Silicone oil pupil block glaucoma in a pseudophakic eye

This report describes a case of acute pupillary block glaucoma related to migration of nonemulsified silicone oil into the anterior chamber (AC) in a young phakic patient. A 24-year-old male diabetic patient underwent uneventful left eye pars plana vitrectomy (PPV) with silicon oil endotamponade for diabetic macula-off tractional retinal detachment. Two weeks after discharge, he presented with severe left eye pain. Examination revealed hand motion vision, high intraocular pressure (IOP) of 67 mmHg with ciliary injection, corneal edema, and two large nonemulsified silicone oil bubbles in the AC at the pupillary margin. Medical management with topical antiglaucoma medications (AGMs) and intravenous acetazolamide and mannitol failed to reduce the IOP. The patient underwent left eye PPV, silicone oil removal, and AC wash. IOP was eventually controlled after the operation without AGM. Pupillary block glaucoma after silicone oil injection is well recognized in aphakic patients, but ophthalmologists should be aware that it can occur in phakic and pseudophakic patients, particularly in complicated cases and patients with a weakness of the iris–lens diaphragm.

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“…Definitive management involves inferior laser PI, surgical iridectomy, or silicone oil removal. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Pupillary block glaucoma due to anterior migration of nonemulsified silicone oil in a phakic patient

Al-Habsi

Al-Abri

2023

Oman Journal of Ophthalmology

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“…In phakic and pseudophakic patients, there is no role of prophylactic iridectomy or iridotomy usually as the risk of silicone oil pupil block is rare [ 5 ]. However, in cases of blunt trauma or cataract surgery with subclinical zonular loss and extensive vitreous base excision, displacement of silicone oil and pupillary block could occur [ 11 – 13 ]. In the present case, surgical iridectomy was not done as there was no reason to believe that there was a significant loss of zonular integrity, and no air entered the anterior chamber during the fluid-air exchange, which could have suggested the likelihood of the possibility of zonular dialysis.…”

Section: Discussionmentioning

confidence: 99%

A New Mechanism of Silicone Oil-Induced Glaucoma and Its Management

Kumar

Talwar

Thulasidas

et al. 2022

Case Reports in Ophthalmological Medicine

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Purpose. To describe a case of secondary acute angle closure glaucoma due to silicone oil migration into the posterior chamber causing entrapment of aqueous and its successful management. Case Presentation. A 69-year-old female presented with decreased vision and pain in the left eye (LE) for one month. She had a history of complicated phacoemulsification with nucleus drop and retinal detachment in LE, for which vitreoretinal surgery with silicone oil endotamponade was done. She was also a known case of primary open angle glaucoma on medications. The corrected distance visual acuity was 20/20 and 20/125 in the right eye (RE) and LE, respectively. The intraocular pressure (IOP) was 18 mmHg in RE and 45 mmHg in LE. Anterior segment examination of LE revealed 270° of iridocorneal apposition in the periphery of the anterior chamber. Fundus examination of LE showed silicone oil filled vitreous cavity with attached retina. Given the recent history of silicone oil injection and elevated IOP despite maximum antiglaucoma medications, we decided to perform laser peripheral iridotomy (LPI) in the area of iridocorneal apposition. Following LPI, the IOP in LE came down to 17 mmHg and remained stable within the normal range for one month, after which the patient was taken up for silicone oil removal. Conclusion. This case report highlights a new mechanism of silicone oil-induced glaucoma and the technique of performing LPI in the area of iridocorneal apposition, for the first time in the literature. Silicone oil migration into the posterior chamber from the vitreous cavity in the presence of zonular dehiscence can push the iris forward and lead to iridocorneal apposition, resulting in an acute rise in IOP. Performing LPI within the area of iridocorneal apposition can help the aqueous seep into the anterior chamber and release the silicone oil globule trapped behind the iris to enter the anterior chamber, thus relieving the iridocorneal adhesions and lowering the IOP.

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“…However, this complication has also been reported in phakic and pseudophakic eyes. 34,71,72 International Journal of General Medicine 2024:17…”

Section: Silicone Oil Migration Into Anterior Chambermentioning

confidence: 99%

Risk Factors and Management of Intraocular Pressure Elevation After Vitrectomy Combined with Silicone Oil Tamponade

Ge,

Su,

Fan

et al. 2024

IJGM

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Silicone oil has emerged as the common option for intraocular tamponade during complicated retina vitrectomy. However, the postoperative elevation of intraocular pressure (IOP), influenced by numerous factors, remains a significant and frequently encountered complication that poses a potential threat to vision. Extensive research has been conducted to investigate the risk factors associated with elevated IOP following silicone oil tamponade, including silicone oil viscosity, preoperative high IOP, diabetes, and lens status. This comprehensive review aims to gather and summarize the current research findings regarding the risk factors contributing to IOP elevation following silicone oil tamponade, as well as the optimal management strategies for secondary glaucoma. The analysis includes the physicochemical properties of silicone oil, preoperative and intraoperative risk factors, and the effective management of secondary glaucoma. Enhancing our understanding of the primary factors associated with silicone oil-induced IOP elevation will facilitate the guidance of timely and appropriate interventions.

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Silicone oil pupil block glaucoma in a pseudophakic eye

Cited by 7 publications

References 14 publications

Pupillary block glaucoma due to anterior migration of nonemulsified silicone oil in a phakic patient

Pupillary block glaucoma due to anterior migration of nonemulsified silicone oil in a phakic patient

A New Mechanism of Silicone Oil-Induced Glaucoma and Its Management

Risk Factors and Management of Intraocular Pressure Elevation After Vitrectomy Combined with Silicone Oil Tamponade

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