Anterior segment complications following silicone oil tamponade

Abstract

We present four images that illustrate anterior segment complications secondary to the use of silicone oil in vitreoretinal surgery. Silicone oil is a critical tool in managing complex retinal detachments; however, it carries the risk of anterior migration and emulsification. We encountered these complications in 4 nonconsecutive patients, who presented at Hassan II University Hospital for treatment of complex rhegmatogenous retinal detachment associated with proliferative vitreoretinopathy and underwent vitreoretinal surgery with silicone tamponade. Uncomplicated surgery was performed. On postoperative follow-up, ranging from 4 weeks to 10 months, the patients developed the following anterior segment complications. The first image shows a classic reverse hypopyon, where emulsified silicone oil droplets accumulated in the superior anterior chamber due to their buoyancy. This phenomenon can cause inflammation, disrupt aqueous outflow, and raise intraocular pressure (IOP). The second image shows subconjunctival silicone migration, a postoperative complication resulting from wound leakage or elevated IOP. It appears as dome-shaped, translucent elevations beneath the conjunctiva. The third image shows nonemulsified silicone oil bubbles occupying the anterior chamber. These bubbles may migrate through zonular defects, surgical incisions, or in aphakic eyes. Their presence can obstruct the trabecular meshwork, increasing the risk of secondary glaucoma. The fourth image shows band keratopathy developing under prolonged silicone oil tamponade. Calcium deposits form in Bowman’s layer and the superficial stroma, leading to corneal opacification and visual disturbance. This complication may result from chronic inflammation, disrupted tear film, or extended oil–cornea contact.