Silicone oil in syringes contributes to cluster of inflammatory reactions
A cluster of post-intravitreal injection inflammatory reaction cases was associated in a study with silicone oil droplets released by Saldanha Rodrigues syringes.
The study was designed after six of 33 eyes receiving aflibercept intravitreal injection in one hospital in Brazil between May and August 2016 developed symptoms and signs of inflammation, primarily anterior uveitis and vitritis. The medical records were analyzed to identify possible contributing factors and biophysical tests were performed to determine if specific substances in the syringes might have altered the aggregation states of the medications.
In all six eyes, silicone oil droplets were detected in the vitreous. All cases were injected using SR syringes from the same batch. In the following months, SR syringes were no longer used and no additional case of inflammation occurred.
The surgeon performing the injections in this study strongly agitated the syringe to separate the liquid from the air to prevent the release of air bubbles into the vitreous. The authors of the study hypothesized that intense agitation in combination with the silicone oil present in the internal coating of the syringe might have led to the formation of particles and agglomerates consisting of silicone oil droplets and aggregated proteins.
“In summary, biophysical characterization showed that intense agitation of samples passed through syringes might be important for aggregate formation,” the authors wrote. All patients were treated with corticosteroids and mydriatic drops, and “recovered fairly well after a short time, and most attained the same final VA as the pre-injection level.” – by Michela Cimberle
Disclosure: The authors report no relevant financial disclosures.