DOI: 10.1097/IAE.0b013e31819a6490

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Issn Print: 0275-004X

Publication Date: 2009/03/01


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Noha S. Ekdawi; Sophie J. Bakri

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We thank Bhende and Jathar1 for their comments on our article.2 Our article2 described the occurrence of intravitreal silicone oil droplets after multiple intravitreal injections, in 15 eyes of 15 patients. Most of those patients had a combination of injections, and most had multiple injections. Because this was a retrospective review, it is possible that the oil droplets may have appeared after a single injection of a single drug. Since publishing the article, we have noted oil droplets in several patients after the first injection. We have also noted it in patients after intravitreal triamcinolone. The droplets have been seen after injection of both compounded medications, and those in prefilled syringes. It would be interesting to know the formulation of the triamcinolone, and the syringe used, in the article by Bhende and Jathar.1
In the Diabetic Retinopathy Clinical Research network study,3 silicone oil droplets were observed in the vitreous of some eyes after injection of a preservative-free preparation (1 mg or 4 mg) of triamcinolone acetonide injectable suspension (manufactured by Allergan, Inc., Irvine, CA; 4 mg, brand name, TRIVARIS). The preparation consisted of micronized triamcinolone acetonide suspended in a hydrogel vehicle with minimal dispersive properties. Initially, siliconized syringes with a staked needle design were used, but the design was changed to use siliconized syringes with a Luer-cone design. This alteration, by increasing the residual space between the needle and the syringe, was made to reduce the amount of silicone oil injected with the triamcinolone, and was confirmed by in vitro testing performed by Allergan. Because all subjects injected with triamcinolone had already received at least one injection with the original syringe before the change was made, it could not be evaluated whether the change in design reduced the amount of silicone oil injected. Silicone oil droplets were noted in 30% of eyes in the 1-mg triamcinolone group (841 injections) and 59 23% of eyes in the 4-mg triamcinolone group (742 injections given). Although some subjects were symptomatic with floaters, no adverse effect of the silicone oil was noted.
Now that we are more aware of the occurrence of intravitreal silicone oil droplets after intravitreal injections, we are more likely to notice them or specifically look for them on examination. Fortunately, no patient has suffered adverse events from these. In future, the use of nonsiliconized syringes and tubes, both for injection and in the compounding process, can be considered to eliminate this adverse event.
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