Surgical Guidelines for Pars Plana Vitrectomy with Silicone Oil Insertion

Pre-operative Preparation

The American Academy of Ophthalmology recommends monitored anesthesia care with local anesthetic as the standard approach, though general anesthesia can be used for anxious or claustrophobic patients 1, 2
If general anesthesia is used, the American Society of Anesthesiologists advises avoiding nitrous oxide during at least the last 10 minutes of fluid-air exchange to prevent unpredictable gas fill complications 1

The American Academy of Ophthalmology suggests creating standard 3-port pars plana access using 23-, 25-, or 27-gauge instrumentation 3
The European Society of Retina Specialists recommends performing core vitrectomy to remove the central vitreous gel, and injecting triamcinolone acetonide following core vitrectomy to highlight the posterior vitreous and facilitate visualization 1, 2
The American Academy of Ophthalmology advises inducing complete posterior vitreous detachment by separating the posterior cortical hyaloid from the retinal surface, particularly over the macula, and extending vitreous removal anteriorly to at least the equator with thorough peripheral vitreous shaving 1, 2, 3
The International Council of Ophthalmology recommends performing meticulous intraoperative examination of the peripheral retina for all breaks or tears prior to fluid-air exchange, and applying endolaser or cryotherapy to completely surround all retinal breaks 1, 2, 4
The European Society of Retina Specialists suggests removing epiretinal membranes and internal limiting membrane if present to release all tractional elements from the macula 3
The American Academy of Ophthalmology advises performing complete fluid-air exchange to remove all subretinal and intraocular fluid 1

The American Academy of Ophthalmology recommends closing all sclerotomies meticulously with mattress sutures using long scleral passes to prevent hypotony, and drying and thoroughly checking the sutured wound for leakage 5, 6

The European Society of Retina Specialists warns that insufficient anterior extension of laser/cryotherapy to the ora serrata is a significant risk factor for surgical failure 4
The American Academy of Ophthalmology advises that hypotony from inadequate sclerotomy closure is one of the most common surgical complications, and close follow-up with pressure patching may be sufficient if no other serious adverse signs are present 5, 6