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Understanding Intravitreal Silicone Oil Droplets Due to Intravitreal Injections.

A recent Class II recall of dexamethasone (700-mg) intraocular implant (Ozurdex; Allergan, Dublin, Ireland) due to the reported presence of silicone particles during routine batch inspection has refocused concern on the potential for silicone to enter the eye during intravitreal injection procedures.1 The Ozurdex applicator includes a stainless-steel enclosure with a 22-G needle and a sleeve at the base of the needle. These particles were found to be of around 300 mm in diameter and were proven to be originating from the sleeve.1 Other details about the silicone particle are unknown. However, potential adverse drug reaction (ADR) indicated in the “Direct Healthcare Professional Communication” letter from the manufacturers was similar to the ones associated with the silicone oil droplets after intravitreal injection such as persistent floaters, inflammation of posterior chamber, and a possibility of the particles entering the anterior chamber and causing the reaction.1,2 Intravitreal silicone oil droplets after injection of pegaptanib sodium (Macugen; Bausch + Lomb, Bridgewater, NJ) were first reported in 2006 by Freund et al.3 In 2008, this finding was reported with the intravitreal injections of ranibizumab (Lucentis; Genentech, Inc, South San Francisco, CA), triamcinolone acetonide, and bevacizumab (Avastin; Genentech, Inc) by Bakri et al and later by other authors also.2,4,5 Since then, there have been additional reports of intravitreal silicone oil droplets, predominantly related to the use of bevacizumab.6,7 An apparent spike in the incidences led to the issuance of an alert by the American Society of Retinal Specialists, and symptomatic floaters are now recognized as a potential side effect of all the drugs given through intravitreal injections.5,8 Although the intravitreal silicone oil droplets seem to be well-tolerated and have not been implicated in producing any adverse effects other than the floaters, it is important for the clinicians to understand this phenomenon, the possible factors causing it, and the ways to reduce its incidence. Source of Silicone Oil