Surgical management of silicone oil migrated into suprachoroidal space after vitrectomy.
ABSTRACT To report a successful surgical management of silicone oil migrated into suprachoroidal space after the repair of the retinal detachment with hemorrhagic choroidal detachment.
Retrospective observational case report. A 30-year-old man with retinal detachment and hemorrhagic choroidal detachment due to severe corneal penetrating injury, underwent a pars plana lensectomy and vitrectomy, endolaser, and silicone oil tamponade followed by transscleral suprachoroidal hemorrhage drainage in the right eye. One week later, a localised temporal choroid elevation was noted. This persistent elevation was confirmed by operation research to be silicone oil migration into suprachoroidal space.
The migrated silicone oil was drained via trans-scleral cut down, and the intravitreal silicone oil was removed and replaced by 16% C2F6. Over the next 2 weeks, the elevation vanished and the choroid became completely flat.
The migration of silicone oil into suprachoroidal space is a rare complication of vitrectomy. The pathway of the migration is most likely through internal orifice of sclerotomy sites. Trans-scleral drainage surgery is an effective method to remove the migrated silicone oil from suprachoroidal space.
- Retina (Philadelphia, Pa.) 05/2013; · 2.93 Impact Factor
窑 Case Report 窑
Surgical management of silicone oil migrated into
suprachoroidal space after vitrectomy
Eye Hospital of Wenzhou Medical College, Wenzhou 325027,
Zhejiang Province, China
Correspondence to: Zong-Duan Zhang. Eye Hospital of Wenzhou
Medical College, Wenzhou 325027, Zhejiang Province, China.
·AIM: To report a successful surgical management of
silicone oil migrated into suprachoroidal space after the repair
·METHODS: Retrospective observational case report. A
30-year-old man with retinal detachment and hemorrhagic
choroidal detachment due to severe corneal penetrating
injury, underwent a pars plana lensectomy and vitrectomy,
endolaser, and silicone oil tamponade followed by transscleral
suprachoroidal hemorrhage drainage in the right eye. One
week later, a localised temporal choroid elevation was noted.
This persistent elevation was confirmed by operation research
to be silicone oil migration into suprachoroidal space.
·RESULTS: The migrated silicone oil was drained via
trans-scleral cut down, and the intravitreal silicone oil was
removed and replaced by 16% C2F6. Over the next 2 weeks,
the elevation vanished and the choroid became completely
suprachoroidal space is a rare complication of vitrectomy. The
pathway of the migration is most likely through internal
orifice of sclerotomy sites. Trans-scleral drainage surgery is
an effective method to remove the migrated silicone oil from
·KEYWORDS: silicone oil; migration; suprachoroidal space;
Zhang ZD, Shen LJ, Zheng B, Qu J. Surgical management of silicone
oil migrated into suprachoroidal space after vitrectomy.
tamponade for retinal detachment surgery since the
1960s. Rare complications of silicone oil migration, such as
migration into lateral ventricles of the brain, subconjunctival
space and orbit, eyelid, subretinal space, and subarachnoid
space have been sporadically reported in the literature[1-7].We
describe a successful surgical management of an unusual
complication of intravitreal silicone oil migrated into
suprachoroidal space after the repair of a retinal detachment
with hemorrhagic choroidal detachment.
A 30-year-old man had undergone an emergency primary
corneal repair and removal of the intraocular foreign body at
a local hospital because of an iron foreign body penetrating
his right eye. Eleven days after surgery, the patient
complained of constant pain, poor vision and a gritty
sensation in the right eye, and then was referred to our
hospital on Dec. 14th, 2008. Upon initial examination, his
right eye visual acuity was light perception. Slitlamp
examination revealed conjunctival congestion, a sutured
swollen corneal wound with the knots exposed and a
defected iris at inferotemporal quadrant, and a ruptured lens
with a formation cataract of the right eye (Figure 1A). The
fundus could not be clearly viewed, the intraocular pressure
hemorrhagic choroidal detachment was detected by B-scan
ultrasonic tomography (Figure 1B).
The patient received surgical repair of the right retinal
detachment, which included corneal suture adjustment, a
pars plana lensectomy and vitrectomy after suprachoroidal
hemorrhage drainage though the same three-port pars plana
incisions, flattening the retina by perfluorocarbon liquid,
argon laser endophotocoagulation, gas-fluid exchange and
5.5mL silicone oil(5000 centistokes, Chiron Adatomed,
Heidelberg, Germany) tamponade. The oil was slowly
injected manually through the superotemporal sclerotomy by
a long infusion cannula under visualization, and the IOP was
maintained at 15mmHg with the air pump. Intraoperative
hemorrhage, vitreous hemorrhage, a total retinal detachment,
ilicone oil has been commonly used to prolong
Silicone oil migration after vitrectomy
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a non-hole choroidea and ciliary body, and two 1/4 papilla
diameter size retinal breaks at 9 o'clock equator. At the time
of postoperative examination, the retina and the choroid
were attached, the IOP ranged from 11 to 22mmHg. One
week after the operation, a localised choroidal elevation at
the temporal mid-periphery was found. Because the retina
attached, the breaks sealed and the oil level retained, the
possibility of recurrent suprachoroidal hemorrhage was
considered initially. However, the localised elevation slightly
progressed over the next 2 weeks, and developed a persistent
and nonassimilable elevation with normal range of IOP and
visual acuity of 20/1000 during this postoperative period.
Six months after the second surgery, the operation of the oil
remove and the fundus explore was performed. After the
intravitreal oil was removed, the intraoperative exploration
of the fundus revealed an attached retina with the normal
optic disc, slight retinal pucker from the macula to the sealed
retinal breaks, and the remaining local choroidal elevation
approximate 0.5mL silicone oil was drained from the
temporal suprachoroidal space (Figure 1D). The silicone oil
diagnosed. A gas-fluid exchange and scleral incisions
suturing followed, 16% hexafluoroethane
injected for short-term tamponade. Two weeks later the right
eye choroidal elevation vanished, the choroid became
completely flat (Figure 1E), the IOP was normal, and the
bare visual acuity was 20/400. During the two-year
follow-up examination, the right eye was quiet and vision
remained stable, and no complications were found.
With the extensively use of silicone oil for repair of complex
retinal detachment in recent years, as rare complications of
silicone oil migration may be more reported in the literature.
Firstly, silicone oil may migrate out of the eye globe, such as
through a glaucoma valve and into the subconjunctival
space, the orbit and the eyelid
portion of the optic nerve and into the lateral ventricles of
the brain[1,4,6]. Secondly, silicone oil may also migrate into the
other intraocular tissue space out of the vitreous cavity, such
as leakage into the anterior chamber of the pseudophakic
eye, the optic nerve retrolaminar space,the subretinal
space and the subarachnoid space.
Silicone oil migration into the suprachoroidal space is an
unusual complication of vitrectomy. To our knowledge,
there have been two papers that each report two cases of
suprachoroidal silicone oil in the literature. Patel
reported two cases of suprachoroidal silicone oil without
further surgery to remove the migrated oil. Gopal
[2,3], and along the intracranial
Figure 1 A: Slitlamp photogragh of the right eye to demonstrate the sutured swollen corneal wound and a ruptured lens with cataract
formation; B: B-scan ultrasonic tomography of the retinal detachment and hemorrhagic choroidal detachment; C: Surgery video showing the
remaining local choroidal elevation; D: The silicone oil drained from the temporal suprachoroidal space through the scleral incision 2.0mm
from the superotemporal sclerotomy; E: Fundus photogragh: the choroidal elevation had vanished, and the choroid became completely flat
described two cases with suprachoroidal migration of
silicone oil and perfluorocarbon liquid
significantly large choroidal holes following ocular trauma
or progressive fibrosis exerting traction. One case, Silicone
oil and PFCL trapped in the suprachoroidal space were
drained externally using a relatively posteriorly placed
sclerotomy. The vitreous cavity was reinjected with silicone
oil, which silicone oil has not been removed because the eye
is still soft. Another case, although was exchanged with
PFCL, silicone oil also entered this space. Four months later,
the silicone oil was seen extending into the pocket of
Our case is the first case of silicone oil migrated into the
suprachoroidal space without retinal defect and was
successful surgical removal. In
suprachoroidal hemorrhage was drained through pars plana
incisions. The same sclerotomies that possibly widened the
internal opening due to performing the vitrectomy, were only
sutured the sclera layer. Thus, the unsealed internal orifice of
the sclerotomy sites, the pars plana ciliary incisions, was
most likely a pathway for migration silicone oil from the
vitreous cavity to the opening suprachoroidal space.
Although the oil was slowly injected superotemporally by a
long infusion cannula under visualization in our case, the oil
seems also possibly entered the suprachoroidal during the
injection process. Regardless of how it happened, the
successful management result shows that the external
approach of trans-scleral drainage surgery is an effective
method to remove the migrated silicone oil from the
1 Eller AW, Friberg TR, Mah F. Migration of silicone oil into the brain: a
complication of intraocular silicone oil for retinal tamponade.
2 Nazemi PP, Chong LP, Varma R, Burnstine MA. Migration of intraocular silicone
oil into the subconjunctival space and orbit through an Ahmed glaucoma valve.
3 Quintyn JC,Genevois O, Ranty ML, Retout A. Silicone oil migration in the eyelid
after vitrectomy for retinal detachment.
4 Yu JT, Apte RS. A case of intravitreal silicone oil migration to the central
5 Kuhn F, Kover F, Szabo I, Mester V. Intracranial migration of silicone oil from an
eye with optic pit.
6 Dong FT, Dai RP, Zheng L, Yu WH. Migration of intraocular silicone into the
7 Dithmar S, Schuett F, Voelcker HE, Holz FG. Delayed sequential occurrence of
perfluorodecalin and silicone oil in the subretinal space following retinal
detachment surgery in the presence of an optic disc pit.
8 Wenkel H, Nauman GO. Retrolaminar infiltration of optic nerve with intraocular
tamponade following silicone oil instillation.
9 Patel AK, Zambarakji HJ, Charteris DG, Sullivan PM. Suprachoroidal silicone
oil: recognition and possible mechanisms.
10 Gopal L, Mittal N, Verma A. Suprachoroidal collection of internal tamponading
agents through a choroidal hole.
Silicone oil migration after vitrectomy