Philippe Koch_SCIENTIFIC POSTER 2015

Introduction:

To present the case of a 55 y.o. patient who developed an inadvertent silicone oil injection into the choroidal space during a vitrectomy for RRD and the resultant 5 y.o. follow-up.

Case Presentation:

A patient presented in 2010 with a LE rhegmatogenous retinal detachment extending from 9 to 7 o’clock, macula OFF. The causative break was a huge superior break extending from 10 to 3 o’clock involving the macular area, associated with breaks from 5 to 7 o’clock and a giant macular hole. At presentation, the patient reported floaters and decreased VA since 3 days, and examination reported the presence of hypotony, choroidal detachment, and vitreous haemorrhages. Unfortunately, even with an appropriate management, this giant macular hole did not initially close and the patient developed a PVR C12A associated to peripheral choroidal detachments at the same time 5 weeks after the initial procedure. He thus underwent further surgery to obtain a macular hole closure and maintain the retina in position. This required a superior 180° retinotomy with silicone oil injection and macular hole closed but with a huge central atrophy. However, the patient developed a new retinal detachment following a recurrent superior PVR and thus underwent a new 23G vitrectomy. During the PFCL-Silicone oil exchange, the infusion line moved back from it normal location following an inadvertent movement from my assistant who did not measure the danger of this incident and did not mention anything to me. Being concentrated, I did not notice that my infusion line was not anymore in the vitreous cavity and Silicone oil was injected in the choroidal space until I observed a choroidal detachment progressing per-operatively. Infusion line was thus switched to another trocar and the causative trocar was removed, conjunctiva opened, and sclerotomy enlarged to allow the passive extrusion of silicone oil. Silicone oil was thus injected again from another trocar to increase intraocular pressure in order to remove silicon oil from the choroidal space. PFCL was then completely aspirated from the posterior pole with the flute needle. However, a small layer of presumed persistent silicon oil was left in place in the choroidal space since it was not possible to extrude it. The sclera was sutured and the surgery was terminated. From the following day, the patient presented superiorly a scleral-like indentation due to a small, peripheral, choroidal persistence of silicone oil in the extreme periphery. Since the retina is stabilised without any further PVR development but the eye has a poor visual prognosis and accordingly to patient decision, the silicone oil was left in place in the vitreous cavity and a close surveillance is performed to ensure that the remaining intrachoroidal silicone oil will not lead to complications. Actually, 5 years later, the remaining silicon oil acts as an external buckling, maintaining the retina in place with the assistance of an intravitreal silicon oil tamponade but without any further PVR development. Last MRI did not show any problem in the brain.

In Conclusion:

Like for any other sort of liquid infusion into the choroidal space, Silicone Oil can be extruded through an enlargement of the sclerotomy associated to an increased intra-ocular pressure to flush out the intrachoroidal Oil. A follow-up of 5 years allows us to say that it is not associated  with any side effects.

Contact Details:

Email: drkoch@docteurkoch.be
Cell Phone: +32496104081