Prótese de íris, na aniridia traumática, como tentativa de controlar glaucoma refratário provocado pela presença de óleo de silicone na câmara anterior: relato de caso

Abstract

The objective of this report is to demonstrate the effectiveness of an iris prosthesis to treat a refractory glaucoma induced by silicone oil in the anterior chamber. This case is about a patient who suffered a trauma caused by firearm shrapnel. A vitreous-retinal surgery was performed to remove intraocular foreign matter and to realign the retina that was detached. Due to the partial traumatic aniridia, silicone oil that was introduced in the vitreous chamber to keep the retina in place migrated to the anterior chamber, resulting in the decrease of endothelium cells and uncontrollable intraocular pressure. We performed transscleral fixation of the iris prosthesis to correct these problems. After a 45-month period of evolution, sight became stable at the 1 meter finger-count distance and intra-ocular pressure at 14 mmHg We may conclude that the triad that consists of lack of: iris diaphragm, aphakia and silicone oil that could not be removed because of inexorable occurrence of detachment of the retina should lead the surgeon to consider transscleral fixation of the iris prosthesis. This procedure might control intraocular pressure and/or preserve corneal transparency, preventing silicone oil from contact with the trabecular net and the corneal endothelium.

Depósito subconjuntival de óleo de silicone após cirurgia vitreorretiniana

“…A cirurgia de vitrectomia posterior associada ao implante intra-ocular de óleo de silicone permitiu maior êxito na aplicação anatômica da retina descolada quando outros procedimentos falharam. Entretanto, inúmeras complicações associadas ao uso intra-ocular de silicone são relatadas na literatura (1)(2)(3)(4)(5)(6) , tais como catarata, ceratopatia em faixa, hipertensão ocular, emulsificação do óleo de silicone, uveíte crônica, dor ocular, proliferação fibrovascular, membranas pupilares, endoftalmite e depósito subconjuntival de óleo de silicone (1,7) . O extravasamento do óleo de silicone para o espaço subconjuntival é, portanto, uma das complicações possíveis (1)(2)(3)5) .…”