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Abstract #19081 Published in IGR 3-1
Silicone oil glaucoma
Minckler DJournal of Glaucoma 2001; 10: 51-54
With regard to these controversial series, the editor presents a 36-year-old man who was treated with vitrectomy, band encirclement, and injection of silicone oil, after a large bullous retinal detachment in his right eye. Intraocular pressure rose to 34 mmHg on the first postoperative day. The patient was given acetazolamide and brimonidine. This treatment was stopped after three weeks. Two months later the pressure was 40 mmHg. Fine globules of silicone oil were noted in the anterior chamber. The editor questions why the pressure is increased, what the treatment options are, what the cause of the increased pressure after two months is, and how the patient should be treated now. The experts in this are Stephen Best and Stephen Vernon. They feel that, among the possible causes of the early rise in intraocular pressure, are pre-existing glaucoma and the results of the scleral buckling procedure, such as decreased episcleral venous drainage and anterior segment ischemia and, furthermore, ciliary body swelling or ciliochoroidal effusion. Treatment consists of medical therapy, which can be effective in one-third of the cases, removal of silicone oil, and surgical management. The experts believe that trabeculectomy with adjunctive antifibrosis therapy may work and, if not, a shunt device can be used. Vernon puts cyclophotocoagulation as his first choice. The editor notes that many eyes with emulsified silicone oil visible in the anterior chamber and angle never develop increased intraocular pressure. His suggestion for the cause of the immediate pressure rise is choroidal effusion. This might give rise to a narrow angle. Diagnostic procedures would include ultrasound images. Alternative causes include postvitrectomy inflammation and vitreous debris occluding the meshwork. In all these cases, a pre-existing disposition to pressure rise is assumed. The editor is particularly in favor of draining devices.
Dr D. Minckler, Glaucoma Service, University of Southern California, Doheny Eye Institute, Los Angeles, CA 90033, USA
Classification:
9.4.11.5 Glaucomas associated with vitreoretinal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)