Silicone-induced ophthalmohypertension

PURPOSE: To demonstrate the results of conservative treatment for secondary ocular hypertension associated with silicone oil (SO) 5000-s tamponade of the vitreal cavity (VC).
METHODS: We conducted a retrospective analysis of conservative treatment for ocular hypertension associated with SO 5000-s tamponade of the VC in 45 eyes (45 patients). Patients’ age ranged from 28 to 75 years: 22 males (49% of 45 patients), 23 females (51% of 45 patients). Among them 16 patients had high myopia (35% of 45 patients), 17 patients (38% of 45 patients) had moderate myopia, 8 patients (18 % of 45 patients) had mild myopia, 4 patients (9% of 45 patients) had emmetropia. All patients had previously underwent an operation for rhegmatogenous retinal detachment (primary and recurrent) with VC tamponade by means of silicone oil 5000-s. The tamponade duration was 3 months or more.
RESULTS. In 33% of cases (15/45) we noted an intraocular pressure (IOP) increase during the first 48 hours after the insertion of SO 5000-s into the vitreal cavity, in 27% (12/45) — within the 1-4 months timeframe, in 24% (11/45) — 4-6 months, in 16% (7/45) — 6-12 months. IOP fluctuation range was 19-32 mm Hg. The first hypotensive regimen (1) included instillations of fixed combination brinzolamide/ timolol twice daily and sufficiently decreased IOP level in 27 patients (60% of 45 patients; IOP range 14-19 mm Hg). The second regimen (2) included additional instillations of brimonidine 0,15% 3 times per day and lead to IOP normalization in 11 more patients (24% of 45 patients; IOP range 15-20 mm Hg). Patients with persisting IOP decompensation had a further regimen enhancement. The third regimen (3) also included latanoprost 0.005% solution instillation once daily in the evening. IOP level normalization was achieved in 6 patients (14% of 45 patients; IOP range 17-19 mm Hg). One patient (2%) had to undergo a glaucoma operation. Out of 16 high myopia patients, 4 patients reached IOP compensation due to the first regiment, 7 patients — the second regimen; 4 patients — the third regimen, 1 patient — to the glaucoma operation.
CONCLUSION: IOP compensation by means of conservative treatment was effective in most cases (98% of 45 patients). In one case (2% of 45 patients) of persisting IOP decompensation glaucoma surgery had to be performed. The highest IOP level was noted in high myopia patients; they needed a more intensive hypotensive regimen than patients with other kinds of refraction.

1. Neroev V.V., Sarygina O.I., Oftal’mologiya, natsional’noe rukovodstvo [Ophtalmology, National guide]. Moscow: «GEOTAR-Media»; 2008: 640 р. (In Russ.).

2. Takhchidi Kh.P., Kazaikin V.N., Sosnovskikh R.V., Burdin A.B. Physicochemical justification for the use of perftluorocarbon and silicone fluids for tamponade of the vitreal cavity. Ophthalmosurgery. 2000;4:76-82. (In Russ.).

3. Lucke K., Laqua H. Silicone oil in the treatment of complicated retinal detachments. Berlin, Springer-Verlag; 1990: 161. doi: 10.1007/978-3-642-84266-5.

4. Costarides A.P. Elevated intraocular pressure following vitreoretinal surgery. Opthalmology Clinics of North America 2004; 17(4):507-512. doi: 10.1007/978-3-642-84266-5.

5. Han D.P. Mechanisms of intraocular pressure elevation after pars plana. Ophthalmology. 1989; 96:1357. doi: 10.1016/j.ohc.2004.06.007.

6. Ahn S.J. Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy. Eye. 2012; 26(6):796-802. doi: 10.1038/eye.2012.23.

7. Hasegawa Y. Intraocular pressure elevation after vitrectomy for varios vitreoretinal disorders. Eur J Ophthalmol. 2013; 24(2):235-241. doi: 10.5301/ejo.5000350.

8. Ho L. Study of intraocular pressure after 23-gauge and 25-gauge pars plana vitrectomy randomised to fluide versus air fill. Retina. 2011; 31(6):1109-1117. doi: 10.1097/iae.0b013e31820b5b9b.

9. Gosse E. Changes in day 1 post-operative intraocular pressure following sutureless 23-gauge and conventional 20-gauge pars plana vitrectomy. The Open Ophthalmology J. 2013; 7:42-47. doi: 10.2174/1874364101307010042.

10. Popovic S. The effect of vitrectomy with silicone oil tamponade on intraocular pressure and anterior chamber morphology. Coll. Antropol. 2001; 25:117-125..

11. Takhchidi Kh.P., Kazaikin V.N., Sosnovskikh R.V. Problems and prospects of application of perfluorocarbons and silicone oils in the treatment of retinal detachment. New in Ophthalmology 2001; 50-53. (In Russ.).

12. Parolini B. Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconuctival pars plana vitrectomy with 1-year follow-up. Retina. 2010; 30(1):107-111. doi: 10.1097/iae.0b013e3181b21082.

13. Ichhpujani P. Silicone oil indused glaucoma. Graefes Arch Clin Exp Ophthalmol. 2009; 247:1585-1593.

14. Ardjomand N. Pupillary block after silicone oil implantation in aphakic eye. Eye. 2001; 15(3):331. doi: 10.1038/eye.2001.106.

15. Sergienko V.V. Hydrodynamics of the eyes with retinal detachment in the first month of a silicone tamponade of the vitreal cavity. Visnik problem biologii i meditsini. 2017; 3(1):137-142.