Effect of silicone oil removal timing on functional and structural outcomes in primary rhegmatogenous retinal detachment

PURPOSE: To compare anatomical and functional outcomes following early (2 months) versus delayed (6 months) silicone oil (SO) removal after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). METHODS: This prospective, randomized, single-center study included 66 eyes with primary macula off RRD and proliferative vitreoretinopathy grade ≤ B. Patients were randomized into two groups: Group A (early SO removal, 2 months) and Group B (delayed SO removal, 6 months). All surgeries were standardized, and postoperative evaluations included corrected distance visual acuity (CDVA), microperimetry, and optical coherence tomography angiography (OCTA) one month after SO removal. Primary outcomes were functional (CDVA, retinal sensitivity) and anatomical (reattachment rate, OCTA parameters) comparisons between groups. RESULTS: At one month post-SO removal, both groups achieved similar primary and final retinal reattachment rates (P = 0.237). Mean CDVA did not differ significantly between groups (0.83 ± 0.26 vs. 0.91 ± 0.29 logMAR, P = 0.147). Microperimetry showed significantly higher retinal sensitivities in Group A across the outer (P < 0.001), middle (P = 0.013), and overall macular areas (P = 0.029). OCTA parameters, including vessel densities and choroidal flow area, were comparable (all P > 0.05). No cases of silicone oil–related visual loss were observed, and postoperative complications were infrequent and similar between groups. CONCLUSIONS: Early SO removal resulted in superior microperimetric retinal sensitivity without compromising anatomical success or increasing postoperative complications. Although CDVA was similar, microperimetry provided additional insight into visual function, underscoring its value in postoperative assessment following PPV for RRD.