Year : 2003 | Volume
: 51 | Issue : 2 | Page : 178--80
Droplets on posterior surface of intraocular lens in silicone oil filled eye.
Y Sharma, R Sudan, A Gaur
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi
Silicone oil adherence to silicone IOLs after silicone oil removal is a known complication in pseudophakic patients. Droplet removal is difficult and may require IOL exchange. We describe two cases in which silicone oil droplets were observed early in the postoperative period in PMMA pseudophakic eyes and disappeared during silicone oil-fluid exchange--a phenomenon that has not been reported earlier in human PMMA pseudophakic eyes.
|How to cite this article:|
Sharma Y, Sudan R, Gaur A. Droplets on posterior surface of intraocular lens in silicone oil filled eye. Indian J Ophthalmol 2003;51:178-80
|How to cite this URL:|
Sharma Y, Sudan R, Gaur A. Droplets on posterior surface of intraocular lens in silicone oil filled eye. Indian J Ophthalmol [serial online] 2003 [cited 2020 Oct 1 ];51:178-80
Available from: http://www.ijo.in/text.asp?2003/51/2/178/14708
Patients who undergo cataract extraction and intraocular lens (IOL) implantation may also require vitreoretinal surgery. Presently acrylic or polymethyl methacrylate (PMMA) IOLs are preferred over silicone IOLs for patients at high risk of undergoing vitreoretinal procedures, because of the possible need for use of silicone oil. Several reports describe silicone oil adherence to silicone IOLs after silicone oil removal (silicone-fluid exchange).,, Adherent silicone oil, besides hindering the surgeon's view of the retina, may also interfere with the patient's visual acuity. Removal of adherent oil droplets is difficult and radical methods like intraocular lens exchange may be required., Recently some techniques have been reported to effectively remove the silicone oil from IOLs in vivo ., In vitro and in vivo studies have shown the adhesion is strongest in case of silicone IOLs, while it is less adherent and easily removable from acrylic and PMMA IOLs.,
We observed droplet formation on the posterior surface of a PMMA IOL, in two patients who had undergone vitreoretinal surgery with silicone oil injection. These droplets were observed early in the postoperative period and persisted for 3 months. This phenomenon differs from the adhesion of silicone oil to the posterior surface of IOLs seen after silicone oil-fluid exchange.
A 60-year-old man presented with diminished vision in left eye in January 2001. Following a detailed eye examination he was diagnosed as having a rhegmatogenous retinal detachment with advanced proliferative vitreoretinopathy (PVR). Visual acuity in the left eye was hand movements. In 1998 he had undergone extracapsular cataract extraction with posterior chamber IOL (PMMA, 6.5mm optic) implantation and had a Nd: YAG laser capsulotomy 6 months later. One year later, in 1999, he developed a rhegmatogenous retinal detachment, for which a scleral buckling procedure was performed and he regained visual acuity 6/24 with refraction. A year later he presented to us with retinal detachment and advanced PVR.
He received pars plana vitrectomy and silicone oil (1000 cs) injection for extended tamponade. Postoperatively, the retina was attached and the patient regained best corrected visual acuity of 6/36. However, a week later he complained of blurred and decreased (3/60) vision, and coloured halos. Slitlamp examination revealed fluid droplets on the posterior surface of the IOL [Figure 1] The retina was attached. These droplets and the patient's complaints persisted at the 3-month follow-up visit. The patient was admitted for silicone oil removal in April 2001. Intraoperatively these droplets disappeared after silicone oil-fluid exchange. No supplemental aspiration or wiping of the lens surface was required. Postoperatively the patient regained 6/36 and the symptoms disappeared.
A 55-year-old female presented to us with history of diminution of vision of 3 months duration in right eye. She had undergone an uncomplicated cataract extraction with implantation of 6.5mm optic all PMMA IOL two years earlier with good visual recovery. On examination, the visual acuity was hand movements close to face. A large Nd: YAG capsulotomy had been performed nearly one and half years after IOL implan-tation. There was a total rhegmatogenous retinal detachment with advanced PVR. She underwent a pars plana vitrectomy and silicone oil (1000cs) injection. Postoperatively, the retina was attached and the patient regained vision of 6/24. The patient however, started complaining of decreased vision (2/60) along with coloured halos two weeks later. A slitlamp examination revealed droplets on the posterior surface of the IOL [Figure 2]. There was no change in the clinical picture for 3 months. These silicone oil droplets disappeared after silicone oil - fluid exchange along with symptoms of coloured haloes, and vision improved to 6/18.
The use of silicone oil in pseudophakic eyes in vitreoretinal surgery is common. The complications of silicone oil use are well-described.  The use of silicone IOLs is a contraindication for patients who may require future vitreoretinal surgery wherein silicone oil might be needed. Silicone oil adheres to silicone IOLs and hinders the visual acuity as well as fundus examination. The silicone oil adhesion to PMMA and acrylic IOLs has been described experimentally in in vivo and in vitro studies ., Both the patients reported here had PMMA IOL, and droplets appeared on the posterior surface of the lens shortly after vitreoretinal surgery using silicone oil (1000 cs). As these droplets appeared one week after surgery, they could not possibly be emulsified silicone oil droplets. Similar observations were made in an experimental animal study in which the IOL changes after exposure to intraocular silicone oil were observed. They formed on the posterior lens surface of PMMA, silicone and acrylic IOLs and at 3 months the droplets disappeared from the acrylic lenses, while those on PMMA and silicone IOLs persisted. It was suggested that these droplets are most likely aqueous droplets, which represent residual fluid originally trapped along the ciliary body, the edges of the capsular bag, the zonules and on the posterior surface of the lens because the posterior segment was filled with silicone oil. Our data supports this concept as these droplets rapidly disappeared during of silicone oil-fluid exchange, quite unlike what happens in silicone-filled eyes with silicone IOLs. To of our knowledge, this phenomenon has not been reported in human PMMA pseudophakic eyes (Medline search). Since these droplets interfered with the patient's visual acuity, it was decided to remove the silicone oil. The complication seen in these two patients is not uncommon in pseudophakic eyes with PMMA IOL. This can be managed with removal of silicone oil as long as it does not cause recurrent detachment. Importantly, this does not demand explantation of the IOL.
|1||Kusaka S, Kodama T, Ohashi Y. Condensation of silicone oil on the posterior surface of a silicone intraocular lens during vitrectomy. Am J Ophthalmol 1996;121:574-75.|
|2||Apple DJ, Federman JL, Krolicki TJ, Sims JC, Kent DJ, Hamburger HA, et al. Irreversible silicone oil adhesion to silicone intraocular lens; a clinicopathologic analysis. Ophthalmology 1996;103:1555-62.|
|3||Khawly JA, Lambert RJ, Jaffe GJ. Intraocular lens changes after short and long term exposure to intraocular silicone oil. An in vivo study. Ophthalmology 1998:105:1227-33.|
|4||Kageyama T, Yaguchi S. Removing silicone oil droplets from the posterior surface of silicone intraocular lenses. J Cataract Refract Surg 2000;26:957-59.|
|5||Zeana D, Schrange N, Kirchchof B, Wenzel M. Silicone oil removal from a silicone intraocular lens with perfluorohexyloctane. J Cataract Refract Surg 2000;26:301-2.|
|6||Apple DJ, Isaacs RT, Kent DG, Martinez LM, Kim S, Thomas SG et al. Silicone oil adhesion to intraocular lenses: An experimental study comparing various biomaterials. J Cataract Refract Surg 1997;23:536-44.|