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 Table of Contents  
OPHTHALMIC IMAGES
Year : 2021  |  Volume : 59  |  Issue : 2  |  Page : 220-221

Migration of silicone oil through aurolab aqueous drainage implant


Department of Glaucoma, Aravind Eye Hospital and Postgraduate Research institute, Madurai, Tamil Nadu, India

Date of Submission04-Dec-2020
Date of Decision15-Jan-2021
Date of Acceptance20-Jan-2021
Date of Web Publication24-Jun-2021

Correspondence Address:
Dr, Sharmila Rajendrababu
Senior Glaucoma consultant, Department of glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Anna Nagar, Madurai, Tamilnadu - 625 020
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_182_20

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How to cite this article:
Rajendrababu S, Senthilkumar VA. Migration of silicone oil through aurolab aqueous drainage implant. TNOA J Ophthalmic Sci Res 2021;59:220-1

How to cite this URL:
Rajendrababu S, Senthilkumar VA. Migration of silicone oil through aurolab aqueous drainage implant. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2021 Jul 27];59:220-1. Available from: https://www.tnoajosr.com/text.asp?2021/59/2/220/319278



A 10-year-old child underwent vitrectomy and lensectomy with (1000 cs) silicone oil (SO) injection for posteriorly dislocated microspherophakic lens in the left eye. Fourteen months later, the child developed medically uncontrolled refractory glaucoma requiring complete SO removal to control his intraocular pressure (IOP). During SO removal, infusion port was introduced inferotemporally 3 mm from the limbus, and tip of the infusion port was confirmed to be in the vitreous cavity. Normal saline was infused into vitreous, and two additional ports were made superonasally and superotemporally, about 3 mm from the limbus. Active SO removal was done through superonasal port, and fluid–air exchange was done multiple times to ensure complete SO removal. Retina was inspected to be on and ports were closed with 6-0 vicryl.

Three months later, as the IOP remained persistently high, the child underwent nonvalved Aurolab aqueous drainage implant (AADI, Aurolab, Madurai, India). A fornix-based conjunctival peritomy was made in the superotemporal quadrant covering >4-5' o clock hours to access the superior and lateral recti muscles. Blunt dissection was done to separate the underlying tenon capsule and adhesions if any, and then, the muscle hooks are inserted deeper and turned right and left side to isolate the two recti muscles (superior and lateral recti). After isolating the recti and confirming that the posterior muscle surface is free from the sclera, the two wings of 350 mm2 plate AADI are pushed gently to slide under the muscles, and then, the plate is secured to the sclera using two 9-0 nylon sutures through the eyelets of the plate. It is important to make sure that the anterior edge of the plate is 8–10 mm away from the limbus. The patency of the tube is checked with a balanced salt solution in a syringe with a 30G cannula. The tube is then fixed to the sclera with a box suture using 9-0 nylon. Distal to this suture, the tube is ligated with a 6-0 vicryl suture at the plate bend and occlusion is tested. Extreme care is taken to achieve a water-tight closure of the suture. The tube length is shortened as appropriate after prior marking and cut to achieve a bevel up tube end. A 23G needle is used to create a scleral track 4 mm behind the limbus and 2 mm medially, to create a sinuous route for the tube in the eye. After placing the tube in the anterior chamber, we ensure a good water-tight closure of the conjunctiva along with Tenon's using 8-0 vicryl wing sutures on the sides. On completion, we also place two corneal anchoring sutures at the limbus using 10-0 nylon to avoid conjunctival retraction.

Eight months later, some of the SO migrated through the tube to the episcleral region under the plate of the AADI. The oil intermittently blocked the tube shunt, causing elevated IOP [Figure 1]. Despite surgical removal of the SO around the tube, a substantial amount possibly remained encapsulated under the plate and the subconjunctival space causing high IOP. The child eventually underwent an inferonasal AADI to control IOP and to preserve vision. Prevention of SO block of the tube shunt can be achieved by placement of a short tube well anterior to the iris in the inferonasal quadrant.[1],[2],[3]
Figure 1: Slit lamp photograph of the left eye showing clear cornea with a superotemporal Aurolab aqueous drainage implant tube in the anterior chamber with the tip of the tube occluded by silicone oil (white arrowhead), aphakia, and an inferior surgical iridectomy

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nazemi PP, Chong LP, Varma R, Burnstine MA. Migration of intraocular silicone oil into the subconjunctival space and orbit through an Ahmed glaucoma valve. Am J Ophthalmol 2001;132:929-31.  Back to cited text no. 1
    
2.
Friberg TR, Fanous MM. Migration of intravitreal silicone oil through a baerveldt tube into the subconjunctival space. Semin Ophthalmol 2004;19:107-8.  Back to cited text no. 2
    
3.
Chan CK, Tarasewicz DG, Lin SG. Subconjunctival migration of silicone oil through a Baerveldt pars plana glaucoma implant. Br J Ophthalmol 2005;89:240-1.  Back to cited text no. 3
    


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