There was a recent article weighing the pros and cons of silicone oil versus intraocular gas tamponade for repair of macular hole.  On one hand is the issue of intraocular gas tamponade, high success rate of hole closure, but the difficulty in maintaining face down positioning for 1 to 3 weeks.  The length of time required for face down positioning would depend upon the surgeon and the gas used.

On the other side of the argument is the usefulness of silicone oil to provide the tamponade.  Closure rates may not be as good as using intraocular gas, but the need for face down positioning may not be so strict.  Silicone oil also requires a second procedure to remove the oil.

Is one better than the other?  I don’t really know.  The use of silicone oil has been reported several times in the past with favorable results.  More recently, there have been reports that face down positioning is not necessary at all.  Even more intriguing is that the practice of peeling the internal limiting membrane during surgery has become more standard over the past several years, that is, there are too many variables to actually compare the gas versus silicone oil.

Peeling of the ILM may actually be the pivotal part of the surgery and, with or without tamponade with either gas or oil, may be the actual reason such high closure rates are being noted.  Perhaps we are just looking at the wrong part of the surgery.

Randall V. Wong, M.D.
www.RetinaEyeDoctor.com ^[1]
Retina Specialist