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    How to avoid explosive silicone oil injector separation

    An unpleasant complication taught a valuable lesson about syringe-cap alignment

    LAS VEGAS – Ensuring correct alignment between the syringe and the cap during silicone oil injection can prevent complications during vitrectomy, said Jay M. Stewart, MD, (San Francisco) presenting during the Retina Subspecialty Day of the 2015 American Academy of Ophthalmology meeting. 

    Case details

    A 54-year-old female presented with severe proliferative diabetic retinopathy and current retinal detachment after recent vitrectomy. A 20-gauge pars plana vitrectomy was performed.

    After removing the gas, there was a large hole in the center macula and further vitreoretinopathy. It was decided to perform an inferior retinectomy in order to flatten the retina.

    The retina was flattened under air and under laser was applied. Silicone oil was chosen for the tamponade and the injection was initiated according to the clinic’s usual method.

    Related Challenges: Pre-existing ruptured posterior capsule presents unique challenges

    “The silicone oil injection was proceeding uneventfully and the fill was almost complete. During the last part of the silicone oil injection, there was a very loud popping noise and the silicone oil tubing and cap separated from the syringe forcefully,” Dr. Stewart said.

    “Not only was there a sudden drawing motion of the syringe and cannula while it was in the eye, but the tubing and cap flew across the room narrowly missing me and the staff.”

    At this point, it became obvious the sclerotomy had traumatically enlarged. In addition, blood could be seen coming into the pupil and entering the anterior chamber.

    “The patient was in distress due to both pain and shock from the loud noise. The surgeons and staff were also unnerved,” Dr. Stewart said.

    Related: Imaging, 27-gauge systems capture retina surgeons’ focus

    On post-op day one, the patient had no pain and her vision had no light perception. The view of the fundus was obscured by blood in the pupil.

    At post-op month two, the patient reported improvement in vision from pre-op and the retina was attached under oil. There is no residual hemorrhage in the eye.

    Typically, pressure in the eye is measured in millimeters of mercury, but silicone oil is measured in psi. 50 psi (a typical pressure when injecting silicone oil) equates to 800-1,000 mm Hg, the panelists said. 

    Thoughts on the complication

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