Sir,

Silicone oil is toxic to the cornea causing endothelial failure and band keratopathy.1 In traumatic aniridia and aphakia, there lacks a barrier for silicone oil between the posterior and anterior chambers. Therefore, if retinal surgery is also required, silicone oil tamponade may cause the cornea to decompensate unless an artificial barrier can be constructed. We report a novel technique in a patient following globe rupture.

Case report

A 43-year-old male who had previous penetrating keratoplasty for keratoconus endured blunt trauma to his left eye. He had total iris loss and required a repeat penetrating keratoplasty and lensectomy due to the globe rupture. Three weeks later, he had a total retinal detachment with severe proliferative vitreoretinopathy (PVR). He underwent pars plana vitrectomy, retinectomy, PVR membrane peel, laser, and silicone oil tamponade. Before silicone oil injection, 360-degree conjunctival peritomy was performed, and an artificial barrier was formed using a continuous 10/0 prolene suture (Ethicon W1713, Somerville, NJ, USA) placed 2.5 mm from the corneal limbus (Figure 1a).

Figure 1
figure 1

(a) Schematic diagram of hexagonal silicone oil retention suture and (b) Opening in peri-silicone oil membrane present 4 months following surgery.

Full size image

Within 2 months, he developed a membrane at the level of the retention suture, seperating the silicone oil from the anterior chamber. Laser capsulotomy was initially planned, but he subsequently spontaneously developed a central opening within the membrane (Figure 1b). His retina remained flat under oil, and visual acuity at 4 months follow-up was counting fingers.

Discussion

Retention sutures are effective in preventing corneal decompensation in aniridic eyes requiring silicone oil tamponade.2 This is because of the surface tension of silicone oil and its propensity to stay as a single bubble within the vitreous cavity. The method described above allows for one continuous suture to be used in forming the barrier, and is an alternative to the previously described technique using multiple sutures. It is not known if the hexagonal shape is better than others at stimulating peri-silicone proliferation and membrane formation,3 the rate of which may also vary between patients and with topical steroid use. In our case, an opening in the membrane formed spontaneously, but in others, laser capsulotomy may be required.