Abstract
Background/objectives
To investigate whether agitation promotes the release of silicone oil by different models of syringe used for intravitreal injection.
Methods
This lab study analyzed eight syringe models by light microscopy for the release of silicone oil under agitation (flick), without agitation, and positive controls. Fourier-Transform Infrared Spectroscopy (FTIR) was performed to identify the molecular compounds inside the syringes.
Results
A total of 240 syringes were analyzed. The presence of silicone oil droplets was observed in all positive controls. When agitated by flicking, 100% of the samples of the syringes disclosed silicone oil, except the BD Plastipak syringe, which presented 40% of positivity. Without agitation, a smaller percentage of samples with silicone oil was observed. Agitation by flicking had a 265-fold greater chance of presenting oil droplets when compared with the syringes without agitation. There was a statistically significant difference between the three conditions (P < 0.05). Analysis of the tip of the plunger rubber by FTIR indicated the presence of polysiloxane (silicone oil) in all models of syringe.
Conclusions
Agitation of the syringe promotes the release of silicone oil. It is recommended to improve the technique of injection and the manufacture of specific syringes for ophthalmological use.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Grzybowski A, Told R, Sacu S, Bandello F, Moisseiev E, Loewenstein A, et al. 2018 Update on Intravitreal Injections: euretina expert consensus recommendations. Ophthalmologica. 2018;239:181–93.
Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, et al. Anti-VEGF therapy and the retina: an update. J Ophthalmol. 2015;2015:627674.
Melo GB, Figueira ACM, Batista FAH, Lima Filho AAS, Rodrigues EB, Belfort R Jr, et al. Inflammatory reaction after aflibercept intravitreal injections associated with silicone oil droplets released from syringes: a case-control study. Ophthalmic Surg Lasers Imaging Retin. 2019;50:288–94.
Khurana RN, Chang LK, Porco TC. Incidence of presumed silicone oil droplets in the vitreous cavity after intravitreal bevacizumab injection with insulin syringes. JAMA Ophthalmol. 2017;135:800–3.
Bakri SJ, Ekdawi NS. Intravitreal silicone oil droplets after intravitreal drug injections. Retina. 2008;28:996–1001.
Avery RL, Castellarin AA, Dhoot DS, Pieramici DJ, Nasir MA, Steinle NC et al. Large silicone droplets after intravitreal bevacizumab (Avastin). Retin Cases Brief Rep. 2019;13:130–4. https://doi.org/10.1097/ICB.0000000000000570.
Yu JH, Gallemore E, Kim JK, Patel R, Calderon J, Gallemore RP. Silicone oil droplets following intravitreal bevacizumab injections. Am J Ophthalmol Case Rep. 2017;10:142–4.
Stone TW, editor. ASRS 2018 Preferences and trends membership survey. Chicago, IL: American Society of Retina Specialists; 2018. https://www.asrs.org/content/documents/_2018-pat-survey-results-for-website.pdf. Accessed 29 Aug 2018.
Melo GB, Dias CS Jr, Carvalho MR, Cardoso AL, Morais FB, Figueira ACM, et al. Release of silicone oil from syringes. Int J Retin Vitreous. 2019;5:1.
Melo GB, Emerson GG, Lima Filho AAS, Ota S, Maia M. Needles as a source of silicone oil during intravitreal injection. Eye. 2019;33:1025–7.
Emerson GG. Silicone oil droplets are more common in fluid from BD insulin syringes as compared to other syringes. J VitreoRet Dis. 2017;1:401–6.
Melo GB, Emerson GG, Dias CS Jr, Morais FB, Lima Filho A, de S, et al. Release of silicone oil and the off-label use of syringes in ophthalmology. Br J Ophthalmol. 2019. https://doi.org/10.1136/bjophthalmol-2019-313823.
Agra LLM, Melo GB, Lima Filho AAS, Ota S, Maia M. Silicone oil found in syringes commonly used for intravitreal injections. Arq Bras Oftalmol. 2019;82:354–5.
Krayukhina E, Tsumoto K, Uchiyama S, Fukui K. Effects of syringe material and silicone oil lubrication on the stability of pharmaceutical proteins. J Pharm Sci. 2015;104:527–35.
Gerhardt A, Mcgraw NR, Schwartz DK, Bee JS, Carpenter JF, Randolph TW. Protein aggregation and particle formation in prefilled glass syringes. J Pharm Sci. 2014;103:1601–12.
Teska BM, Brake JM, Tronto GS, Carpenter JF. Aggregation and particle formation of therapeutic proteins in contact with a novel fluoropolymer surface versus siliconized surfaces: effects of agitation in vials and in prefilled syringes. J Pharm Sci. 2016;105:2053–65.
Williams PD, Chong D, Fuller T, Callanan D. Noninfectious vitritis after intravitreal injection of anti-VEGF agents. Variations in rates and presentation by medication. Retina. 2016;36:909–13.
Hahn P, Chung MM, Flynn HW Jr., Huang SS, Kim JE, Mahmoud TH, et al. Postmarketing analysis of aflibercept-related sterile intraocular inflammation. JAMA Ophthalmol. 2015;133:421–6.
Chisholm CF, Nguyen BH, Soucie KR, Torres RM, Carpenter JF, Randolph TW. In vivo analysis of the potency of silicone oil microdroplets as immunological adjuvants in protein formulations. J Pharm Sci. 2015;104:3681–90.
Wambier CG, Danilau Ostroski TK, Perillo de Farias Wambier S, Beltrame FL, Cappel MA, Piñeiro Maceira JM. Syringe lubricant and adverse reactions. Int J Dermatol. 2018;57:122–3.
Krayukhina E, Yokoyama M, Hayashihara KK, Maruno T, Noda M, Watanabe H, et al. An assessment of the ability of submicron- and micron-size silicone oil droplets in dropped prefillable syringes to invoke early- and late-stage immune responses. J Pharm Sci. 2019;108:2278–87.
Author information
Authors and Affiliations
Contributions
All authors conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results, drafted or revised the paper, approved the final version, and agreed to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dias Júnior, C.d.S., Cardoso, A.L., Figueiredo, A.G.d.A. et al. Agitation of the syringe and release of silicone oil. Eye 34, 2242–2248 (2020). https://doi.org/10.1038/s41433-020-0800-9
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-020-0800-9
This article is cited by
-
Silikonöltröpfchen im Glaskörper nach intravitrealer Injektion
Der Ophthalmologe (2022)
-
Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review
International Journal of Retina and Vitreous (2021)


