Secondary glaucoma following vitreo-retinal surgeries

Abstract

Vitreoretinal surgeries either in the form of external compression by buckles or by increasing the intraocular volume by tamponades can cause a significant rise in intraocular pressure (IOP), causing glaucoma to be one of the most common consequences of vitreoretinal surgeries despite improved surgical techniques. Identifying the mechanism that causes the raised IOP is crucial as the management of glaucoma can differ accordingly. Intravitreal (IVT) injections in the form of IVT steroids or anti-vascular endothelial growth factor (anti-VEGF) injections can also cause a significant rise in the IOP and effect, especially the glaucomatous eyes, which are already predisposed. Not just the overlapping clinical features make the diagnosis confusing but also associated scarring of the conjunctiva, and the presence of episcleral hardware in some cases due to scleral buckle make the surgical management of glaucoma in these eyes very challenging. In this review, we describe in detail the various mechanisms causing secondary glaucoma post vitreoretinal surgeries with a focus on how to distinguish between them. We also discuss the possible consequences of anti-VEGF agents on IOP, various surgical challenges, and modifications with newer surgical options in the management of this refractory glaucoma.

Anterior Chamber / Iris / Pupil / Lens Related Complications in Vitreoretinal Surgery

“…29 Cerrahiye bağlı enflamasyon ve dejenere eritrositler tarafından trabeküler ağda oluşan blokaj, GİB'i artıran diğer mekanizmalardır. 30 Silikon yağı enjeksiyonunu takiben sekonder glokom insidansı %11 ile %48 arasında değişmektedir. Katarakttan sonra glokom gelişimi silikon yağı enjeksiyonunun ikinci sırada görülen geç postoperatif komplikasyonudur.…”

Challenges of Secondary Glaucoma Management Following Congenital Cataract Surgery, Penetrating Keratoplasty and Vitreoretinal Surgery

“…Mechanisms could include secondary pupillary block, preexisting glaucoma [20], chronic inflammation [21], silicone oil migration into the anterior chamber [22], trabecular meshwork obstruction caused by silicone emulsion [23], rubeosis iridis [24], or iridocorneal angle closure caused by anterior synechiae [25,26]. Identifying the mechanism that causes the raised IOP is crucial as the management of glaucoma can differ accordingly [27]. In our case, it was decided that the patient would need another antiglaucomatous surgery, and RE trabeculectomy was performed.…”

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