OPHTHALMIC SURGERY, LASERS & IMAGING · VOL. 43, NO. 1, 2012 69 ■ TECHNIQUE ■ Transscleral Drainage of Subretinal/Suprachoroidal Silicone Oil Mahesh P. Shanmugam, DO, FRCS (Edin), PhD Rajesh Ramanjulu, MD, DNB, FVR R. Madhu Kumar, MS, FICO, FVR C. K. Minija, DO, DNB ABSTRACT Silicone oil migration into the subretinal space fol- lowing vitreoretinal surgery may occur in complex cases of retinal detachment with proliferative vitreo- retinopathy. This complication prevents achievement of the primary goal (ie, to attach the retina) and fails to provide the internal tamponade, leading to a perma- nent decrease in visual acuity. Successful and complete removal of the subretinal oil is a challenge. Internal drainage as described earlier in the literature advocates a large relaxing retinotomy. The authors describe two similar cases, one with retinal detachment secondary to type II iridochoroidal coloboma wherein the oil had passed into the subretinal space and the other with dia- betes mellitus and retinal detachment with oil in the suprachoroidal space. In both cases, silicone oil was removed successfully through a transscleral approach. The transscleral approach for removal of subretinal/su- prachoroidal oil appears to be relatively safe, less time- consuming, and effective. [Ophthalmic Surg Lasers Imaging 2012;43:69-71.] INTRODUCTION Silicone oil tamponade is often used to treat com- plex retinal detachments with proliferative vitreoreti- nopathy (PVR). Subretinal migration of silicone oil may occur in recurrent retinal detachment with PVR or as an intraoperative complication due to an acciden- tal injection into the subretinal/suprachoroidal space. Removal of the subretinal or suprachoroidal silicone oil in such situations is essential to achieve retinal reat- tachment. Silicone oil in the subretinal space is usually accessed through a large relaxing retinotomy, making the surgery more complex and also increasing the risk of PVR. 1 We describe a simple technique to remove subretinal/suprachoroidal silicone oil without the need for a large retinotomy. TECHNIQUE Case 1 A 24-year-old woman presented with microph- thalmia, total recurrent retinal detachment with PVR, coloboma choroid, and a large bubble of sub- retinal silicone oil (1,000 centistokes) (Fig. 1). The subretinal migration had occurred through the in- tercalary membrane break within the coloboma cho- roid. A three-port pars plana revision vitrectomy with non-vented infusion system (bottle height of 30 cm from the eye level) was performed, the minimal pe- ripheral PVR was relieved with peeling of the mem- branes, and a relaxing retinotomy was not necessary. The two superior sclerotomies were then temporar- ily closed. To facilitate removal of the subretinal sili- cone oil, a posterior sclerotomy (stab incision with 20-gauge microvitreoretinectomy blade) was made 6 mm from the limbus in the superior-nasal quadrant where the subretinal oil was found to be maximum. A choroidotomy through the sclerotomy allowed egress of the subretinal oil, the intravitreal infusion pressure facilitating the process. The sclerotomy was secured with the pre-placed suture once subretinal fluid start- From Sankara Eye Hospital, Karnataka, India. Originally submitted December 27, 2010. Accepted for publication October 3, 2011. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Rajesh Ramanjulu, MD, DNB, FVR, Sankara Eye Hospital, Vitreo-retina & Ocular oncology, Bangalore, Karnataka 560033, India. E-mail: drragraj@gmail.com doi: 10.3928/15428877-20111129-07 Video available on www.osli.com VIDEO