Intraocular Pressure Control and Long-Term Outcomes With the Reservoir Technique: The Wisconsin Silicone Oil Study (Report 2)

<b>Purpose:</b> To evaluate the long-term outcomes of silicone oil (SO) tamponade using the reservoir technique vs standard oil fill technique for complex vitreoretinal surgery. <b>Methods:</b> This retrospective comparative case series evaluated 313 SO tamponade surgeries (230 eyes). In the reservoir technique, the posterior segment is filled with SO. The infusion line is temporarily opened to atmosphere, allowing SO to egress into the line, creating the reservoir. The pressurized air infusion is then reset to 15 mm Hg to maintain a complete SO fill during sclerotomy closure. In the palpation method, SO is introduced without creating a reservoir or moderating infusion pressure, and digital palpation of the globe determines adequate fill. <b>Results:</b> Moderately severe ocular hypertension (intraocular pressure [IOP] ≥ 30 mm Hg) occurred less frequently in the reservoir group (1.6%) compared with the palpation group (9.3%; <i>P</i> = .005). Prolonged ocular hypertension (IOP ≥ 25 mm Hg for ≥ 2 visits) was also less frequent in the reservoir group (2.9% vs 9.1%; <i>P</i> = .02). SO emulsification was less frequent in the reservoir group (2.7% vs 9.4%; <i>P</i> = .04). Eyes in the reservoir group required fewer SO placement surgeries (1.2 vs 1.5 surgeries per eye; <i>P</i> = .01), while final anatomic success rates were similar (reservoir: 80.4%, palpation: 78.2%; <i>P</i> = .5). Visual outcomes were comparable between groups. <b>Conclusions:</b> The reservoir technique for SO tamponade placement reduces the risk of IOP elevation, minimizes the need for reoperation, and decreases SO complications. These findings support the reservoir technique as a reliable and consistent method for SO placement in complex vitreoretinal surgeries.