Early postoperative silicone oil migration causing wound gape with secondary glaucoma and reversal with prone positioning

A 36-year-old male patient presented with RE corneal tear and retained IOFB in the posterior segment. He underwent corneal tear repair, pars plana vitrectomy, lensectomy, IOFB removal, and SOI with surgical peripheral iridectomy. On the next day (8 am), his RE IOP was elevated (36 mmHg). Anterior chamber was completely filled with silicone oil. Retina was attached. On high magnification, tiny silicone oil bubbles were trapped between the sutured margins of the corneal tear, causing wound gape, which was confirmed on anterior segment optical coherent tomography [Fig. 1]. The patient was started on two topical AGMs (brimonidine and timolol) and asked to adopt strict prone positioning. At 12 pm, the silicone oil bubble started to recede, corneal wound gape was apposed, and IOP became normal (15 mmHg) [Fig. 2]. At 4 pm, silicone oil bubbles had completely receded, corneal wound was stable, IOP was normal, and retina was attached [Fig. 3]. We are reporting this case for the rare sequence of events – silicone oil in an aphakic vitrectomized eye migrating anteriorly, partially dehiscing the sutured corneal wound with subsequent raised IOP. Lowering of IOP with AGM and prone positioning aided the silicone oil bubble to recede from the corneal wound and go back posteriorly. This avoided a secondary intervention, as well as mitigated keratotoxicity.Figure 1: RE post operative day 1 picture at 8 in the morning, (a) Slit lamp photograph showing tiny silicon bubbles trapped within the sutured corneal wound. (b) AS OCT image- hyper-reflective shadow of the silicon bubble (depicted with the orange arrow) within the corneal wound, causing the wound gapeFigure 2: RE post operative day 1 picture at 12 pm, after adopting 4 hours of prone position. Slit lamp biomicroscopic photograph showing partially receding silicone oil from anterior chamberFigure 3: RE post operative day 1 picture at 4 pm, after adopting 8 hours of prone positioning. (a) Slit lamp biomicroscopic photograph depicting well apposed corneal wound with complete recession of silicon oil bubbles. (b) AS OCT confirming the corneal wound is well apposed (yellow star) and absence of any silicone oil bubbles within the wound siteDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.