Glaucoma management after vitreoretinal surgeries

Abstract

Purpose of review The surgical management of retinal disorders, including scleral buckling procedures, pars plana vitrectomy, and intravitreal injections of gas or silicone oil, can lead to short-term elevations in intraocular pressure (IOP) and ultimately long-term glaucomatous damage if not treated in a timely manner. Glaucoma in these cases is commonly refractory to conventional therapies. This review highlights the treatment strategies for glaucoma in eyes that have previously undergone vitreoretinal surgery. Recent findings Although medical therapy is often used initially to control a temporary rise in IOP, laser and surgical therapy may be required to treat sustained IOP elevation and subsequent glaucomatous damage in eyes that have undergone intraocular surgery for retinal disorders. Glaucoma drainage devices are an important treatment modality, particularly when there is high risk of failure with filtering surgery. Summary Previous vitreoretinal surgery is a known risk factor for the development of glaucoma. Treatment is usually initiated with medical therapy, however, surgical intervention is frequently required to control IOP and prevent progressive glaucomatous damage in patients with refractory glaucoma.

<p>Incidence and outcomes of ocular hypertension from rhegmatogenous retinal detachment surgery in the acute postoperative setting</p>

“…Transient and sustained elevation of IOP is a relatively common occurrence following surgery to repair retinal detachment. The reported range of incidence of IOP elevation in the literature ranges from 4.8% to 44%, while modern literature reports a range of 11.6–12.9% 9–15. The calculated incidence obtained from the study is consistent with rates reported in other studies.…”

Silicone Oil-Induced Ocular Hypertension in Mouse Models Glaucomatous Neurodegeneration and Neuroprotection

“…Although intravitreal injection of SO in vitreoretinal surgeries can cause post-operative secondary glaucoma in humans(30, 31), we reasoned that direct injection of SO into the anterior chamber of mice would be more efficient, preventing the need to remove the vitreous and reducing toxicity due to direct contact with the retina. As illustrated in Fig.…”

“…A well-documented, secondary glaucoma with acutely elevated IOP occurs as a post-operative complication following the intravitreal use of silicone oil (SO) in human vitreoretinal surgery(30, 31). SO is used as a tamponade in retinal detachment repair due to it being buoyant with high surface tension.…”

Early Postoperative Intraocular Pressure Elevation after Vitreoretinal Surgery

“…Examinations included best-corrected visual acuity (BCVA), IOP, anterior segment detection by slip lamp and fundus examination via indirect ophthalmoscopy. Eyes with IOP ≥ 30 mmHg were treated with topical or systemic antiglaucomatous medication, anterior chamber paracentesis, laser iridoplasty, and inferior iridectomy [9]. Oil removal with or without concurrent glaucoma surgery may be required in eyes with uncontrolled high IOP after silicone oil injection.…”