These thoughts and actions taken by Dr Muhammad Azeem, written with the help of ChatGPT.
Managing Intravitreal Injections in a Silicone-Oil–Filled Eye:
A Challenging Clinical Scenario
Managing intravitreal injections in an eye filled with silicone oil is one of the most challenging situations in retina practice. The altered dynamics of fluid, drug diffusion, and intraocular pressure make every decision critical. When the patient also has uncontrolled metabolic conditions such as very high blood sugar, hypertension, or compromised renal function, the complexity increases even further.
In this blog, we discuss the essential principles behind intravitreal injections in a siliconized eye and highlight why metabolic stabilization is just as important as local ocular treatment.
Why Silicone Oil Makes the Situation Difficult
Silicone oil significantly changes the internal environment of the eye.
Drug distribution becomes slow and unpredictable.
Intraocular pressure can rise rapidly even after a standard-volume injection.
Infection control (such as endophthalmitis) becomes more challenging because antibiotics do not mix efficiently within the oil-filled cavity.
This means even a standard intravitreal injection requires extra caution, precise technique, and close monitoring.
Local Treatment Alone Is Not Enough
A key message for patients and families is this:
Local eye treatment cannot work effectively unless the metabolic status of the body is under control.
If the patient has:
High blood sugar (e.g., RBS 363 mg/dL)
High blood pressure (e.g., 153/105 mmHg)
Potential kidney impairment (needing nephrology input)
then the following problems occur:
Infections do not respond well to local antibiotics.
Swelling and inflammation worsen.
Systemic osmotic drugs (like mannitol) may become dangerous without nephrologist clearance.
Retinal perfusion decreases, causing further damage.
Therefore, eye surgeons must work closely with a medical specialist, cardiologist, and nephrologist to stabilize the patient before planning silicone-oil removal or vitrectomy. Treating the eye without treating the body is not safe and not effective.
The Clinical Goal:
Stabilize Systemically, Then Intervene Locally
Managing a siliconized eye with high IOP or infection requires a team approach:
1. Medical Specialist
To control blood sugar rapidly and safely.
2. Cardiologist
To stabilize blood pressure and reduce cardiac risk before any ocular procedure.
3. Nephrologist
To assess kidney function and approve (or avoid) osmotic agents like mannitol.
4. Eye Surgeon / Vitreo-retinal Specialist
To manage intravitreal injections, control IOP, and plan silicone-oil removal or vitrectomy once it is safe.
Only after systemic stability is achieved can local eye treatments succeed.
Conclusion
Intravitreal injections in a silicone-oil–filled eye are never straightforward, and the presence of uncontrolled diabetes, hypertension, or renal issues further complicates the picture. Successful outcomes depend not only on precise ophthalmic management but also on comprehensive systemic stabilization.
#rp#pain#myopia#25#blurry
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