Silicone oil droplets in the vitreous after intravitreal injections: review of literature with clinical examples

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Abstract

Currently, intravitreal injections are firmly in the lead as a drug delivery method for treatment of a wide range of eye diseases. With the accumulation of clinical material, knowledge about the complications and side effects of this technique is expanding. One of the undesirable phenomena that has been actively studied recently is the ingress of silicone oil droplets from single-use syringes and needles used to perform the procedure into the vitreous cavity of patients’ eyes. The analysis of the results of original studies on this issue is carried out, and the currently available practical recommendations aimed at reducing the risk of this complication are presented. The article is illustrated with original clinical examples. It can be concluded that the penetration of silicone oil into the eye cavity during intravitreal injections is an urgent problem of modern ophthalmology that requires further investigation and solution.

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About the authors

Evgeniy V. Bobykin

Ural State Medical University

Author for correspondence.
Email: oculist.ev@gmail.com
ORCID iD: 0000-0001-5752-8883
SPIN-code: 2705-1425
Scopus Author ID: 26430475300

MD, PhD, cand. Sci. (Med.), associate professor

Russian Federation, 3 Repin str., Yekaterinburg, 620028

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2. Fig. 1. Schematic representation of a single-use syringe. 1 – zero graduation line; 2 – graduation lines; 3 – line of graduation of the nominal capacity; 4 – line of full graduated capacity; 5 – reference line; 6 – finger flange; 7 – adaptor cap; 8 – adaptor hole; 9 – syringe adaptor; 10 – barrel; 11 – piston; 12 – plunger seal; 13 – plunger; 14 – plunger top. This figure is an illustration of the elements of the assembled syringe. The plunger can be one piece or consist of separate parts, and can also have more than one seal

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3. Fig. 2. Droplets of silicone oil (shown by red arrows) in the vitreous of patient N.: a, c – biomicroscopy; b – two-dimensional ultrasound scanning

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4. Fig. 3. Inclusions in the vitreous of patient Sh.: a, c, е – two-dimensional ultrasound scanning; b, d, f – biomicroscopy

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5. Fig. 4. Different models of single-use syringes: a – U-100 Insulin Syringe, SFM Hospital Products GmbH, volume 1.0 ml, integrated needle 29 G × 12.7 mm; b – syringe with a Luer cone 1.0 ml with a 30 G × 12.7 mm needle; c – silicone oil – free syringe Norm-Ject, Henke-Sass Wolf, 1.0 ml; d – comparison of the volume of “dead space” (highlighted in red) when using different models of syringes and needles [43]

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Copyright (c) 2021 Bobykin E.V.

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