Surgical Technique
Williams
An Elementary and Effective Method for Silicone
Oil Removal
O f the myriad of techniques to remove silicone oil
from the vitreous cavity, there is one common
goal of the procedure: to remove the tamponade as
completely as possible while avoiding complications.1
Secondary aims include time efficiency, surgical sim-
plicity, and material availability.
To our knowledge, the following method of silicone
oil removal has not been previously described in the
literature. The principle is based on creating suction in
a 60-mL syringe and using the resultant vacuum to
aspirate silicone oil.
Surgical Technique
We open the eye for a 20-gauge, 2-port pars plana
vitrectomy in a standard fashion. The apparatus is
constructed using parts from a 60-mL syringe, 10-mL
syringe, 20-gauge angiocatheter, and 3-way stopcock
(Figure 1). The end of a 20-gauge angiocatheter
(Smiths Medical ASD, Inc., Southington, CT) is cut
on a shallow bevel to 15 mm to 20 mm. The length
should be adjusted so that the tip is visualized through
the pupil and a segment of the proximal end can be
visualized outside of the eye. The angiocatheter is
attached to the tip of a 60-mL syringe (Tyco Health-
group LP, Mansfield, MA) through a 3-way stopcock
with a capped side port (B. Braun Medical Inc., Be-
thlehem, PA) (Figure 2A). With the stopcock turned
off toward the syringe or angiocatheter, drawing
back on the 60-mL plunger creates a vacuum of 760
mmHg. Suction is maintained by inserting the shaft of
the 10-mL plunger with the rubber toward the eye
inside the shaft of the 60-mL plunger (Figure 2B). An
assistant may be useful for this step.
Fluid is infused at normal pressure (30 cm). The
angiocatheter is inserted bevel-up through the pars plana
being sure to visualize the tip through the pupil at all
times (Figure 3). To begin aspiration, turn the stopcock
off toward the side port. It is important to always
From the Retina Division, Jules Stein Eye Institute, Department
of Ophthalmology, David Geffen School of Medicine, University
of California, Los Angeles, California.
None of the authors have relevant financial or proprietary
disclosures.
Reprint requests: Jean-Pierre Hubschman, MD, 100 Stein Plaza,
Los Angeles, CA 90095; e-mail: hubschman@jsei.ucla.edu
524
Edited by George A.
maintain the tip inside the silicone oil bubble and away
from the retina, the posterior capsule, and out of the fluid
interface, because the eye will collapse otherwise. The
tip is quickly pulled out of the eye in a controlled manner
or the stopcock is turned off as the bubble disappears.
To wash away silicone oil droplets lodged in the
ciliary body, a partial airfluid exchange is performed
while keeping the tip of the 20-gauge cannula at the
airfluid interface. The approximate duration of 5,000
centistokes silicone oil removal is 5 minutes; 1,000 cen-
tistokes silicone oil removal is 1 minute. At the end of
the case, we check the peripheral retina with the AVI
(Advanced Visual Instruments, Inc., New York, NY)
visualization system and, if needed, we open a third
sclerotomy to peel epiretinal membranes when present.
Comments
The method of silicone oil removal is largely based
on surgeon preference, because there are many equiv-
alent ways to achieve the same surgical purpose. We
prefer this procedure because it is fast, uncomplicated,
adaptable, available in any operating room, and inex-
pensive. The total price of the 4 pieces that comprise
our device is $2.48 (10-mL syringe $0.09, 60-mL
syringe $0.40, 3-way stopcock $0.37, and 20-gauge
angiocatheter $1.62).
The same technique can be used for 1,000 or 5,000
centistokes silicone oil removal with aphakia, pseu-
dophakia, or phakia. It has been performed in 100
cases by a single surgeon, during a 10-year period,
without any complications. There have been no inci-
dents of incarcerated ocular tissue.
Although our device is unique, its components
have been used in different contexts for silicone oil
removal, which highlights their advantages.2,3 Im-
monen et al2 described the use of a 20-gauge an-
giocatheter with a general surgery vacuum kit to
remove silicone oil. We also prefer the angiocath-
eter tip because it is flexible, available in any op-
erating room, and easily moveable inside the eye,
which helps maintain the tip inside the silicone oil
bubble. Beveling the tip at a shallow angle allows
better visualization and control of the silicone oil
vortex. Another benefit of the angiocatheter is its
 SURGICAL TECHNIQUE 525

Fig. 1. Materials needed (left to right): 1) 60-mL syringe and plunger;

Fig. 3. Intraoperative photograph showing the beveled tip of a 20-
2) 10-mL plunger; 3) 20-gauge angiocatheter; and 4) 3-way stopcock.
gauge catheter, visualized through the pupil, within the silicone oil
bubble (a portion of the angiocatheter can be seen outside).

transparency, which allows for improved visualiza-

tion of the silicone oil extraction and helps to de-
termine when to pull out of the eye (Figure 3).
Gopal et al3 described silicone oil removal by gen-
erating a vacuum with a 50-mL syringe in combina-
tion with a control valve and metal cannula. We
believe that their complex control valve has the dis-
advantage of longer surgical time, increased cost, and
may not be available in all operating rooms.
In our method, the vacuum created is maximized by
eliminating small-bore tubing, which exponentially
affects pressure by the Bernoulli principle. We mea-
sured a vacuum of 760 mmHg at the tip of the
catheter. In comparison, an Accurus vitrectomy con-
sole (Alcon, Fort Worth, TX) has a maximum aspira-
tion of 600 mmHg at the machine, which is greatly
reduced by the connection tubing.
In summary, we describe an elementary and effec-
tive method of silicone oil removal, which requires
minimal equipment (Figure 1). Another advantage is
the extremely high vacuum created, which decreases
operating time; however, in learning the technique,
care must be taken to control the suction by constantly

Fig. 2. Constructed apparatus (A) without and (B) with the 10-mL plunger in place (white arrow), which maintains suction.
526 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES 2010 VOLUME 30 NUMBER 3

maintaining the angiocatheter tip within the silicone References

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Key words: cost-efficacy, silicone oil removal, vit- Ophthlamol 2000;15:99 91.
reoretinal surgery. 2. Immonen I, Vuorinen R, Tommila P. A simple and inexpensive
technique for the removal of silicone oil through 20-gauge
IRENA TSUI, MD cannula. Retina 1995;15:263264.
SHANTAN REDDY, MD, MPH 3. Gopal L, Mehta S. Silicone oil removal: a simple technique.
JEAN-PIERRE HUBSCHMAN, MD Retina 1997;17:266 267.