Silicone oil vs. gas tamponade in giant retinal tear associated rhegmatogenous retinal detachment: a systematic review and meta-analysis.

PURPOSE: To compare anatomical, visual, and safety outcomes of silicone oil (SO) versus gas tamponade in the surgical management of giant retinal tear (GRT)-associated rhegmatogenous retinal detachment (RRD).

METHODS

We conducted a PRISMA-compliant systematic review and meta-analysis with protocol registration in PROSPERO (CRD420251207629). We searched PubMed, Scopus, CENTRAL, Web of Science, and Google Scholar and included studies comparing SO and gas tamponade in GRT-associated retinal detachment with at least 10 eyes per group. We pooled data using random-effects models and reported risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). We assessed risk of bias using RoB 2, NOS, or JBI tools, and evaluated certainty of evidence using GRADE. The primary outcome was anatomical success, assessed as primary and final anatomical success. Secondary outcomes included visual acuity and postoperative complications.

RESULTS

Nine studies comprising 619 eyes with GRT-associated RRD were included. Final anatomical success was high and comparable between silicone oil and gas tamponade groups (RR = 1.00; 95% CI, 0.96-1.03; I² = 0%). Primary anatomical success also did not differ significantly between groups (RR = 1.08; 95% CI, 0.98-1.20; P = 0.14; I² = 49%). Most studies reported postoperative visual improvement regardless of tamponade type, while several studies suggested better final visual outcomes with gas tamponade, particularly in macula-on detachments. No significant differences were observed in postoperative complications. Overall certainty of evidence ranged from low to very low.

CONCLUSION

SO and gas tamponade achieved comparable anatomical success in GRT-associated retinal detachment. However, gas tamponade may be associated with better visual outcomes without an increased risk of postoperative complications.