Surgical management of silicone oil migrated into suprachoroidal space after vitrectomy

AIM: To report a successful surgical management of silicone oil migrated into suprachoroidal space after the repair of the retinal detachment with hemorrhagic choroidal detachment. 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 flat. CONCLUSION: 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 sclerotonny sites. Trans-scleral drainage surgery is an effective method to remove the migrated silicone oil from suprachoroidal space.

A simple technique for suprachoroidal space injection of triamcinolone acetonide in treatment of macular edema

AIM:To introduce a simple resistance controlled suprachoroidal space(SCS)injection technique using a disposable 30-gauge needle connected to a 1 m L syringe and evaluate the effectiveness and applicability of this technique in the treatment of macular edema.METHODS:A total of 20 patients with various types of macular edema were subjected to a resistance controlled SCS injection of triamcinolone acetonide(TA)with a disposable 30-gauge needle connected to a 1 m L syringe.This technique allows the easy and smooth injection of the TA only once the tip of the needle reached the potential SCS which was indicated by the lower resistance on the plunger.The main outcome measures were anterior segment spectral-domain optical coherence tomography(AS-OCT)measurements post-operation immediately and central subfield thickness(CST),best-corrected visual acuity(BCVA),and intraocular pressure(IOP)measurements at 3mo postoperation.RESULTS:AS-OCT examination showed the expansion of the SCS near the injection site immediately after SCS injection.At three months of follow-up,as compared to the baseline,the mean CST was significantly decreased from 535.0±157.24 to 319.55±127.30μm(P<0.001),the mean BCVA was significantly improved from 1.05±0.41 to 0.73±0.41 log MAR(P<0.001),and the mean IOP was not significantly different,from 15.05±2.54 to 15.85±3.60 mm Hg(P=0.185).Any complication related to the injection procedure including cataract,choroidal and retinal hemorrhage,retinal detachment,or endophthalmitis was not observed in this study.CONCLUSION:The simple and minimally invasive technique of SCS injection of TA with a disposable 30-gauge needle connected to a 1 m L syringe is useful and applicable for macular edema.

Suprachoroidal injection of ketorolac tromethamine does not cause retinal damage

Rabbit right eyes were injected with 3 or 6 mg ketorolac tromethamine into the suprachoroidal space. Electroretinography results demonstrated no abnormal changes in rod cell response, maximum rod cell or cone cell mixing reaction, oscillation potential, cone cell response, waveform, amplitude, and potential of 30 Hz scintillation response in right eyes before injection, and at 1,2, and 4 weeks after injection. There was no difference between left （control） and right eyes. Under light microscopy, the histomorphology of cells in each retinal layer was normal at 4 weeks following 6 mg ketorolac tromethamine administration. These results indicate that a single suprachoroidal injection of 3 or 6 mg ketorolac tromethamine into rabbits was safe. Suprachoroidal space injection appears to be safe.