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INTRODUCTION AND IMPORTANCE: Complications related to silicone oil tamponade are frequent. There are reports of events related to silicone oil (SO) injection during Pars Plana Vitrectomy (PPV). This case presents the unexpected injection of SO in the suprachoroidal space. The proper management of this complication along with the preventive measures are discussed. CASE PRESENTATION: A 38-year-old male presented with a one-week history of decreased vision in his right eye (OD). His visual acuity was hand motion (HM). A late-onset retinal detachment recurrence with proliferative vitreoretinopathy (PVR) in his OD was diagnosed. Cataract surgery and PPV were scheduled. During PPV, a choroidal detachment (CD) secondary to the suprachoroidal injection of silicone oil (SO) was noted. Suprachoroidal SO was identified timely and was managed with external drainage through a posterior sclerotomy. CLINICAL DISCUSSION: Suprachoroidal silicone oil injection is a potential complication during PPV. For the management of this complication, the drainage of the silicone oil from the suprachoroidal space through a posterior sclerotomy may be considered as an option. This complication may be avoided by periodically checking the correct position of the infusion cannula during the PPV, by injecting the SO into the vitreous cavity under direct visualization and by using automated injection systems. CONCLUSION: Suprachoroidal silicone oil injection is an intraoperative complication that might be avoided by cross-checking the correct position of the infusion cannula and by injecting SO under direct visualization.
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Diabetic retinopathy (DR) is one of the leading causes of blindness worldwide. Multiple treatment options have been used over time to attempt to modify the natural progression of the disease in both proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). These two retinal complications are the result of microvascular occlusions and vascular hyperpermeability and are considered one of the leading causes of irreversible blindness in patients of working age. It is now well demonstrated that PDR and DME are associated with increased levels of inflammatory and pro-angiogenic factors in the ocular compartment. To date, laser photocoagulation, vascular endothelial growth factor (VEGF) inhibitors, and corticosteroids have demonstrated efficacy in their treatment in large randomized controlled trials and in real-life observational studies. This manuscript aims to provide a comprehensive review of current treatments, including the main drugs used in diabetic pathologic manifestations, as well as new therapeutic alternatives, such as extended-release intraocular devices.
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Purpose: To assess the relationship and prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with poor final best-corrected visual acuity (BCVA) after surgical repair of open globe injuries (OGI) in adults. Design: Retrospective analysis of data from an ongoing prospective cohort of consecutive patients. Methods: In a tertiary university hospital, 197 eyes of 197 patients were included between 2013 and 2017. NLR and PLR were obtained from pre-operative blood tests to analyze its relationship with poor final BCVA. Results: Severe visual impairment (SVI) was defined as ≤20/200, and was observed in 96 (48.7%) patients after surgical repair of OGI. SVI patients had higher NLR (7.4 ± 6.6 vs. 4.0 ± 3.2, p < 0.001), and PLR (167 ± 92 vs. 139 ± 64; p = 0.021) than non-SVI. NLR ≥ 3.47 and PLR ≥ 112.2 were the best cut-off values for SVI, were univariate risk factors for SVI, and had sensitivity: 69.0, 71.4, and specificity: 63.6, 44.8, respectively. In multivariate analysis, only OTS, athalamia, and hyphema remained as risk factors. NLR had significant correlation with ocular trauma score (OTS) (r = -0.389, p < 0.001) and final BCVA (r = 0.345, p < 0.001). Limitations: Simultaneous trauma in other parts of the body that could influence the laboratory findings. Conclusion: Patients with SVI after a repaired OGI had increased pre-operative NLR and PLR levels. High NLR and PLR are risk factors for SVI in univariate analysis. It is confirmed that low OTS is a risk factor for SVI. High NLR and PLR could be used as a prognostic tool to identify patients at higher risk for SVI after repair of OGI.
