Subconjunctival migration of silicone oil through a Baerveldt pars plana glaucoma implant

Eyewatch adjustable drainage device in vitrectomized eyes with refractory glaucoma

BACKGROUND

To describe the efficacy and safety of the adjustable system eyeWatch in vitrectomized glacomatous eyes.

METHODS

Prospective, non-comparative, small case series of 2 patients who underwent glaucoma drainage device implant with the eyeWatch system. Intraocular pressure, number of medications and early and late complications were evaluated.

RESULTS

None of the operated eyes developed early or late complications. After 1 week post operatively, the IOP raised at 28 mmHg in the first eye and 25 mmHg in the second one. The eyeWatch Pen was used to open and set the device into position 3 (that means implant half opened) After waiting for 30 min, IOP was 15 mmHg and 11 mmHg, respectively. Thirty days after surgery we set the EyeWatch into position 0 (that means implant full opened) even though the IOP was under control. A new IOP measurement was done and we registered that IOP was 14 mmHg and 10 mmHg respectively, and it remained stable after six months of follow up.

CONCLUSION

In conclusion, in our case series the use of eyeWatch adjustable system allows a safe and gradual regulation of the flow during post-operative management also in vitrectomized eyes. Considering the percentage of hypotony related complications in vitrectomized eyes this system is an effective and safe technique to handle glaucoma in post vitreoretinal surgery eyes.

Silicone Oil Migration to the Lateral Rectus Muscle: An Unusual Finding

We report a case of silicone oil migration to the lateral rectus muscle discovered during otherwise uncomplicated strabismus surgery in a patient with multiple previous vitreoretinal surgical interventions. A 58-year-old female underwent strabismus surgery to correct a long-standing sensory exotropia. This patient underwent numerous previous vitreoretinal surgical interventions due to a complex history of retinal detachments with subsequent repairs, including inserting and removing intraocular silicone as an endotamponade. During this procedure, silicone oil cysts were discovered firmly adhered within the substance of the lateral rectus muscle. These cysts were subsequently removed either by rupture or whole excision, and specimens were sent for pathological examination. Microscopy confirmed sections of fat necrosis of the lateral rectus muscle with areas incorporating silicone oil. Following this, a lateral rectus recession and medial rectus resection were performed, and the exotropia was satisfactorily corrected. This report highlights an unusual complication of otherwise unchallenging strabismus surgery. Intraocular silicone oil introduced during vitreoretinal surgical procedures may present as cysts embedded on extraocular muscle, thus presenting a unique finding of strabismus surgery.

Foreign body giant cell reaction to silicone oil presenting as a salmon-patch conjunctival lesion

Purpose

To describe a case of foreign body giant cell reaction to silicone oil that presented as a salmon-patch conjunctival lesion.

Observations

An elderly female with prior retinal surgery and oil tamponade was referred for a salmon-patch lesion in the conjunctiva. Biopsy revealed multiple vacuolations and foreign body giant cells in the substantia propria, consistent with a foreign body reaction to silicone oil.

Conclusion and importance

Silicone oil can elicit an inflammatory reaction in the conjunctiva that could mimic a neoplasm. Excessive leakage of oil into the subconjunctival space should be avoided to prevent this complication.

Trabeculectomy with OloGen versus Mitomycin C for the Treatment of Silicone Oil-Induced Glaucoma

AIM

To compare the intraocular pressure-lowering effect and success rate of trabeculectomy with OloGen to that of trabeculectomy with mitomycin C (MMC) in cases of silicone oil-induced glaucoma.

MATERIALS AND METHODS

Forty eyes of forty patients with elevated intraocular pressure (IOP) after vitrectomy and silicone oil injection (followed by silicone oil removal) were assigned to two groups. Group A included 20 cases who underwent trabeculectomy with OloGen, while group B cases contained 20 cases undergoing trabeculectomy with MMC. The follow-up period was 24 months. Patients enrolled had IOP > 21 mmHg despite being on antiglaucoma medications.

RESULTS

The mean postoperative IOP reduction was lower in group A than in group B at all follow-up visits, but this difference was not statistically significant (p > 0.05). Moreover, group A and B patients were found to be similar as regards the need for postoperative antiglaucoma medications on all follow-up visits. The Kaplan-Meier survival analysis curves for the two groups revealed slightly higher success rates in group B than in group A. However, these differences were not statistically significant for both qualified success (IOP ≤ 21 mmHg with or without antiglaucoma medications) and complete success (IOP ≤ 21 mmHg without antiglaucoma medications). There was no significant difference in the postoperative complication rate between the two groups.

CONCLUSION

OloGen implant lowers IOP to a similar extent as MMC when combined with trabeculectomy for the treatment of silicone oil-induced glaucoma, and with comparable success rates. The rate of postoperative complications is similar for OloGen implantation and MMC.

Silicone oil-associated orbital cellulitis with lipogranulomatous inflammation in the setting of HIV: a management challenge and clinicopathological correlation

A 58-year-old Indian man presented with pain and redness of the left eye (OS) for one day. Patient had undergone silicone oil removal in OS for emulsified oil following vitrectomy and oil tamponade six months ago when he was diagnosed with retinal detachment in both eyes due to HIV retinopathy. Retinal detachment in the right eye (OD) was inoperable and had turned prephthisical at presentation, while his vision in OS was finger counting. Intraocular pressure in OD was 8 mm Hg and unrecordably elevated in OS. Extraocular movements were limited by periorbital oedema and proptosis. Slit-lamp examination revealed corneal haze, cells 2+/flare 1+ with pseudophakia, and attached retina. Histopathology showed lipogranulomatous inflammation, hitherto unreported in association with silicone oil. The index case posed a management challenge since his only functional eye had potentially been compromised by glaucoma and orbital cellulitis with compartment syndrome, against the backdrop of an immunocompromised status.

Migration of Silicone Oil into the Orbit and Eyelid as a Cyst

A 7-year-old female presented with left upper eyelid swelling following pars plana deep vitrectomy and silicone oil injection 1 year before admission. The left upper eyelid had mechanical ptosis and on palpation there was a lobulated mobile mass in the lateral portion of eyelid. Computed topography scan showed multiple isodense masses with silicone oil in vitreous in the eyelid and orbit; histopathology after excisional biopsy proved the silicone oil migration. Silicone oil migration followed by vitrectomy may be due to leakage from the site of initial wounds or vitrectomy ports. It is important to suspect extraocular silicone oil migration in patients who presented with eyelid mass-like lesions with a history of silicone oil injection following pars plana deep vitrectomy.

Extraocular silicone oil migration to orbit and retrolaminar region: case report and systematic review

BACKGROUND

Silicone oil insertion is a common modality in vitreoretinal surgeries. The purpose of this study is to conduct a systematic review to summarize the uncommon complication of extraocular silicone oil migration.

METHODS

Following the PRISMA guidelines, a systematic review of the literature was performed on January 11, 2020, using PubMed and EMBASE with the following terms: "silicone oil," "eye," and "migrat*."

RESULTS

A total of 69 patients-68 patients from 59 articles and one case from our institution-were included in the final analysis. The median age was 54 years (range, 9-92) and 40 patients (57.9%) were men. Orbital migration was reported in 34 patients, and retrolaminar migration (including optic nerve, optic chiasm, suprasellar, subarachnoid space, intraventricular spaces) was reported in 35 patients. Orbital migration group had more aphakics (p = 0.007), implanted glaucoma drainage device (p = 0.005), scleral buckle (p = 0.000), history of trauma-related indications for pars plana vitrectomy (p = 0.000), shorter silicone oil endotamponade time (p = 0.008), more symptomatic (p = 0.000), and requiring surgical intervention (p = 0.000). Retrolaminar migration group had older patients (p = 0.016) and more diabetics (p = 0.041).

CONCLUSION

Systematic review sheds light on plausible risk factors on site of silicone oil migration. Majority of orbital cases are symptomatic and require intervention while retrolaminar cases are incidental and can be managed conservatively. Awareness of this complication can help guide clinicians predict which patients would likely need surgical intervention. Graphical abstract.

Pars plana Ex-Press mini shunt for management of persistent glaucoma in vitrectomized eyes: A novel technique

PURPOSE

To evaluate the safety and efficacy of a novel approach to implant Ex-Press mini shunt via the pars plana under a scleral flap in pseudophakic or aphakic, vitrectomized patients with secondary refractory glaucoma.

METHODS

A prospective interventional case series of three patients with secondary glaucoma after pars plana vitrectomy. Intraocular pressure was not controlled by silicone oil removal, if the patient was siliconized, nor the maximum medical treatment. Ex-Press mini shunt via the pars plana was implanted. We evaluated the control of intraocular pressure and the development of intraoperative and postoperative complications.

RESULTS

During 1-year follow-up, control of intraocular pressure was achieved; 14, 15, and 15 mmHg at the 3 months, and 15, 15, and 16 mmHg at the 6 months in our three cases without antiglaucoma treatment and 16, 16, and 18 with single antiglaucoma medication at 1 year. Blebs were posterior and diffuse. No complications were encountered intraoperatively or postoperatively. Ultrasound biomicroscopy showed suprachoroidal posterior lake of fluid as an additional filtration route without any choroidal or retinal complication.

CONCLUSION

Implantation of Ex-Press mini shunt via the pars plana in aphakic or pseudophakic, vitrectomized eyes is a promising, safe, and effective technique in patients with secondary glaucoma.

Subconjunctival silicone oil complicating strabismus surgery

Purpose: To report a case of an otherwise simple strabismus surgery that became complex due to the presence of extensive subconjunctival silicone oil.

Methods: A 15-year-old boy underwent strabismus surgery for sensory exotropia. He had undergone two prior vitreoretinal surgeries for traumatic endophthalmitis and retinal detachment, respectively. The second procedure involved injection of silicone oil as an endotamponade. During the strabismus surgery, subconjunctival nodules filled with silicone oil were noted. This made the surgery difficult due to episcleral fibrosis. The multiple silicone oil cysts were removed by rupturing or resecting them along with the tenon’s fascia. The extraocular muscles were meticulously isolated and operated using adjustable suture technique.

Results: Following surgery, the strabismus was corrected satisfactorily and the patient was relieved of his ocular discomfort and congestion.

Conclusions: Subconjunctival leakage of silicone oil can lead to capacious inflammation and complicate strabismus surgery manifold.

Massive Silicone Oil Migration into the Subconjunctival Space: A Leakage Mechanism Dilemma

Purpose

To report a case in which an early, massive silicone oil migration into the subconjunctival space occurred in a patient after sutureless vitrectomy with the presence of a previously implanted pars plana glaucoma drainage device.

Case Report

An 80-year-old man presented with neovascular glaucoma secondary to a proliferative diabetic retinopathy in his left eye. After an intracamerular bevacizumab injection and panretinal photocoagulation, a 23-gauge pars plana vitrectomy (PPV) combined with a superotemporal Ahmed pars plana glaucoma valve implantation was performed. Afterwards, the patient underwent a new 23-gauge PPV for a dense vitreous hemorrhage. Intravitreal 1,000 centistokes silicone oil was placed to prevent recurrent intraocular bleeding. No sutures were performed. In the first postoperative month, a massive migration of silicone oil into the 360° subconjunctival space was noted until no intraocular silicone oil was observed.

Conclusions

We discuss the possible leakage mechanisms in this particular case.

Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes

Purpose

To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes.

Materials and Methods

The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception.

Results

The mean follow-up duration was 11.7 ± 5.5 (range, 6–23) months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg (p=0.001) and the mean number of glaucoma medications decreased to 2.3 ± 1.3 (p=0.021). At the last visit, 11 eyes (84.4%) had stable or improved VA and one eye (7.7%) had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%). Postoperative complications were bleb encapsulation (69.2%), early hypotony (38.5%), hyphema (23.1%), decompression retinopathy (23.1%), choroidal detachment (15.4%), intraocular hemorrhage (7.7%), and late endophthalmitis (7.7%). One eye (7.7%) was enucleated because of late endophthalmitis.

Conclusions

Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation.

Echographic Evaluation of a Subconjunctival Cystic Lesion

Migration of intraocular silicone oil, used in the treatment of complicated retinal detachment, has been rarely described, but when it happens it can arise with a differential diagnosis with scleral buckling extrusion, tumor, dermoid, ocular cysticercosis, and abscess. The presence of silicone oil in the eye gives very ugly echographic pictures, but these kinds of pictures can be very useful in making a differential diagnosis in the above-mentioned cases. A 39-year-old white female complained of the presence of conjunctival hyperemia and tearing in the right eye (RE); her visual acuity was hand motion, and the intraocular pressure was 14 mmHg. In the upper nasal quadrant a dome shaped lesion was detected. Due to the lens opacities, the patient underwent an echographic examination, which revealed the presence of silicon oil both in the vitreous chamber and in a large subconjunctival space, corresponding to the lesion. This article in addition provides a possible explanation of such cystic formation and discusses the risk factors and the role of the echographic examination in such cases.

Trabeculectomy Versus Ex-Press Glaucoma Filtration Device in Silicomacrophagocytic Open Angle Glaucoma Secondary to Silicone Oil Emulsification

Purpose:

To compare the outcomes of Ex-PRESS device implantation versus trabeculectomy in patients with ocular hypertension after pars plana vitrectomy and silicone oil injection (SOI).

Materials and Methods:

Twenty-six consecutive eyes with ocular hypertension after pars plana vitrectomy and SOI were included in this study and randomized to one of two groups: A group treated with Ex-PRESS (model P50) placed under a scleral flap (Ex-PRESS group), and a group treated with trabeculectomy (trabeculectomy group). Complete success (intraocular pressure [IOP] <21 mmHg without medication) and qualified success rates (IOP <21 mmHg with one or two glaucoma medications) at 2 years postoperatively were analyzed. Between-groups comparison was performed with the Mann-Whitney U-test for continuous variables, and Fischer exact test for categorical data. Success rates between groups were compared using Kaplan-Meier life analysis and the log-rank test. P < 0.05 was considered statistically significant.

Results:

In the Ex-PRESS group, complete success was achieved in 73% eyes and qualified success in 81.8% of eyes. In the trabeculectomy group, complete success was achieved in 40% and qualified success was achieved in 60% of eyes. The difference in mean IOP between groups was statistically significant from the 3^rd postoperative month onward (P = 0.007 at 3 months, P = 0.003 at 6 months, and P = 0.03 at 24 months).

Conclusion:

Ex-PRESS implantation was more effective than trabeculectomy in controlling IOP in ocular hypertensives after pars plana vitrectomy and SOI, but the surgical technique may require improvement.

Migration of intraocular silicone oil from the vitreous cavity into the upper eyelid causing ptosis

Introduction

To report a case in which intraocular silicone oil migrated into the upper eyelid and caused ptosis.

Methods

A 65-year-old woman presented with proliferative vitreoretinopathy in the right eye. Vitrectomies, injection of silicone oil and encircling were performed. Two months after the last operation, swelling of her right eyelid occurred.

Result

Magnetic resonance imaging revealed moisture in the palpebral fat tissue. We incised the bulbar conjunctiva and confirmed silicone oil leakage from the vitreous cavity through the scleral button hole of the encircling suture. Postoperatively, the right upper eyelid swelling decreased. Histopathologically, dense macrophage infiltration was seen in the palpebral tissues.

Conclusions

We report a rare case with a postoperative complication caused by silicone oil. In cases with swelling of the eyelid and decreased silicon oil in the vitreous cavity postoperatively, clinicians should consider the possibility of silicone oil leakage.

A case involving an Ahmed™ glaucoma valve transferred from the vitreous into the anterior chamber of the eye with a silicone oil tamponade for the treatment of neovascular glaucoma

PURPOSE

To report the short-term efficacy and safety of the transfer of an Ahmed(™) glaucoma valve (AGV™) tube from the vitreous into the anterior chamber, in a patient with neovascular glaucoma who had undergone pars plana AGV(™) implantation and ultimately needed a silicone oil tamponade.

CASE

A 41-year-old male with proliferative diabetic retinopathy in both eyes was referred to us for treatment in December 2009. Although the patient previously underwent several surgeries, he ultimately lost vision in his right eye. His left eye suffered from neovascular glaucoma after undergoing a pars plana vitrectomy for tractional retinal detachment. After several vitreous and glaucoma surgeries, the patient underwent implantation of a pars plana AGV™. Postoperatively, although his intraocular pressure was stabilized at approximately 10 mmHg, he had repeated vitreous hemorrhage and hyphema without improvement. He ultimately underwent PPV with a silicone oil tamponade and at the same time, the AGV™ tube was pulled out from the vitreous and inserted into the anterior chamber in order to avoid complications caused by the silicone oil.

RESULTS

At 19 months postoperative, the patient's intraocular pressure had stabilized at 10 mmHg with no recurrence of vitreous hemorrhage and hyphema. Eventually, he lost vision in his left eye because of cerebral hemorrhage.

CONCLUSION

The findings show that insertion of a pars plana AGV™ tube into the anterior chamber in a patient undergoing a silicone oil tamponade is both effective and safe in the short-term.