Intraocular inflammation following endotamponade with high-density silicone oil

Background: The use of a mixture of silicone oil and partially fluorinated alkanes (high-density silicone oil) has recently been suggested as intraocular tamponade in complicated retinal detachment of the inferior quadrants. We describe a series of patients who developed a clinical picture resembling anterior granulomatous uveitis following endotamponade with high-density silicone oil. Methods: We evaluated 19 eyes of 18 patients who underwent pars plana vitrectomy and intraocular tamponade with high-density silicone oil (Oxane HD(R)). The indication for this type of intraocular tamponade was limited to cases with complicated retinal detachment of the inferior quadrants. Oxane HD was removed after a mean period of 3 months. Results: One to eight weeks following vitrectomy with high-density silicone oil, an intraocular inflammation was observed in 7 of 19 eyes (37%). These eyes presented with keratic precipitates (KP), pigmented clumps in the inferior part of the anterior chamber and increased anterior chamber cellular reaction. This inflammatory response did not react to topical steroids. In addition to KP a considerable amount of cellular precipitation was noted on the surface of the oil bubble. Strikingly, the intraocular inflammatory signs completely resolved following removal of the high-density silicone oil. Conclusions: An inflammatory response, resembling granulomatous uveitis, occurs in a significant number of patients after high-density silicone oil endotamponade. It is likely that this vitreous substitute is an immunogenic agent, given the complete resolution of the inflammation after removal of the high-density silicone oil. The routine use of this newly developed silicone oil should therefore await the outcome of additional controlled clinical trials.