Silicone oil is a widely used vitreous substitute, particularly in eyes with complex retinal detachments. Although its use can lead to a variety of well-known complications in the anterior segment, including cataract, glaucoma, and keratopathy, silicone oil is generally well tolerated in the posterior segment.45

Several clinicians in Europe have described unexpected central vision loss around the time of silicone oil removal.20,55,113,153 Although such cases are rare, the clinical descriptions have been similar: Patients with macula-sparing retinal detachment undergoing silicone oil tamponade developed deep central scotomata, often around the time of oil removal. Evaluation and work-up, including optical coherence tomography and fluorescein angiography, were unrevealing. In such cases, multifocal ERG demonstrated decreased central visual response, and pattern ERG indicated pathology within the macula as opposed to the optic nerve.20,56

The etiology of this profound central vision loss remains unclear. Possible etiologies include electrolyte shifts within the vitreous cavity at the time of oil removal leading to excitotoxicity within the retina;113,154 intraoperative phototoxicity, especially in cases of combined cataract extraction and oil removal; environmental light phototoxicity during silicone oil tamponade as the result of poor short wavelength filtering by silicone oil;5 and direct retinal toxicity. Other more common causes of vision loss after silicone oil removal, including redetachment, cystoid macular edema, proliferation of epiretinal membranes, and hypotony, are ruled out with dilated fundus examination and OCT.