Silicone oil tamponade in vitreoretinal surgery and future perspective: a narrative review

PURPOSE: Silicone oil (SO) represents an essential ocular tamponade in complex vitreoretinal surgery, due to its transparency, chemical inertness, and long-term stability. This review aims to describe the current role of SO in vitreoretinal surgery, highlighting its indications, physicochemical characteristics, and the spectrum of associated complications. Special attention is given to the timing of removal and the balance between efficacy and safety. METHODS: We performed a narrative review of PubMed, Scopus and Google Scholar, focusing on indications, physicochemical determinants, complications and removal strategies of SO. The literature search was conducted up to January 2026. Inclusion was limited to English-language clinical and translational studies. RESULTS: Silicone oil provides a reliable long-term internal tamponade and contributes to favorable anatomical outcomes in eyes at high risk of recurrent retinal detachment. However, complications such as emulsification, ocular hypertension, corneal decompensation, cataract formation, and unexplained visual loss remain significant concerns. The risk of these adverse events increases with the duration of tamponade, underscoring the need for timely removal. Many centers plan removal around 3-6 months, tailored to retinal stability, IOP, and anterior SO migration. In selected cases with particularly severe or recurrent pathology, extended tamponade can still offer functional benefits and preserve useful vision. CONCLUSION: Silicone oil continues to play a central role in complex vitreoretinal surgery. Careful patient selection, appropriate choice of oil formulation, meticulous surgical technique, and vigilant follow-up are critical to optimizing outcomes. Future directions should focus on the development of improved SO formulations and surgical strategies to enhance safety, minimize complications, and expand therapeutic indications.