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Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study

Lookup NU author(s): Nik Tzoumas, Professor David SteelORCiD, Roxane Hillier



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 American Academy of OphthalmologyPurpose: To establish whether Densiron 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment (RD) surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy (PVR). Design: Cohort study of routinely collected data from the European Society of Retina Specialists and British and Eire Association of Vitreoretinal Surgeons vitreoretinal database between 2015 and 2022. Participants: All consecutive eyes that underwent primary rhegmatogenous RD surgery using Densiron 68 or light silicone oil as an internal tamponade agent. Methods: To minimize confounding bias, we undertook 2:1 nearest-neighbor matching on inferior breaks, large inferior rhegmatogenous RDs, PVR, and, for visual analyses, baseline visual acuity (VA) between treatment groups. We fit regression models including prognostically relevant covariates, treatment–covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals (CIs) using bias-corrected cluster bootstrapping with 9999 replications. Main Outcome Measures: Presence of a fully attached retina and VA at least 2 months after oil removal. Results: Of 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomic and visual outcome analyses, respectively. The primary success rate was higher in the Densiron 68 group (113 of 142; 80%) compared with the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI, 1.63–2.23, P < 0.001). We also observed a significant improvement favoring Densiron 68 of –0.26 logarithm of the minimum angle of resolution (logMAR) in postoperative VA between the 2 groups (95% CI, –0.43 to –0.10, P = 0.002). The anatomic benefit of using Densiron 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with PVR grade C. We found no evidence of visual effect moderation by anatomic outcome or foveal attachment. Conclusions: Densiron achieved higher anatomic success rates and improved visual outcomes compared with conventional light silicone oil in eyes with inferior retinal pathology and severe PVR. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Publication metadata

Author(s): Tzoumas N, Yorston D, Laidlaw DAH, Williamson TH, Steel DH, Ellabban AA, Chandra A, Davies A, Morris AHC, Meireles A, Casswell AG, Jalil A, Babar A, Groenewald C, Goldsmith C, Vayalambrone D, Sanchez-Chicharro D, Hughes EH, Herbert EN, Uys E, Jenkins H, Pearce IA, Masri I, Khan I, Mitrut I, Paget J, Park J, Smith J, Gonzalez-Lopez JJ, Balaggan KS, Cornish KS, Wakely L, Membrey L, Figueroa MS, Crama N, Chua PY, Sheard R, Hillier R, Cherubini SDS, Tan SZ, Tarafdar S, Winder S, Cochrane T, Ivanova T, Papastavrou VT, Tanner V, Forsaa V, Le Mer Y

Publication type: Article

Publication status: Published

Journal: Ophthalmology

Year: 2024

Pages: epub ahead of print

Online publication date: 15/12/2023

Acceptance date: 11/12/2023

Date deposited: 05/03/2024

ISSN (print): 0161-6420

ISSN (electronic): 1549-4713

Publisher: Elsevier Inc.


DOI: 10.1016/j.ophtha.2023.12.016

PubMed id: 38104666


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