46 I RETINA TODAY I OCTOBER 2011 RETINA SURGERY SURGICAL UPDATES SECTION CO-EDITORS: ROHIT ROSS LAKHANPAL, MD; AND THOMAS ALBINI, MD A print & video series from the Vit-Buckle Society S uccessful surgical management of complex reti- nal detachment often requires the use of long- acting intraocular tamponades to achieve anatomical success. Choice of endotamponade varies depending on the extent and location of the detachment as well as other factors such as ability of the patient to maintain postoperative positioning. Silicone oil has been widely used for many years with good success as an endotamponade for retinal detach- ment. 1 Silicone oil is considered to be a safe long-term endotamponade, although some recent studies using more modern imaging techniques including optical coherence tomography suggest that the use of silicone oil may have a long-term effect on retinal thinning. 2 Despite this, there are some cases with significant inferior pathology including giant retinal tears or signifi- cant proliferative vitreoretinopathy (PVR) where use of silicone oil may be necessary to achieve long-term endotamponade. One must take special care to ensure a silicone-oil fill that is as complete as possible. This is sometimes difficult to achieve because a complete infu- sion of silicone-oil mist be balanced with other consid- erations including final postoperative intraocular pres- sure which can be elevated in cases of overfill, as well as anterior migration of silicone oil into the anterior cham- ber in cases where the eye is overfilled. Underfilling the eye with silicone oil, on the other hand, is also problematic since this leads to failure of tamponade of inferior pathology and subsequent re- detachment of the retina. For this reason, use of “heavy” silicone oils including Densiron 68 (Fluoron, Ulm, Germany), 3 F 6 H 8 (Fluoron), 4 and Oxane HD (Bausch + Lomb, Rochester, NY) 5 are being investigated as alterna- tives. Some studies have even advocated the very short term use of perfluorocarbon heavy liquid despite con- cerns of intraocular toxicity. 6 In cases where inferior redetachment occurs in a patient already with silicone oil, few options remain. It is important to first ensure that the reason for redetach- ment is not a result of tractional forces including forma- tion of PVR. In these cases, it may be necessary to place a scleral buckle for inferior support of the detachment and also to remove tractional membranes with vitrecto- my techniques. To achieve this, it is often necessary to remove the existing silicone oil and proceed with mem- The Silicone Sandwich Technique BY MARK S. MANDELCORN, MD FRSCS; EFREM D. MANDELCORN, MD FRCSC; ANDRES EMANUELLI, MD; AND THOMAS A. ALBINI, MD Figure 1. The top piece of bread represents silicone oil in the anterior chamber, the bottom piece of bread represents sili- cone oil in the vitreous, and the air is the filling between the 2 locations of oil. Figure 2. As the air bubble gets larger, silicone oil is pushed posteriorly keeping the retina attached and at the same time, the silicone oil is prevented from migrating anteriorly. 1011RT_VBS_Mandelcorn.qxd 10/18/11 11:15 AM Page 46