Abstract Purpose: To identify and assess the available information regarding the frequency of complications following the use of silicone oil (SO). Methods: A systematic search was conducted in PubMed/Medline, Cochrane and Embase, up to June 2020. The reference lists of identified studies and relevant reviews were also reviewed. We included studies in Spanish and English, with no publication date limits, of all types of methodology, with populations over 50 eyes, with patients previously diagnosed with tractional retinal detachment, proliferative diabetic retinopathy, giant retinal tears, traumatic retinal detachment and patients with proliferative vitreoretinopathy from any cause, with a minimum follow-up of 6 weeks. The quality assessment of the studies was conducted according to the Centre for Evidence-Based Medicine classification of levels of evidence. Results: A total of 13 studies were included, most of which were retrospective, with a level of evidence 2b. Cataract (median: 90, interquartile range [IQR]: 80-100%), silicone oil emulsification in the anterior chamber (median: 64.5; IQR: 46.5-82.25%), ocular hypertension (median: 23.3; IQR: 22.15-35.1%) and retinal redetachment (median: 22; IQR: 18.5-30%) were the most frequent complications; while pupillary block (median: 4.3; IQR: 3.8-4.8%), subconjunctival silicone oil deposits (median: 4.15; IQR: 3.75-4.57%), and expulsive suprachoroidal hemorrhage (median: 1; IQR: 0.95-1.05%) were the least frequent. Conclusions: The most frequent complications reported in decreasing order were cataracts, silicon oil emulsification in the anterior chamber, ocular hypertension, retinal redetachment, keratopathy, hypotonia, subretinal silicone oil migration, rebleeding, secondary glaucoma, unexplained visual loss, pupillary block, subconjunctival silicone oil deposits and expulsive suprachoroidal hemorrhage.

Resumen Objetivo: Identificar y evaluar la información disponible sobre la frecuencia de las complicaciones tras el uso del aceite de silicona. Método: Se realizó una búsqueda sistemática en PubMed/Medline, Cochrane y Embase, hasta junio de 2020. Las listas de referencias de los estudios identificados y de las revisiones relevantes también fueron revisadas. Se incluyeron estudios en español e inglés, sin límite de fecha de publicación, de cualquier metodología, con una muestra mayor de 50 ojos, con pacientes con diagnóstico previo de desprendimiento de retina traccional, retinopatía diabética proliferativa, desgarros gigantes, desprendimiento de retina, por trauma, y pacientes con proliferación vitreorretiniana independientemente de la causa, con un seguimiento mínimo de 6 semanas. La evaluación de la calidad de los estudios se realizó según la clasificación del Centre for Evidence-Based Medicine. Resultados: Se incluyeron 13 estudios, la mayoría retrospectivos, con un nivel de evidencia 2b. La catarata (mediana: 90; rango intercuartílico [RIC]: 80-100%), la emulsificación en la cámara anterior (mediana: 64.5; RICL: 46.5-82.25%), la hipertensión ocular (mediana: 23.3; RIC: 22.15-35.1%) y el redesprendimiento de retina (mediana: 22; RIC: 18.5-30%) fueron las complicaciones más frecuentes, mientras que el bloqueo pupilar (mediana: 4.3; RIC: 3.8-4.8%), el depósito conjuntival de aceite de silicona (mediana: 4.15; RIC: 3.75-4.57%) y la hemorragia expulsiva (mediana: 1; RIC: 0.95-1.05%) fueron las menos reportadas. Conclusiones: Las complicaciones más frecuentes en orden decreciente fueron cataratas, emulsificación en la cámara anterior, hipertensión ocular, redesprendimiento de retina, queratopatía, hipotonía, migración de aceite de silicona subretinal, resangrado, glaucoma secundario, pérdida visual inexplicable, bloqueo pupilar, depósitos conjuntivales de aceite de silicona y hemorragia expulsiva.

RESUMO O implante intravítreo de dexametasona é um sistema anti-inflamatório de liberação sustentada que libera 0,7 mg de dexametasona na cavidade vítrea. O relato de caso a seguir descreve uma complicação rara: injeção acidental do implante de Dexametasona no cristalino. Uma mulher de 73 anos foi diagnosticada com oclusão da veia central da retina e edema macular cistóide. O tratamento inicial incluiu três doses intravítreas mensais de tratamento com fator de crescimento endothelial anti-vascular, que não tiveram sucesso. O tratamento foi então mudado para um implante intravítreo de dexametasona. Dez semanas depois, o implante foi observado no córtex posterior do cristalino. Como não houve melhora, a paciente foi submetida à cirurgia de facoemulsificação, durante a qual parte do cristalino migrou para a cavidade vítrea. Portanto, foi realizada vitrectomia completa via pars plana 23-gauge com administração de aflibercepte intravítreo durante a cirurgia. Lesões no cristalino devido a implantes intravítreos de dexametasona são uma complicação rara e geralmente resulta do procedimento de injeção. Abordagens cirúrgicas ou conservadoras imediatas devem ser consideradas caso a caso.

ABSTRACT The intravitreal dexamethasone implant is a sustained-release anti-inflammatory drug system that releases 0.7 mg of dexamethasone into the vitreous cavity. The following case report describes a rare complication: accidental injection of the dexamethasone implant into the crystalline lens. A 73-year-old woman was diagnosed with central retina vein occlusion and cystoid macular edema. Initial tSreatment included three monthly intravitreal doses of anti-vascular endothelial growth factor treatment, which was not successful. Treatment was then modified to an intravitreal dexamethasone implant. Ten weeks later, the implant was observed in the posterior cortex of the crystalline lens. Because no improvement had occurred, the patient underwent phacoemulsification surgery, during which part of the lens migrated into the vitreous cavity. Therefore, 23-gauge pars plana complete vitrectomy was performed with trans-surgical administration of intravitreal aflibercept. Crystalline lens injury due to an intravitreal dexamethasone implant is a rare complication and typically results from the injection procedure. Immediate surgical or conservative approaches should be considered on an individual basis.