Release of Silicone Oil Droplets from Off-label Syringes Used for Intravitreal Injection

Background/aimsTo assess silicone oil (SO) release by different brands of syringes used for intravitreal injection under different handling conditions.MethodsEight syringes were analysed: from the USA, Terumo 0.5 mL, Becton-Dickinson (BD) Tuberculin 1 mL, BD Luer-lok 1 mL, BD Ultra-Fine 0.3 mL and Exel Insulin 0.3 mL; from Germany, Braun Omnifix-F 1 mL and Braun Injekt-F 1 mL and from Spain, BD Plastipak 1 mL. The impact of air, priming the plunger, agitation by flicking and fluid temperature on SO release were assessed by light microscopy. Fourier transform infrared spectroscopy (FTIR) was performed to identify the molecular compound in each syringe.ResultsFive hundred and sixty syringes were analysed. Terumo 0.5 mL and BD Ultra-Fine 0.3 mL released more SO than all others. BD Luer-lok 1 mL, BD Plastipak and Braun Omnifix-F 1 mL released little SO; BD Tuberculin 1 mL, Exel 0.3 mL and Braun Injekt-F 1 mL released the least SO. Priming the syringe and different temperatures did not significantly affect SO release. Agitation by flicking caused a significantly higher proportion of samples to have SO droplets and an increased number of oil droplets. Air had an additive effect on the release of oil in the agitation groups. FTIR identified polysiloxane in all syringes but Injekt-F.ConclusionSyringes commonly used for intravitreal injections frequently release SO droplets, especially when agitated by flicking. To avoid unnecessary ocular risks, syringes should not be agitated before intravitreal injection. It is desirable that syringes be manufactured specifically for ophthalmic use.

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Silicone Oil Droplets in Vitreous after Intravitreal Bevacizumab Injection

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v34i2.958 ◽

2019 ◽

Vol 34 (2) ◽

Author(s):

Haroon Tayyab, Asad Aslam Khan Muhammad Ali A Sadiq Sana Jahangir, Suhail Sarwar

Keyword(s):

Macular Edema ◽

Intravitreal Injection ◽

Diabetic Macular Edema ◽

Silicone Oil ◽

Intravitreal Bevacizumab ◽

Oil Droplets ◽

Vascular Disorders ◽

Intravitreal Bevacizumab Injection ◽

Bevacizumab Injection

Intravitreal injection of Bevacizumab for various retinal vascular disorders has become the mainstay of treatment. The injection of Bevacizumab is usually dispensed through local pharmacies after formulating from a larger vial under sterile conditions. We report an interesting finding of silicone oil bubble in vitreal cavity after intravitreal Bevacizumab injection. This is attributed to the fact that the syringes used for dispensing bevacizumab are coated with silicone oil that acts as a lubricant. These silicone oil droplets can lead to floaters and other possible complications. We report two cases of such occurrence and propose strategies to avoid this complication. Keywords: Bevacizumab, diabetic macular edema, silicone oil, ranibizumab.

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Silicone Oil Droplets are More Common in Fluid From BD Insulin Syringes as Compared to Other Syringes

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417735963 ◽

2017 ◽

Vol 1 (6) ◽

pp. 401-406 ◽

Cited By ~ 8

Author(s):

Geoffrey G. Emerson

Keyword(s):

Adverse Events ◽

Intravitreal Injection ◽

Analysis Of Variance ◽

Dead Space ◽

Silicone Oil ◽

Oil Droplets ◽

Syringe Needle ◽

Silicone Lubricant

Purpose: During 2016 and 2017, numerous retina specialists reported silicone oil droplets after intravitreal injection, primarily associated with insulin syringes with a fixed needle. By contrast, adverse events were relatively rare for tuberculin syringes. We hypothesized that fixed-needle syringe injections have more silicone droplets due to the lack of dead space at the syringe–needle junction. Methods: Fluid from Becton Dickenson (BD) insulin syringes, BD tuberculin syringes, Henke Sass Wolf (HSW) insulin syringes, and HSW silicone-free syringes was examined microscopically for silicone oil droplets. Fluid was sampled at the beginning, middle, and end of injection; and droplets were photographed and quantified. Results: Silicone oil droplets were identified in 30% of the BD insulin syringes, measuring 0.9 ± 0.2 mm3; no oil droplets were found in BD tuberculin syringes or HSW silicone-free syringes (analysis of variance, P < .05). All 6 samples with silicone oil droplets were from the end of injection (full depression of the plunger), while samples from the beginning and middle of injections did not have droplets. Challenging syringes with extra silicone oil resulted in increased droplets for fixed-needle syringes (but not for syringes with detachable needles). Conclusion: Significant silicone oil droplets were present in BD insulin syringes and were expressed at the end of injection (with plunger depressed maximally), supporting the hypothesis that insulin syringe injections have more droplets due to the lack of dead space where the plunger meets the hub of the needle. However, there are additional factors such as the amount or type of silicone lubricant in a syringe.

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Prevalence of silicone oil droplets in eyes treated with intravitreal injection

International Journal of Retina and Vitreous ◽

10.1186/s40942-019-0184-9 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Gustavo Barreto Melo ◽

Celso de Souza Dias Junior ◽

Fábio Barreto Morais ◽

Alexandre Lima Cardoso ◽

Ana Galrão Almeida Figueiredo ◽

...

Keyword(s):

Intravitreal Injection ◽

Silicone Oil ◽

Antiangiogenic Therapy ◽

Wilcoxon Test ◽

Control Group ◽

Slit Lamp ◽

Oil Droplets ◽

Cross Sectional ◽

Significant Difference ◽

Number Of Injections

Abstract Objective To assess the number of eyes with silicone oil in the vitreous after intravitreal injection. Methods This cross-sectional, comparative study was divided into 2 groups: (1) treatment—eyes subjected to antiangiogenic therapy; (2) control—no history of intravitreal injection. Subjects were assessed regarding age, gender, clinical diagnosis, lens status, visual acuity and number of previous intravitreal injections. All eyes underwent a meticulous slit-lamp and ultrasound examination for the identification of silicone oil. ImageJ software was used to quantify the index of silicone oil (IOS) by ultrasonography. Results Sixty-seven eyes (30 controls, 37 treated) were included. Slit-lamp examination found silicone oil droplets in 25 out of 37 (67.57%) treated eyes and in none of the control group. Ultrasonography identified silicone oil in 28 out of 37 (75.68%) treated eyes and in 1 out of 30 (3.33%) controls. An observed agreement of 85.07% and a Cohen’s Kappa coefficient of 69.10% (p < 0.0001) between ultrasonography and biomicroscopy were found. Wilcoxon test showed a statistically significant difference (p = 0.0006) in IOS between controls (0.41 ± 0.43%) and treated eyes (2.69 ± 2.55%). Spearman’s correlation test (0.61; p < 0.0001) showed that the greater the number of injections, the higher the IOS. Conclusions Silicone oil droplets were found in the majority of the eyes previously treated with antiangiogenic intravitreal injection. The greater the number of injections, the higher the likelihood of finding silicone oil. An improvement in the technique of injection and better-quality syringes post-injection silicone oil droplets.

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