A comparison of retrokeratoprosthetic membrane and conjunctival inflammatory responses to silicone oil
© Gilbert et al.; licensee Springer 2014
Received: 15 April 2014
Accepted: 20 May 2014
Published: 26 June 2014
Silicone oil continues to be an important aid in retinal detachment surgery. We report a case in which disparate responses to silicone oil were noted in the conjunctiva and intraocularly. Intraocularly, the oil permeated a fibrous membrane that formed behind a keratoprosthesis, the first example of this phenomenon. We detail the histological response to the oil at this site as well as a distinctly different reaction present to oil in the conjunctiva of the same eye. The divergence of histological responses provides a demonstration of the eye's apparent retained capacity to protect against intraocular inflammation, despite multiple previous surgeries.
KeywordsRetrokeratoprosthetic membrane Granulomatous reaction Silicone oil Conjunctiva
Silicone oil continues to be an important aid in the performance of retinal detachment surgery. As complications of its use, we report a 52-year-old man with ocular mucous membrane pemphigoid (MMP) who developed disparate responses to silicone oil in the conjunctiva and intraocularly. The oil permeated a fibrous membrane that formed behind a keratoprosthesis, the first example of this phenomenon.
Histopathologic findings similar to those described for the conjunctival sample above have been noted in prior reports of reactions to silicone oil []. Although the movement of silicone oil into many other intraocular structures has also been reported, a histiocytic retinal or uveal response has been either absent or severely dampened [], even in eyes enucleated after a decade with oil, except in cases with massive fibrovascular responses []. There is no earlier published case detailing silicone impregnation of a fibrous retroprosthetic membrane. Such membranes have been shown to arise from corneoscleral stromal downgrowth [], but the potential effect of silicone oil in accelerating or worsening the development of a retroprosthetic membrane must be considered. Some reports have documented the alleged ability of silicone oil to promote the formation of preretinal membranes [,]. There is at least one study describing the increased concentrations of fibrogenic growth factors in the setting of intraocular silicone oil [].
One can speculate whether the increased intraocular pressure that the eye experienced may have played a role in forcing silicone oil droplets into the retroprosthetic membrane. The divergence of histological responses to the presence of silicone oil in the conjunctiva versus the retroprosthetic membrane provides a demonstration of the eye's apparent retained capacity to protect against intraocular inflammation, despite multiple previous surgeries.
AG is a resident in Ophthalmology. FJ is a former Chief of Ophthalmology and current Director of Ophthalmic Pathology. JC is the Associate Director of the Cornea and Refractive Surgery Service, Director of Boston Keratoprosthesis Clinical Programs, and Director of Education and Fellowship training for the Cornea Service. DE is the Associate Director of the Retina Service.
mucous membrane pemphigoid:
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