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Abstract #18395 Published in IGR 3-3
Surgical management of secondary glaucoma after pars plana vitrectomy and silicone oil injection for complex retinal detachment
Budenz DL;
Taba KE;
Feuer WJ;
Eliezer R;
Cousins S;
Henderer J;
Flynn HW JrOphthalmology 2001; 108: 1628-1632
OBJECTIVE: To evaluate the outcome of surgical intervention for secondary glaucoma after pars plana vitrectomy and silicone oil injection for the repair of complex retinal detachment. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Forty-three eyes of 43 patients who underwent incisional surgery for secondary glaucoma after pars plana vitrectomy and silicone oil injection for the repair of complex retinal detachment over a nine-year period. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), intraoperative and postoperative complications, visual acuity, and the need for further surgical intervention for glaucoma. Success was defined as IOP ≤21 mmHg and 5 mmHg with or without medication, but without surgical reoperation for glaucoma. RESULTS: Findings associated with elevated IOP included emulsified oil in the anterior chamber (n = 14), pupillary block from silicone oil (n = 13), open-angle glaucoma without silicone oil in the anterior chamber (n = 9), and angle-closure glaucoma without pupillary block (n = 7). The mean (± SD) IOP was 41.4 ± 15.1 mmHg before surgery for glaucoma and 17.2 ± 10.2 mmHg after an average follow-up of 19.6 months (p < 0.001). Cumulative success was 69, 60, 56, and 48% at six, 12, 24, and 36 months, respectively. In patients who underwent silicone oil removal alone for the surgical management of glaucoma (n = 32), 11 of 12 IOP failures (92%) were due to uncontrolled IOP, whereas most IOP failures in the group that underwent silicone oil removal plus glaucoma surgery (n = 8), were because of hypotony (three of four, 75%, p = 0.027). Of three patients who underwent glaucoma surgery alone to control IOP, one failed because of hypotony. There was no significant change in visual function at the last follow-up (logarithm of the minimum angle of resolution (logMAR) 2.01) compared with preoperative visual function (logMAR 2.07, p = 0.74). CONCLUSIONS: Surgical management of secondary glaucoma after silicone oil injection for complex retinal detachment may achieve good IOP control and stabilization of visual function in most patients. Patients who undergo silicone oil removal alone to control IOP are more likely to have persistent elevation of IOP and possibly have to undergo reoperation for glaucoma, whereas patients who undergo concurrent silicone oil removal and glaucoma surgery are more likely to have hypotony.
Dr D.L. Budenz, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136, 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)
