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

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) The injection of intravitreal silicone oil for the management of complicated retinal detachment can be associated with elevated intraocular pressure (IOP). When secondary glaucoma is resistant to medical treatment, removal of this oil is the treatment of choice. Owing to complications such as redetachment of the retina or hypotony, a physician may, however, be reluctant to follow this course of action. In intractable glaucoma cases, trans-scleral cyclophotocoagulation (TSCPC) has recently been shown to eVectively reduce IOP in silicone oil induced glaucoma. The eYcacy of this treatment in the eye retaining intravitreal silicone oil has not yet been reported, however. We retrospectively reviewed the course of postoperative IOP in patients who underwent TSCPC for medically uncontrolled secondary glaucoma following intravitreal silicone oil injection for complicated retinal detachment. Subjects and methods Between 1 April 1996 and 31 July 1997, surgery for the management of medically uncontrolled glaucoma secondary to intravitreal silicone oil injection was performed at Seoul National University Hospital on 11 eyes of 11 consecutive patients who had given their informed consent. Medically uncontrolled glaucoma was defined as occurring (1) when IOP was equal to or higher than 25 mm Hg, in spite of the use of two or more antiglaucoma medications, and (2) when eyeball pain, headache, or a sign of corneal oedema presented as a secondary symptom. Patients with severe ocular pain or severe corneal decompensation due to increased IOP underwent TSCPC, even though they had no light perception. Patients with advanced glaucoma intolerant of antiglaucoma medications (for example, oral acetazolamide in patients with severe diabetic nephropathy) in an attempt to reduce or stop medications were also included in this study. Eyes with pupillary block were not treated by TSCPC. Eyes with a diagnosis of glaucoma antedating silicone oil injection, or with a history of filtering, implant, or cyclodestructive surgery did not undergo TSCPC. Of the 11 patients who underwent TSCPC, nine were men and two were women; their mean age was 46.9 (SD 9.2) (range 29–63) years. The mean follow up period was 52.5 (8.2) (42–68) weeks. At the time of silicone oil injection, three patients (cases 1, 7, 10) presented with combined rhegmatogenous and tractional retinal detachment associated with high risk proliferative diabetic retinopathy, one patient (case 3) presented with traumatic retinal detachment, three patients (cases 2, 5, 8) presented with proliferative vitreoretinopathy with aphakic or pseudophakic retinal detachment after cataract extraction or clear lens extraction, and four patients (cases 4, 6, 9, 11) presented with severe proliferative vitreoretinopathy with rhegmatogenous retinal detachment (Table 1). The mean number of operations before TSCPC was 3.4 (SD 1.1) (range 2–5). Seven patients (cases 1, 2, 5, 8, 9, 10, 11) had corneal subepithelial oedema and Br J Ophthalmol 1999;83:713–717 713 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea S K Han K H Park D M Kim B L Chang