Corneal intrastromal silicone injection in severe corneal decompensation as a last resort for pain management: A case series.

PURPOSE: To describe a surgical approach to treating painful bullous keratopathy using an intracorneal silicone bubble in patients with poor visual potential.

METHODS

Two eyes of two patients with painful bullous keratopathy are presented in this paper. The surgical technique consists of two steps. First, a corneal stromal pocket is created using the femtosecond laser. Then, an intrastromal bubble of heavy silicone is injected into this corneal pocket. The pocket is then tightly sutured with a nylon suture. Care must be taken to inject an adequate size silicone bubble that is big enough to relieve the epithelial edema and pain while sparing enough corneal tissue to allow proper corneal nutrition and prevent corneal ischemia.

RESULTS

The intrastromal corneal silicone bubble was successful in stopping the hydration of the cornea around the silicone bubble thus relieving the ocular pain in both patients. Pain control and the intrastromal silicone bubble remain stable with up to one year of follow-up.

CONCLUSIONS

Intrastromal injection of a silicone bubble is a safe technique that can reduce corneal edema and relieve ocular pain in bullous keratopathy.