Long-term results of the management of silicone oil-induced raised intraocular pressure by diode laser cycloablation

Abstract

Aims/background To analyse the effectiveness and safety of cyclodiode treatment in eyes with silicone oil-related raised intraocular pressure (IOP) and to correlate the results with clinical features of treated eyes. Methods Retrospective review of case notes of all eyes that underwent cyclodiode treatment following injection of silicone oil at Moorfields Eye Hospital between April 1993 and January 2003 and were followed up for at least 1 year. Results In all, 38 patients were followed up for between 13 and 113 months. Totally, 17 had silicone oil in situ at the time of first treatment. The mean pretreatment IOP was 31.4 mmHg (SD 10.9), reducing to 18.6 mmHg (SD 8.6) at 1 year and to 13.9 mmHg (SD 8.4) at the final follow-up visit (Po0.001). Before treatment, 28 (73.7%) patients were on two or more topical medications. This was reduced to 18 (47.4%) patients (P ¼ 0.013) at 1 year and 13 (34.2%) patients (P ¼ 0.0007) at final follow-up. Use of oral acetazolamide for glaucoma was reduced from 16 (42.1%) patients precyclodiode to five (13.2%) patients at 1 year (P ¼ 0.0034) and three (7.9%) patients at the final visit (P ¼ 0.001). Four patients (10.5%) at 1 year and five patients (13.2%) at the final visit had hypotony (defined as IOP of less than 5 mmHg). One patient had enucleation 75 months following first cyclodiode treatment. Conclusion Diode laser photocoagulation can successfully control silicone oil-induced raised intraocular pressure where medical treatment fails. Reduction of IOP appears to be maintained long term.

Silikon Emülsifikasyonuna Bağlı Kontrol Edilemeyen Göz İçi Basıncı Yüksekliğinde Transskleral Diod Lazer Siklofotokoagülasyon

“…Its success rate varies from 66% to 86%. 11,12,17 According to our best knowledge, this is the largest study that evaluates the results of TDCP in eyes with medically uncontrolled IOP secondary to emulsification of SiO. Our present study suggests a long-term success (IOP<21 mmHg) rate of 84% at 12 months and 90% at final follow-up visit of up to 41 months.…”

“…The secondary glaucoma following the use of SiO with retinal surgery may be caused by migration of emulsified oil to the anterior chamber, synechial angle closure, rubeosis iridis, pupillary block, and inflammation, or a combination of these. 17,18 However, prophylactic surgical inferior iridectomy reduces the risk of pupillary block glaucoma in aphakic eyes. The migration of emulsified oil to the anterior chamber and into the trabecular meshwork may mechanically obstruct the trabecular meshwork or it may cause inflammation of the trabecular meshwork, leading to decreased outflow facility.…”

“…[13][14][15][16] Among the risk factors for IOP elevation after SiO injection, a history of preexisting glaucoma, SiO bubbles in the anterior chamber, emulsification of the SiO, diabetes mellitus, and aphakia have been reported. 9,14,17,18 Although the exact mechanism of IOP elevation is unknown, there are many theories about the role of SiO in IOP elevation. The secondary glaucoma following the use of SiO with retinal surgery may be caused by migration of emulsified oil to the anterior chamber, synechial angle closure, rubeosis iridis, pupillary block, and inflammation, or a combination of these.…”

Glaucoma management after vitreoretinal surgeries

“…Successful IOP control has been reported in 66–82% of patients at 1 year [90–92]. However, Sivagnanavel et al [93] reported a 56% treatment failure rate despite the use of higher mean laser energies and a higher retreatment rate.…”

Effectiveness of diode laser trans-scleral cyclophotocoagulation in patients following silicone oil-induced ocular hypertension in Chinese eyes

“…[1–3] A few reports have shown diode laser trans-scleral cyclophotocoagulation (TSCPC) as an effective tool in controlling IOP in SO-induced glaucoma. [45] We intended to look for short-term and long-term IOP control following diode laser TSCPC in Chinese eyes.…”