Surgical management of secondary glaucoma after pars plana vitrectomy and silicone oil injection for complex retinal detachment

Objective: To evaluate the outcomes of surgical intervention for secondary glaucoma after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment. Design: Retrospective noncomparative interventional case series. Participants: Forty-three eyes of 43 patients who underwent incisional surg ery for secondary glaucoma after pars plana vitrectomy and silicone oil inj ection for repair of complex retinal detachment over a 9-year period. Main Outcome Measures: Intraocular pressure (IOP), intraoperative and posto perative complications, visual acuity, and the need for further surgical in tervention for glaucoma. Success was defined as IOP less than or equal to 2 1 mmHg and greater than or equal to5 mmHg with or without medication but wi thout surgical reoperation for glaucoma. Results: Findings associated with elevated IOP included emulsified oil in t he anterior chamber (n = 14), pupillary block from silicone oil (n = 13), o pen-angle glaucoma without silicone oil in the anterior chamber (n 9), and angle-closure glaucoma without pupillary block (n = 7). The mean (+/- stand ard deviation) IOP was 41.4 +/- 15.1 mmHg before surgery for glaucoma and 1 7.2 +/- 10.2 mmHg after an average follow-up of 19.6 months (P < 0.001). Cu mulative success was 69%, 60%, 56%, and 48% at 6, 12, 24, and 36-months res pectively. In patients who underwent silicone oil removal alone for surgica l management of glaucoma (n = 32), 11 of 12 IOP failures (92%) were due to uncontrolled IOP, whereas most IOP failures in the group who underwent sili cone oil removal plus glaucoma surgery (n = 8) failed because of hypotony ( 3 of 4, 75%, P = 0.027). Of three patients who underwent glaucoma surgery a lone to control IOP, one failed because of hypotony. There was no significa nt change in visual function at last follow-up (logarithm of the minimum an gle of resolution [logMAR] 2.01) compared with preoperative visual function (logMAR 2.07, P = 0.74). Conclusion: Surgical management of secondary glaucoma after silicone oil in jection for complex retinal detachment may achieve good IOP control and sta bilization of visual function in most patients. Patients who undergo silico ne oil removal alone to control IOP are more likely to have persistent elev ation of IOP and possibly undergo reoperation for glaucoma, whereas patient s who undergo concurrent silicone oil removal and glaucoma surgery are more likely to have hypotony.