HEAVY VERSUS STANDARD SILICONE OIL TAMPONADE IN PRIMARY RETINAL DETACHMENT SURGERY: A Systematic Review and Meta-Analysis.

Abstract

To compare the anatomical and functional outcomes of heavy silicone oil (HSO) and standard silicone oil (SSO) in primary rhegmatogenous retinal detachment, along with postoperative complications. Meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and registered on PROSPERO (CRD42024507061). We retrieved randomized trials, prospective and retrospective studies comparing HSO and SSO to manage primary inferior/posterior or complex rhegmatogenous retinal detachments published from 2000 to nowadays in PubMed/Medline-Embase-Cochrane-Scholar-Web of Science. This meta-analysis focused on primary success rates, best-corrected visual acuity improvement, and postoperative complications. A total of 6 studies on 984 eyes (615 in SSO and 369 in HSO group) were included. In a fixed-effect model ( P = 0.112, I 2 = 43.99%), HSO and SSO tamponades showed comparable primary anatomic success rates (odds ratios 1.461, 95% confidence interval [CI]: 0.890-2.399, P = 0.134). Average best-corrected visual acuity improvement was similar between the two groups (I 2 = 79.21%, weighted mean difference -0.071 logarithm of the minimum angle of resolution; 95% CI: -0.524 to 0.382, P = 0.61). Conversely, HSO tamponade was associated with higher rates of IOP elevation (I 2 = 37.42%, odds ratios 2.073, 95% CI: 1.182-3.634, P = 0.011) and emulsification (I 2 = 16.43%, odds ratios 2.953, 95% CI: 1.109-7.862, P = 0.030). Finally, inflammation rates did not differ between HSO and SSO (I 2 = 66.46%, odds ratios 2.015, 95% CI: 0.234-17.323, P = 0.523). Heavy silicone oils showed similar rates of primary anatomic success when compared with SSOs in complex primary rhegmatogenous retinal detachments. Although hindered by poor baseline values, visual outcomes were generally comparable among the two groups. In contrast, HSO group showed higher rates of postoperative IOP elevation and emulsification.