Silicon Oil Bubble in AC
A 48 year old male with uncontrolled diabetes mellitus presented with DOV in the left eye. On fundus examination, patient had a Tractional RD with Vitreous Haemorrhage in OS. Patient was planned for Phaco+IOL+Vitrectomy+Endolaser+ Silicon Oil injection.
This is his postoperative picture
Silicone oil in the anterior chamber (AC) is a complication that can arise after vitreoretinal surgery, especially when using silicone oil tamponade for retinal detachment
It can lead to various complications, including corneal damage, increased IOP, and pupillary block glaucoma.
Causes and Mechanisms:
Migration:
Silicone oil can migrate from the vitreous cavity into the AC, particularly in aphakic or pseudophakic eyes, especially when there is poor posterior capsule or zonular support.
Iatrogenic:
Trauma, high myopia, or surgical manipulations (like vitrectomy) can weaken the zonules, making it easier for oil to enter the AC
Pupillary Block:
Increased aqueous humor in the posterior chamber can push the silicone oil forward through the pupil, blocking the outflow of aqueous and causing pupillary block
Emulsification:
Silicone oil can break down into smaller droplets, which can then infiltrate the trabecular meshwork and obstruct aqueous outflow
COMPLICATIONS:
-Corneal Endothelial Damage: Leads to edema and band keratopathy
-Glaucoma: Causes elevated IOP by obstructing the trabecular meshwork or through pupillary block.
-Cataract Formation: In phakic eyes, it can contribute to cataract development.
-Inflammation
-Refractive Changes: Causes hyperopia in phakic eyes and myopia in aphakic eyes.
MANAGEMENT:
-Observation: In some cases, if the oil is minimal and not causing significant problems, close monitoring may be sufficient.
-AC wash
-Inferior iridotomy: to prevent pupillary block
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Image from Rajan Eye Care Hospital
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