Unusual Case of Secondary Corneal Perforation With Silicone Oil Leakage After Vitrectomy
Yeh, Tsai-Chu MD, MTM*,†; Hsu, Chih-Chien MD, PhD*,†
*Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
†National Yang Ming Chiao Tung University, Taipei, Taiwan
Address correspondence and reprint requests to: Chih-Chien Hsu, Department of Ophthalmology, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Taipei 11217, Taiwan. E-mail: [email protected]
The authors have no conflicts of interest to declare.
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We report a case of corneal perforation with silicone oil leakage following extensive vitrectomy with an iatrogenic trauma in a 50-year-old man. The patient remained aphakic after receiving vitrectomy. Slitlamp examination revealed a corneal perforation from which silicone oil was slowly percolating (Fig. 1A). A computed tomography scan of the orbit (Fig. 1B) showed hyperattenuating silicone oil migrated into the anterior chamber. Corneal optical coherence tomography showed a full-thickness corneal perforation at the periphery (Fig. 1C), which appeared to be the original insertion site of the anterior chamber maintainer. Even after a bandage contact lens was placed, the patient suffered from corneal edema with active silicone oil leakage. The perforation was then repaired with 10–0 nylon corneal suture. Following the suture of the corneal wound, a “cracked windshield” opacity surrounding the perforation as well as presence of Descemet folds were noted after resolution of corneal edema (Fig. 1D).
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FIGURE 1: A, Slitlamp image showing corneal perforation (arrow) with silicone oil leakage. B, Computed tomography scan of the orbit showed hyperattenuating silicone oil migrated into the anterior chamber over the right eye (arrow), with no evidence of a foreign body. C, Corneal optical coherence tomography showed a corneal wound from the original insertion site of the anterior chamber maintainer at the periphery. D, Slitlamp image showing the pigmented corneal opacity in a “cracked windshield” pattern.
Despite the serious complications that can arise with intraocular silicone oil tamponade, silicone oil is still widely used in vitreoretinal surgeries.1 Among all reported complications, full-thickness corneal perforation is extremely rare. Potential risk factors contributing to corneal perforation including prolonged silicone oil tamponade in the anterior chamber, repeated ocular surgeries, and aphakic status.1 Unlike other case reports with spontaneous perforation of the cornea due to band keratopathy associated corneal ulceration, our patient was found to have a poor healing wound resulting from the channel of the anterior chamber maintainer. Silicone oil may induce transient elevation of intraocular pressure and inflammation, causing delayed epithelialization and corneal wound healing.2 Ophthalmologists should be aware of delayed surgical wound healing, especially when oil is present in the anterior chamber. Furthermore, prolonged hypotony results in corneal edema and may cause irreversible opacification. Thus, timely closure of corneal wound must be performed in patients with active silicone oil leakage from an iatrogenic wound.
References
1. Venkatesh P, Chawla R, Tewari HK. Spontaneous perforation of the cornea following silicone oil keratopathy. Cornea. 2005;24:347–348. doi: 10.1097/01.ico.0000138859.03141.46.
2. Chen WL, Lin CT, Ko PS, et al. In vivo confocal microscopic findings of corneal wound healing after corneal epithelial debridement in diabetic vitrectomy. Ophthalmology. 2009;116:1038–1047. doi: 10.1016/j.ophtha.2009.01.002.
