Visual outcomes of silicone oil versus gas tamponade for macular hole surgery

Purpose. To determine the effectiveness of silicone oil versus gas tamponade to treat macular holes. Methods. A retrospective review of patients who underwent macular hole repair with either silicone oil or gas tamponade. Results. Data collected from 66 eyes from a retina only practice (Retina and Vitreous of Texas) were reviewed to assess visual outcomes of surgery with silicone oil versus 14% C3F8 gas tamponade. 21 eyes were non-randomized to silicone oil tamponade and 45 eyes underwent gas tamponade. The average overall follow-up time was 11.8 months. Stage 2 holes constituted 9% of the holes; stage 3 and 4 made up 75%; recurrent holes were 11%; and 5% were traumatic holes. Of the macular holes not treated previously, 81.3% (13 of 16) were sealed successfully with silicone oil tamponade while 83.7% (36 of 43) of the gas-treated eyes were sealed. The overall primary closure rate was 83.1% (49 of 59). The pre-operative decimal visual acuity was 0.104 (20/192) for the silicone oil group and 0.193 (20/104) for the gas-treated group. The post-operative decimal visual acuity at 1 year was 0.208 (20/96) for the silicone oil group and 0.453 (20/44) for the gas-treated group. The reopening rate for the silicone oil group was 14% (3 of 21) and 9% (4 of 45) for the gas-treated group. The need for cataract surgery post macular hole repair was 36% (4 of 11 phakic patients) for the silicone oil group and 61% (17 of 28 phakic patients) for the gas-treated group. Conclusions. With short-term follow-up silicone oil tamponade and gas tamponade are both: successful in anatomic closure of macular holes. In eye with macular holes surgically repaired with gas tamponade significant improvements in visual acuity are seen more frequently than eyes treated with silicone oil tamponade. Toxicity of silicone oil to the retinal pigment epithelium and/or photoreceptors may play a role in these results.