![]() ![]() Our goal was to determine the silicone oil-retinal configuration after macular hole surgery, and to study the effects of positioning on this relationship. ![]() We used spectral domain OCT (SD-OCT) to study silicone oil tamponade in post-operative macular hole patients. 11, 12 However, these reports do not address how the silicone oil-retinal approximation changed with positioning. The case series available use time domain OCT to show that silicone oil “bridges” across macular holes, or the foveal depression, creating a small pre-foveal fluid filled space between the lowest point of the retinal depression and the silicone oil bubble in all patients studied. The use of optical coherence tomography (OCT) in oil filled eyes after macular hole surgery allows quality images of macular hole morphology and can help monitor post-operative hole closure, 10 but very few studies have focused specifically on the silicone oil-retinal interface. ![]() 5 Presumably, this is because the silicone oil tamponade physically “waterproofs” the macular hole and isolates it from fluid in the vitreous space. Silicone oil, like intraocular gas, likely works by isolating the macular hole from liquid in the vitreous cavity, 9 and evidence supports that a complete oil fill of the vitreous cavity is an important factor in surgical success. Additionally, a report of silicone oil use for re-operations after failed macular hole surgery with gas showed at least anatomical success with hole closure in more than half of cases. 5, 6 Although some evidence suggests that C3F8 gas provides a higher hole closure rate and better final visual acuity, 7 silicone oil may be advantageous due to increased freedom from positioning in patients who are unable, or unwilling, to maintain face-down posture post-operatively or in patients who must travel at altitude post-operatively. 3 While common practice is tamponade with intra-ocular gas and face-down positioning post-operatively, 4 silicone oil tamponade can also be used safely and effectively. 2 One carefully studied component of successful surgery is proper tamponade of the macular hole after vitrectomy. Since the introduction of vitrectomy for macular holes, 1 surgical success rates for hole closure and vision improvement are reported at close to 90%. ![]()
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