Effect of diode laser trans-scleral cyclophotocoagulation in the management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments

Abstract

Aims-To evaluate the eVect of trans scleral cyclophotocoagulation (TSCPC) on intraocular pressure (IOP) in the eyes retaining intravitreal silicone oil with medically uncontrolled secondary glaucoma following intravitreal silicone oil injection. Methods-Medical records of 11 eyes of 11 patients who underwent TSCPC for medically uncontrolled glaucoma without pupillary block following intravitreal silicone oil injection for complicated retinal detachment were reviewed retrospectively. In all cases, intravitreal silicone oil was not removed for fear of retinal redetachment. Diode laser contact TSCPC was performed at a power of 1.5-2.5 W, for a duration of 2 seconds, and with 20-27 applications. IOP, number of glaucoma medications, and success rate were evaluated. Results-After a mean follow up period of 52.5 (SD 8.2) (range 42-68) weeks, the mean pretreatment level of IOP, 43.0 (14.4) (26-67) mmHg, had fallen to 14.5 (4.3) (7-20) mm Hg (p=0.003). The number of glaucoma medications was reduced from 2.6 (0.8) to 0.6 (1.0) (p= 0.005). Qualified success was achieved in nine eyes (81.8%) and complete success in six (54.5%). After TSCPC, patients' retinal status had not changed. Conclusion-Patients with medically uncontrolled glaucoma secondary to intravitreal silicone oil injection can be treated with TSCPC in spite of the retained intravitreal silicone oil. (Br J Ophthalmol 1999;83:713-717)

Diode laser trans-scleral cyclophotocoagulation in the management of glaucoma in patients with long-term intravitreal silicone oil

“…Trans-scleral cyclodiode photocoagulation (TSCPC) has been demonstrated as a safe and effective method of treating intractable glaucoma in eyes retaining silicone oil. [1][2][3] Below, we describe the effect on IOP of TSCPC based on the retrospective review of medical records of patients with intravitreal silicone oil and intractable glaucoma.…”

“…3 Nguyen et al 6 reported a higher incidence of 48%. 5 The glaucoma associated with intravitreal silicone oil presents a difficult management problem.…”

“…Inflammation, phacolysis, steroid response, pupillary block and rubeosis iridis were among such mechanisms proposed by De Corral et al 9 Removal of silicone oil is at present the primary surgical method of reducing IOP when medical treatment no longer affords control. 3 Reports of successful medical control of IOP rises after silicone oil removal alone vary from three out of five patients (60%) by Casswell and Gregor 5 and eight out of 14 patients (57%) by Nguyen et al 6 However, removal of silicone oil is not a viable option in many patients with PVR and Casswell and Gregor 6,10 report retinal re-detachment as the most common major complication following silicone oil removal.…”

“…2 TSCPC has recently been reported as a safe and effective method of controlling glaucoma that is refractory to medical treatment in eyes with reasonable visual potential. [1][2][3] However, there are few detailed published reports of the use of TSCPC in silicone oilrelated glaucoma. One of the largest series reported is by Bloom et al who performed TSCPC in 210 eyes with various types of glaucoma uncontrolled on medical or surgical methods including previous cycloablative treatment.…”

Secondary Glaucoma After Vitreoretinal Procedures

“…However one case underwent a modified Schocket procedure but didn't achieve normal IOPs. Transscleral cyclophotocoagulation has shown successful IOP control in 74-82% of patients after 1 year although the visual function was poor in these patients (Bloom et al 1997 andHan et al, 1999). Early removal of silicone oil (6/12) has been noted to have reduced risk of secondary glaucoma and similar redetachment rates (Han et al 1998).…”