Kamath Sripathi, Charlotte Akshata, Nandan Nandini
Ophthalmology, Father Muller Medical College, Mangalore, IND.
Ophthalmology, Dr. Suresh Babu Eye Foundation, Kasaragod, IND.
Cureus. 2025 Feb 7;17(2):e78715. doi: 10.7759/cureus.78715. eCollection 2025 Feb.
Intravitreal anti-vascular endothelial growth factor (VEGF) injections are a cornerstone treatment for various retinal conditions, including diabetic macular edema and age-related macular degeneration. While generally safe, these injections can introduce unintended substances, such as silicone oil droplets, into the vitreous cavity due to the silicone-based lubricant used in syringe manufacturing. Although frequently asymptomatic, silicone oil droplets can occasionally cause significant visual disturbances and discomfort. We report a rare case of symptoms caused by silicone oil droplets following a single intravitreal bevacizumab injection. A 54-year-old diabetic male patient presented with pain and iridescent floaters in his right eye, which began immediately after receiving an intravitreal bevacizumab injection and persisted for four weeks. The patient, with a 20-year history of diabetes and prior scatter laser photocoagulation, exhibited a visual acuity of 20/80 in the right eye or oculus dexter (OD) and 20/40 in the left eye or oculus sinister (OS), with an elevated intraocular pressure (IOP) of 24 mmHg in the right eye. Dilated fundoscopy revealed multiple silicone oil droplets floating in the vitreous cavity, alongside severe non-proliferative diabetic retinopathy and macular edema. The patient was started on anti-glaucoma medications, brimonidine, and timolol, which effectively reduced his IOP to 18 mmHg within a week. Despite IOP control, the patient remained distressed by persistent floaters, which gradually became less symptomatic with time. This case is unique because the symptoms due to the silicone oil droplets occurred after a single injection, unlike most reports of asymptomatic presentations or those arising after multiple injections. The disproportionate amount of silicone oil observed raises concerns about syringe design and transport conditions. While silicone oil is inert, its presence can cause the patient anxiety and visual disturbances.
玻璃体内注射抗血管内皮生长因子（VEGF）是治疗多种视网膜疾病的基石疗法，包括糖尿病性黄斑水肿和年龄相关性黄斑变性。虽然这些注射通常是安全的，但由于注射器制造中使用的硅基润滑剂，这些注射可能会将意外物质，如硅油滴，引入玻璃体腔。硅油滴虽然通常无症状，但偶尔会引起严重的视觉障碍和不适。我们报告了一例单次玻璃体内注射贝伐单抗后由硅油滴引起症状的罕见病例。一名54岁的糖尿病男性患者右眼出现疼痛和彩虹色飞蚊症，在接受玻璃体内贝伐单抗注射后立即开始出现，并持续了四周。该患者有20年糖尿病病史，之前接受过散在激光光凝治疗，右眼视力为20/80，左眼视力为20/40，右眼眼压升高至24 mmHg。散瞳眼底检查发现玻璃体腔内有多个硅油滴漂浮，同时伴有严重的非增殖性糖尿病视网膜病变和黄斑水肿。患者开始使用抗青光眼药物溴莫尼定和噻吗洛尔，一周内眼压有效降至18 mmHg。尽管眼压得到控制，但患者仍因持续的飞蚊症而苦恼，随着时间的推移，症状逐渐减轻。该病例独特之处在于，与大多数无症状表现或多次注射后出现症状的报告不同，硅油滴引起的症状在单次注射后出现。观察到的硅油量不成比例，引发了对注射器设计和运输条件的担忧。虽然硅油是惰性的，但其存在会导致患者焦虑和视觉障碍。
