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Release of silicone oil and the off-label use of syringes in ophthalmology
  1. Gustavo Barreto Melo1,2,
  2. Geoffrey Guy Emerson3,
  3. Celso Souza Dias Jr1,
  4. Fábio Barreto Morais1,2,
  5. Acacio de Souza Lima Filho2,4,
  6. Shoko Ota5,
  7. Michel Eid Farah2,4,
  8. Eduardo Büchele Rodrigues2,4,
  9. Maurício Maia2,4,
  10. Rubens Belfort Jr2,4
  1. 1 Hospital de Olhos de Sergipe, Aracaju, Brazil
  2. 2 Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  3. 3 Retina Center of Minnesota, Minneapolis, Minnesota, USA
  4. 4 Vision Institute, IPEPO, São Paulo, Brazil
  5. 5 Chemical Analysis Laboratory, Center for Chemistry and Manufactured Goods, Institute for Technological Research, São Paulo, Brazil
  1. Correspondence to Dr Gustavo Barreto Melo, Hospital de Olhos de Sergipe, Aracaju 49020-380, Brazil; gustavobmelo{at}


Background/aims To assess silicone oil (SO) release by different brands of syringes used for intravitreal injection under different handling conditions.

Methods Eight syringes were analysed: from the USA, Terumo 0.5 mL, Becton-Dickinson (BD) Tuberculin 1 mL, BD Luer-lok 1 mL, BD Ultra-Fine 0.3 mL and Exel Insulin 0.3 mL; from Germany, Braun Omnifix-F 1 mL and Braun Injekt-F 1 mL and from Spain, BD Plastipak 1 mL. The impact of air, priming the plunger, agitation by flicking and fluid temperature on SO release were assessed by light microscopy. Fourier transform infrared spectroscopy (FTIR) was performed to identify the molecular compound in each syringe.

Results Five hundred and sixty syringes were analysed. Terumo 0.5 mL and BD Ultra-Fine 0.3 mL released more SO than all others. BD Luer-lok 1 mL, BD Plastipak and Braun Omnifix-F 1 mL released little SO; BD Tuberculin 1 mL, Exel 0.3 mL and Braun Injekt-F 1 mL released the least SO. Priming the syringe and different temperatures did not significantly affect SO release. Agitation by flicking caused a significantly higher proportion of samples to have SO droplets and an increased number of oil droplets. Air had an additive effect on the release of oil in the agitation groups. FTIR identified polysiloxane in all syringes but Injekt-F.

Conclusion Syringes commonly used for intravitreal injections frequently release SO droplets, especially when agitated by flicking. To avoid unnecessary ocular risks, syringes should not be agitated before intravitreal injection. It is desirable that syringes be manufactured specifically for ophthalmic use.

  • syringe
  • intravitreal injection
  • silicone oil droplets

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  • Contributors GBM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. GBM, GGE, ASL, MM, EBR contributed to the study concept and design. RBJr, CSDJr, MEF, GBM, FBM, SO, GGE and ASL contributed to the acquisition, analysis or interpretation of data. GBM and GGE drafted the manuscript. All authors contributed to the critical revision of the manuscript for important intellectual content and the final approval.

  • Funding This study was supported by EyePharma (São Paulo, Brazil), FAPESP (São Paulo, Brazil), CNPq (Brasília, Brazil) and Pan-American Association of Ophthalmology/Pan-American Ophthalmological Foundation, Paul Kayser/Retina Research Foundation Global Award (Pan-American Association of Ophthalmology/Pan-American Ophthalmological Foundation, Arlington, Texas, USA). None of the funders/sponsors had any role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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