Sutureless vitrectomy techniques gained widespread acceptance recently, and their indications have expanded. We describe a case in which silicone oil in an eye leaked out through unsutured sclerotomies and caused widespread conjunctival scarring.

Case report

A 58-year-old man with a complex ocular history of the right eye (OD) was referred for silicone oil removal. His surgical history OD at another institution included two retinal detachment repairs with 23-gauge pars plana vitrectomy using the Constellation Vision System (Alcon Laboratories, Inc., Fort Worth, TX, USA). Ports were created with conjunctival displacement and oblique-angled sclerotomies (30°) with the bevel facing up, parallel to the limbus. The wounds were watertight at the end of the operations and not sutured. Silicone oil was used in the second surgery. Eight months later, most of the oil was removed using the 23-gauge vitrectomy system, with minor residual intraocular emulsified silicone oil left behind. 10% SF6 gas was injected at the end of surgery, and the sclerotomies were left unsutured. During the first postoperative week, the patient had hypotony that resolved without treatment.

Six months later, the patient presented to our hospital with shiny subconjunctival droplets, consistent with silicone oil, in all quadrants (360°). These extended 4 mm posterior to the equator (Figure 1). The patient complained of foreign body sensation and reported that his acquaintances had commented upon the unusual appearance of his eye. At surgery to remove residual oil, it was noted that the conjunctiva was tightly adherent to the underlying Tenon’s capsule and sclera in all quadrants secondary to oil and scarring. It was not felt that removal of the oil was feasible, as it was invested in the scarred conjunctiva. The previous sclerotomy sites could not be visualized. At postoperative month 2, the extensive subconjunctival silicone oil was still present.

Figure 1
figure 1

An intraoperative photograph shows extensive subconjunctival silicone oil accumulation (arrows).

Full size image

Comment

Our case confirms that unsutured sclerotomies may be associated with diffuse subconjunctival oil spillage. Mild subconjunctival silicone oil leakage occurs commonly after vitrectomy.1 Histopathological studies have found that small subconjunctival silicone oil deposits occur 30% of the time and often cannot be detected on slit lamp exam.2 Using a similar wound construction technique as in our patient, case series with 23-gauge systems have detected small subconjunctival silicone oil bubbles 8–10% of the time, sometimes with mild postoperative discomfort.3, 4 We recommend a lower threshold to suture sclerotomies in silicone oil cases.