Risk Factors for Band Keratopathy in Aphakic Eyes With Silicone Oil Tamponade for Open-Globe Injuries: A Multicenter Case-Control Study

Abstract

Band keratopathy (BK) is a common complication in aphakic eyes with silicone oil tamponade for open-globe injury (OGI), characterized by the grayish-white opacities in the cornea, resulting in a significantly decreased vision when extending to the visual axis. To identify the risk factors for BK in aphakic eyes following vitreoretinal surgical treatment with silicone oil tamponade for OGIs, we performed a multicenter case-control study. The incidence of BK was 28% (28/100 eyes). The multivariate binary logistic regression revealed the silicone oil retention time (SORT) ≥6 months and zone III injury were significant risk factors for BK. From the hierarchical interaction, SORT ≥6 months had a significant risk for BK in eyes with rupture, aniridia, and zone III injury, while zone III injury had a significant risk for BK in eyes with rupture, incomplete/complete iris, and SORT ≥6 months. By using restricted cubic splines with three knots at the 25th, 50th, and 75th centiles to model the association of SORT with BK, we also found a marked increase in the risk for BK at ≥10 months and a slow increase after 6 months, but almost stable within 4–6 months.

Sociodemographic Factors and Comorbidities Including Hyperparathyroidism Are Associated With an Increased Risk of Band Keratopathy: A Population-Based Study in Taiwan

“…Silicone oil is either removed 3–6 months postoperatively or long-term silicone tamponade is performed depending on various diseases and situations. The observation is the same as that in several studies, which demonstrated that silicone oil tamponade is an important risk factor for band keratopathy ( 6 , 7 , 37 ) even after removal ( 38 ). Although the mechanism of band keratopathy is multifactorial, many studies have shown that silicone oil plays a significant role in the development of band keratopathy ( 7 , 37 ) and that the tissue toxicity of silicone oil or pH changes due to from decreased flow across the corneal tissue may be associated with band keratopathy development ( 39 ).…”

“…Histological analysis of affected corneas shows a fine granular calcification in the superficial cornea including the Bowman’s membrane and deep-situated calcium plaques involving the anterior stroma ( 1 , 3 ). A variety of factors are associated with band keratopathy, including chronic ocular conditions such as uveitis ( 4 , 5 ), silicon oil retention ( 6 , 7 ) and phthisis bulbi; and systemic condition such as diabetes mellitus (DM), chronic kidney disease (CKD) ( 8 ), elevated serum phosphate levels and increased serum calcium levels that are possibly related to secondary hyperparathyroidism ( 9 – 11 ).…”

Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

“…The pathophysiology of BK can be multifactorial, oftentimes resulting from chronic inflammation, corneal ulcers, chemical burns and multiple surgeries. 37 However, it has been reported that SO can contribute to the development of BK, 38 which usually occurs following prolonged SO contact with the corneal endothelium, [38][39][40] with an incidence of 6% to 28%. 38,39,41,42 SO blocks the transport of nutrients from the aqueous humor, leading to a lower endothelial metabolic rate.…”

“…37 However, it has been reported that SO can contribute to the development of BK, 38 which usually occurs following prolonged SO contact with the corneal endothelium, [38][39][40] with an incidence of 6% to 28%. 38,39,41,42 SO blocks the transport of nutrients from the aqueous humor, leading to a lower endothelial metabolic rate. 43 This results in a reduction of lactic acid production, with no change in the rate of carbon dioxide loss due to constant evaporation.…”

“…67 Although there are no reported differences in the rate of corneal complications based on the type of oil, the rate of complications does increase the longer the oil remains inside the vitreous cavity, with a significantly increased risk after 6 months. 38,39,41,42 A considerable risk factor for developing corneal abnormalities with the use of SO is aphakia or pseudophakia given the compromised lensiris diaphragm, which allows for anterior migration of the SO and subsequent endothelial damage. 68 Animal studies have shown that exposure to SO increases membrane permeability, disrupting the barrier function of the corneal endothelium.…”