Silicone Oil Droplets After Bevacizumab Intravitreal Injection

Although this rare occurrence is not harmful, patients and clinicians should be educated on the potential sequelae following anti-VEGF treatment.

By Eric K. Chin, MD; and David R.P. Almeida, MD, MBA, PhD

Intravitreal injection of VEGF antagonists is the accepted gold standard for the management of neovascular (exudative) age-related macular degeneration, diabetic retinopathy with and without diabetic macular edema, and macular edema secondary to retinal vein occlusion.

Figure. Ultra-widefield color fundus photographs taken with the California (Optos) highlighting silicone oil droplets (red circles) in three patients receiving intravitreal bevacizumab (Avastin, Genentech). Commonly, these droplets are described as symptomatic vitreous opacities consisting of a dark ring surrounding a bright center. Note the varying sizes and appearances.

Reports of symptomatic silicone oil droplets accumulating in the vitreous cavity immediately upon injection occurred in the early days of intravitreal injection,1,2 and reports of silicone oil droplets following injection of compounded bevacizumab (Avastin, Genentech) can be found in the more recent literature (Figure).3,4 These have been attributed to silicone oil used as a lubricating agent in needles and syringes. The oil droplets should not be confused with a contamination or complication of the medication itself, but rather are secondary to the repackaging of the medication in polypropylene syringes lined with silicone oil.

1. Bakri SJ, Ekdawi NS. Intravitreal silicone oil droplets after intravitreal drug injections. Retina. 2008;28(7):996-1001.

2. Freund KB, Laud K, Eandi CM, Spaide RF. Silicone oil droplets following intravitreal injection. Retina. 2006;26(6):701-703.

3. Avery RL, Castellarin AA, Dhoot DS, et al. Large silicone oil droplets after intravitreal bevacizumab (Avastin). Retin Cases Brief Rep. 2019;13(2):130-134.

4. Olea JL, Gómez-Resa M, Cervera-Peris MM, Aragón JA. Silicone oil droplets in repackaged anti-vascular endothelial growth factors for intravitreal injections: In search for the main source of contamination. Eur J Ophthalmol. 2019:1120672118823133.

David R.P. Almeida, MD, MBA, PhD
• Vitreoretinal Surgeon, Erie Retinal Surgery, Erie, Pennsylvania; Twitter: @davidalmeidaMD
• Financial disclosure: Advisory Board, Consultant, Speaker, (Alcon, Allergan, Bayer, Genentech, Novartis, Regeneron), Cofounder, Equity Holder (Citrus Therapeutics)

Eric K. Chin, MD
• Vitreoretinal Surgeon, Retina Consultants of Southern California, Redlands, California
• Assistant Professor, Loma Linda University and Loma Linda Veterans Affairs Hospital, Loma Linda, California
• Financial disclosure: Consultant (Alcon, Allergan, Chendgu Kanghong Biotechnology, Citrus Therapeutics, Genentech, Novartis, Ophthotech, Opthea)


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Retina Today is a publication that delivers the latest research and clinical developments from areas such as medical retina, retinal surgery, vitreous, diabetes, retinal imaging, posterior segment oncology and ocular trauma. Each issue provides insight from well-respected specialists on cutting-edge therapies and surgical techniques that are currently in use and on the horizon.