubble put in. The next Monday pain was so
    bad they done another surgery to move blood. Did not work on Wed. the same week done another
    surgery to rmove blood and put a band around the retina then thurs. the next day went in and
    removed the band and wash the eye out again. Pain has been so bad he has lost 30 pounds and
    still no relief. So on June 13 a different Dr. in the same office put a Silcone oil bubble to help the
    bleeding. Is this a normal thing to happen are the messing up. They told him his eye was
    weak because of near sightedness and the other surgeries he has had done. A need to know. So so
    sad he is still in pain. Pain pills do not help much it seems. My husband is not a whimp. Takes pain
    better then most. So what is the answer. Ar

    • Randall V. Wong, M.D. June 16, 2013 at 5:42 pm

      Addie,

      This seems really, really complicated. Eye issues, especially retina, can become complex, but this seems unusual.

      Where are you located?

      Randy

  • Michael August 15, 2013 at 7:19 pm

    Randy:

    I had a vitrectomy/reinectomy with oil here in Wisconsin in May to reattach my retina for a third time (PVR troubles) and I’m coming up on my appointment next month to evaluate progress and maybe plan to have the oil removed. I haven’t been able to find any information about the procedure — how long that surgery lasts, and what I can expect afterwards as far as recovery time, being out of work, resuming normal activities, etc.

    I have no idea how stable things are. I had no new scarring apparent after the one-month exam. I still see occasional dim flashing in the center of my vision…though that has been going on since the day after surgery and my docs have said it will likely stop.

    Also, I seem to be seeing double occasionally, which I attribute to the buckle I got after my second detachment. Is that common and is it usually treatable in some way?

    Thanks,
    Michael

    • Randall V. Wong, M.D. August 26, 2013 at 11:25 pm

      Michael,

      1. Surgery to remove the oil can take at last 20 minutes due to the extreme thickness of the oil.

      2. I have no idea how stable you are as I can not examine you.

      3. My usual plan would be to laser your retina in prep for the oil removal. I usually don’t plan on gas after removal unless I see something during the operation to change my mind, but your surgeon may have a different opinion.

      All the best,

      Randy
      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, VA 22030

      http://www.TotalRetina.com

  • Uma September 10, 2013 at 6:09 pm

    Hi ,

    My husband had a retinal detachment surgery in May where a gas bubble was inserted but after 3 weeks there was another detachment as the bubble could not hold the retina in place. This time in June the doctor put a silicon oil in his eye so it can better hold the retina. The silicon oil is still in his eye and with today’s doc appointment we came to know that a cataract had formed in his eye.

    Doctor said he is not sure what to do and asked us to take a second opinion. We are now confused and worried. What is the best approach to this…in order to avoid further damage to the eye.

    Thanks,
    Uma

  • Amy November 5, 2013 at 7:32 pm

    Hi Dr. Wong,
    My husband had very large retinal tear over the weekend. He has very bad myopia and also his mom had a detached retina. He is 49 and had a moderate cataract taken out last spring in the eye that got the tear. This is the first tear he has had, it is quite large, and getting a bit larger after some laser which was supposed to keep it in place until getting to the surgery. The retina is not detached yet, but vision is blurred. The doc is giving him a choice between oil and gas. He says the success rate is about the same. But I am not sure which is best.
    1- what is the risk for the second procedure to remove the oil.?
    2-Is it more dangerous to have two procedures instead of one? My husband is very workaholic and he is a little crazy he does not want to take four weeks off of work for the gas procedure, which is why the doc offered the oil. I do not want his crazy urge to work to harm his vision. He is at work right now, he never listens.
    3-Are the results truly the same? I am digging through trying to come up with good information on the internet. Thanks for any advice you have.

  • Emily December 4, 2013 at 9:19 pm

    Dr. Wong,
    On 11-13-13 I went in for emergency detached retina surgery, got a buckle and silicone oil was placed in eye due to large tear. I am nearsighted had LASIK twice in my left eye and was rearended a month before this tear.
    I had unusual swellening according to the doctors and now three weeks later my eye is still blood red, seeing double vision. I’ve been off work and I’m thinking I should be off until my eye clears up.
    Feb. Is the anticipated oil removal. They say the retina is flat and looks very good.
    1. Will my retina stay intact
    2. Based on what I’m reading, it appears I will be off for a minimum of two weeks to ensure my retina stays attached.
    3. Is there swelling and bloody eyes and tears with oil removal.

    • Randall V. Wong, M.D. December 23, 2013 at 2:30 pm

      Emily,

      1. No guarantees. I usually wait a couple of months before removing the oil. Sounds like your doc is doing the same. Can’t tell beforehand if you’ll detach or not.

      2. Possibly. Depends if gas is put back in at the end of the operation.

      3. There can always be swelling and blood after any eye operation. My guess is that most of the swelling was due to the original buckle.

      Hope this helps.

      Thanks and Happy Holidays!

      Randy
      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, VA 22030

      http://www.TotalRetina.com

  • Renda January 30, 2014 at 7:01 am

    Hello Dr. Wong,

    Can a patient have MRI, during she/he has silicone oil in eye?

    Thank you.

    Best regards,

    Renda

  • Renda February 6, 2014 at 2:35 am

    Hello Dr. Wong,

    I will have MRI from my brain, so that I am worried.

    If I understood right, MRI won’t effect my eye that with silicone oil probably?

    Thank you.

    Best regards,

    Renda

  • Eric February 8, 2014 at 5:53 pm

    I had a vitrectomy in March 2013 to remove a large number of floaters that were making my life miserable. Unfortunately this turned out to be the wrong decision as I’ve now had 6 surgeries to fix recurrent retinal detachment due to PVR (this is disappointing because the original surgery went well and two months later I had a tiny tear in the periphery, but after the surgery to repair that my vision was extremely distorted — a buckle was not done and I’m not sure why??). I’m 43, and was told I was more prone to PVR.

    Anyway, the fourth surgery left me with a diagonal stripe of vision across the center and was filled was silicone oil. I think he blasted most of my retina to save the macula. The oil apparently stopped the PVR, but five months later the oil was removed in a fifth surgery and my retina detached again within two weeks. A sixth surgery was done last week, however I chose not to have the silicone oil put in. My eye has been through enough and even though the doctor wanted to keep the oil in long term, I know that it emulsifies and becomes useless after 1-2 years. I would need an “oil change” periodically the rest of my life, and since it’s impossible to see through the oil, I opted for C3F8 in a last ditch effort. I’ll know in 2-4 weeks if it will work. Hopes are high, but I’m realistic.

    Wanted to get your thoughts on long term silicone oil in the event I do decide to have one more surgery. My eye is mostly gone at this point. I am counting on stem cell therapy or retinal / visual cortex prothesis. What are your thoughts on these new technologies, and I’m really wondering if the laser scarring rules me out as a candidate for stem cell retinal regeneration. Thank you.

  • irfan June 16, 2014 at 7:56 am

    16 years back my mother had an RK and after that right eye was good but on the left eye my mother saw a Black hole on the center of the left eye and a doctor said that the center vision of the left eye had been damaged but side vision from the left eye was alright. Now, a few time back ( two months) my mother went to the doctor to check the eye so the doctor said that the retina has detached and the eye wall also removed, after operation the doctor used silicon oil and still the left eye is blurred , so how long is will it take to get clear vision and what’s the healing procedure here, and beneath the eye a black shadow has appeared so what should she do to heal it , she should just rub ICE over it or what?

    Thanks.

    • Randall V. Wong, M.D. July 12, 2014 at 2:22 pm

      Irfan,

      Blurred vision could be from both the oil AND retinal detachment. Tough to say if the blurred vision will ever clear.

      r

  • shilpa June 19, 2014 at 9:06 am

    Hi Dr Randall,

    I had a detachmnt surgery 2 yrs back by buckling……which was unsuccessful , then it was again operated and the silicon oil was used . Since it was almost a year n half the oil was not removed , Catract was developed .immediately the lens was placed but the oil wasn’t removed, it was removed after 2 months…..thatz now.Its 3 weeks now the is removed but my eye pressure is high GAT 28 and I have a severe head caught.I visited the dr today…….n he has again prescriped the pressure control drops.I am worried why is the pressure so high and I’m scared of again a re detachmnt occurring. Your suggestions please.

    • Randall V. Wong, M.D. July 12, 2014 at 2:36 pm

      Shilpa,

      High pressure and your retina being attached/detached are not usually causally related.

      r

  • Husein July 26, 2014 at 4:31 pm

    Dear Dr. Wong:

    Are there any adverse effects if I choose not to go through oil removal surgery. If so what are they. I do have Glaucoma since some years but it is under control by using prescribed eye drops.

    Thank you.

    • Randall V. Wong, M.D. July 27, 2014 at 5:45 am

      Husein,

      Adverse effects from oil are controversial. Some say there are none whereas there may be toxicity to the optic nerve, cornea or cause glaucoma. If you were my patient, one option would be to leave the oil indefinitely and monitor frequently for complications.

      Randy

  • Tom July 29, 2014 at 12:14 pm

    July 2013 I had successful vitrectomy with gas inserted in my right. As a result of this surgery my right eye developed a quickly maturing cataract.
    8 months my right eye’s detachment, March 2014, I suffered a detachment in my left eye. This was a macula off (80%) detachment. This required two vitrectomy with gas, the last including a buckle. This eye also suffers from a quickly maturing cataract.
    One week ago today I was scheduled for cataract surgery (right eye), unfortunately the Weekend before this surgery my left eye re-detached. We ended up performing cataract surgery on my right eye in the morning and a second surgery on my left eye in the afternoon that included: vitrectomy, lensectomy, retinectomy and silicon oil.
    Until yesterday, I was actually capable of seeing faces and counting fingers with my left eye, even without a lens. As my Dr. stated, because of the oil and lensectomy my vision will fluctuate. Having gone through 4 surgeries for detachments I pretty aware of what to expect for recovery process. But here’s my concern.

    Our plan is to keep the oil in place for 6 to 9 months. If all stays in tacked, remove the oil and monitor for 4-6 weeks. With that success insert IOL to achieve best vision.
    * Can we leave the oil in and inset an IOL? Would that make sense?
    * Are there any other options?
    * My Dr. stated that if the eye detaches again we are out of options. He will just leave the oil and I will just lose the vision in that eye. I’m not one for giving up.

    Good news… I now have 20/20 in my right eye after cataract surgery. Fingers crossed this eye continues flourish

    Thank you for your time,
    Tom

    • Randall V. Wong, M.D. August 5, 2014 at 9:41 am

      Tom,

      Wow.

      1. You can leave the oil in place indefinitely as long as there are no signs of toxicity. Your doctor should see you regularly to look for those signs.

      2. Oil changes the refractive error (the power of your glasses). Inserting an IOL with the oil will require a change later. I highly doubt this would work well with your other eye.

      I would suggest (if I may). Make absolutely sure the right eye is stable before going further with surgery in the left.

      Best of luck,

      r

  • Tom August 11, 2014 at 1:51 pm

    Dr. Wong,
    Thank you for your response. Your suggestions align very well with my doctors.
    My right eye is seeing perfectly and surprisingly, my left currently holding oil and without a lens can actually read large print. Of course this varies due to the its current disposition.

    Question:
    The dilation of the pupil in my left eye which has oil and does not have a lens seems to be un-dilating unevenly. While the mid to lower portion of the eye seems to be returning to its normal perspective, the upper 1/4 is somewhat unchanged. Is this a concern?

    I was happy to see the dilation reducing as it had not done so after my previous operations.

    Thank you,
    Tom

    • Randall V. Wong, M.D. August 12, 2014 at 10:42 am

      Tom,

      There are so many reasons for asymmetric constriction of the pupil, I’d rather not guess and give you bad information.

      Regardless, pupil symmetry is not very “important” when compared to retinal detachment. In my opinion, not much to do.

      Randy

  • Rob August 23, 2014 at 6:37 pm

    1. Had LASIK in March 2013 in both eyes
    2. Had uveitis episode 2 weeks after LASIK in right eye only(left eye is fine throughout all of this)
    3. LASIK company could not figure out what was wrong with me and though it was simple iritis and put me on predforte drops 4 times a day for 2 months and my pressure was fine but blurred vision from uveitis did not go away.
    4. LASIK referred me to Retina specialist. He had me tested for everything – totally healthy and no reason for uveitis to occur just one of those who has it. I actually had a episode in 2009 and 2011 and healed fine from prednisone and duresol. I did No traveling outside US either.
    5. Retina doctor could prescribed prednisone , methotrexate, and duresol. No results.
    6. Starting November 2013 Received a series of steroid injections in eye and no results. Also Had another bad episode in November 2013. Eye is super red.
    7. Feb 2014 my vision was at its best and thought it was going to heal but it seemed like another flare happened causing me to have hardly any sight. Eye starts to be blood shoot more. From this day my vision starts to worsen day by day till Mid March when I can no longer see. Only blurry vision in right eye.
    8. March 30 pressure rose and hurt so much dr prescribed me on high pressure meds. Later that night it got worse. I believe my pressure was up to 40. Met a new glaucoma dr on a Saturday to have my eye tapped to relieve pressure. Glaucoma dr recommended surgery right away to put in Ahmed implant.
    9. April 7 2014 – surgery to have implant took place
    10. April 16 – started feeling bad whelp in right elbow
    11. April 17 – went to local ER bc could not walk and was weak. Elbow bercitis got bigger and they prescribed meds and gave me a shot to alleviate pain.
    12. April 18 – wood up 12am. High pressure in eye was back , pain in elbow still there. Called glaucoma doctor as I felt it may be due to surgery.
    13. I go in in the morning. Have my wife drive as I am in tremendous pain. Cannot walk into office have to use wheel chair. Glaucoma doctor says I need to see primary care right away. They set it up. Primary care says you need to be in Hospital for a week.
    14. During this time the bercitis sack was popped and tested and turned out to be staph.
    15. My retina doctor took advantage of this hospital time and removed my lens , he also took samples and sent in to lab. Hospital doctors completely take me off prednisone and methotrexate
    16. Infectious disease doctor tested me again for everything. Perfectly healthy!!!
    17. Lab samples came back – Coccidiomycosis
    18. Infectious disease dr starts me on oral fluconozale in May for 6 months.
    19. Retina dr injects me in eye few more times since may 2014 with voricanozale and amphotericn b.
    20. Eye is no longer red
    21. Eye starts to heal and look normal.
    22. Pressure drops in July 2014
    23. Doctors feel the implant may be hosting fungus and cycling infection in my eye
    24. August 6 surgery with glaucoma dr to remove implant
    Doctor saw me next day and a week later. Put me on muro 128 , predforte, and diclofenac
    25. Two weeks after surgery my pressure has not increased and I am showing 2+ cells and edema?
    26. Today retina doctor asked me how I feel about surgery to raise my pressure by injecting oil in my eye. This will then allow him to inject voricanozale to my eye. He also says if my pressure is too low to long I can lose it.

    Keep in mind both doctors my retina and glaucoma are also communicating and i have seen other doctors on their staff for other opinions before today.

    Any thoughts on this? I told him I think my eye has been through a lot and may need a rest and maybe the fluconozale just needs the recommended 6 months to kill the fungus. And maybe my pressure will rise in a few weeks.

    Please help. Should I do the vitrectomy oil placement?

    • Randall V. Wong, M.D. August 25, 2014 at 12:50 pm

      Rob,

      I would seriously suggest getting a second opinion from another retina specialist – I really don’t want to add anything to your complex history because I am disadvantaged from not being able to examine you.

      Sorry for not answering.

      Randy

  • Donna T September 12, 2014 at 3:51 am

    Hi, Dr. Thanks so much for this forum, I have learned so much. My son 25 had a retinal detachment in his left eye 3 months ago. His 1st surgery was with gas bubble. It detached again due to scar tissue in the 4th week. He had surgery again with oil and now the Dr. at 10 weeks says he has scar tissue that is tenting. My son sees a spot in his 6:00 position. Dr. says to wait and he will remove scar tissue several weeks from now when it is all done scarring. Does this type of surgery cause addl problems with vision? Does each addl surgery cause more vision loss? We are devastated for his future and need questions answered. I do not like asking questions in front of him because I am so afraid of the answers that he will hear. Thank you

    • Randall V. Wong, M.D. September 21, 2014 at 10:16 pm

      Donna T,

      This type of surgery doesn’t necessarily cause problems, but this recurrent type of retinal detachment can certainly cause problems. Stay close to the doctor. Each time he detaches can jeopardize vision.

      Randy

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