Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2017 Sep 5.
Published in final edited form as: Curr Opin Ophthalmol. 2016 Mar;27(2):125–131. doi: 10.1097/ICU.0000000000000238

Glaucoma management after vitreoretinal surgeries

Helen L Kornmann 1, Steven J Gedde 1
PMCID: PMC5584058  NIHMSID: NIHMS896052  PMID: 26595848

Abstract

Purpose of review

The surgical management of retinal disorders, including scleral buckling procedures, pars plana vitrectomy, and intravitreal injections of gas or silicone oil, can lead to short-term elevations in intraocular pressure (IOP) and ultimately long-term glaucomatous damage if not treated in a timely manner. Glaucoma in these cases is commonly refractory to conventional therapies. This review highlights the treatment strategies for glaucoma in eyes that have previously undergone vitreoretinal surgery.

Recent findings

Although medical therapy is often used initially to control a temporary rise in IOP, laser and surgical therapy may be required to treat sustained IOP elevation and subsequent glaucomatous damage in eyes that have undergone intraocular surgery for retinal disorders. Glaucoma drainage devices are an important treatment modality, particularly when there is high risk of failure with filtering surgery.

Summary

Previous vitreoretinal surgery is a known risk factor for the development of glaucoma. Treatment is usually initiated with medical therapy, however, surgical intervention is frequently required to control IOP and prevent progressive glaucomatous damage in patients with refractory glaucoma.

Keywords: glaucoma, medical and surgical management, vitreoretinal surgery

INTRODUCTION

Intraocular pressure (IOP) elevation and progressive glaucomatous damage are known postoperative complications following vitreoretinal surgeries. Moreover, eyes that require vitreoretinal surgery may already be prone to pressure elevations. Eyes with primary open angle glaucoma (POAG) experience retinal detachments at a higher rate than normal eyes, and the prevalence of POAG in eyes with a retinal detachment is reportedly 4–12 times higher than the general population [1,2]. Although it is not clear why POAG predisposes to retinal detachment, the prevalence of myopia as a common risk factor in both disorders [3] and the use of miotics in glaucoma therapy producing retinal detachments have been suggested as possible explanations [2,4,5]. Additionally, glaucoma may occur as a direct consequence of the surgical repair of retinal detachment. Detecting glaucomatous damage may be difficult when the underlying retinal disorder precludes accurate assessments of visual fields or the optic nerve, but early recognition and treatment can reduce ocular morbidity.

GLAUCOMA AFTER SCLERAL BUCKLE

Incidence, risk factors, and pathogenesis

The incidence of angle-closure glaucoma after scleral buckling procedures has been reported to range from 1.4 to 4.4% [2,6–9]. Clinical and experimental data suggest that angle-closure occurs as a result of impaired venous drainage through the vortex veins by the scleral buckle, leading to congestion and swelling of the ciliary body. As the ciliary body swells, it rotates anteriorly and shifts the lens-iris diaphragm forward. These morphological changes have been demonstrated experimentally and can be seen on fundoscopic examination or by ultrasonography and ultrasound biomicroscopy [10,11]. Several factors are associated with the development and extent of angle shallowing, including preexisting narrow angles [6,8], use of an encircling band [7,12], placement of an encircling band anterior to the equator [8], high myopia [6], older age [6], and postoperative ciliochoroidal detachment [8].

Medical therapy

In most cases, angle-closure glaucoma after scleral buckling procedures resolves spontaneously over a period of several days to weeks as the ciliary body congestion and swelling improve. Medical therapy includes cycloplegics to relax the ciliary muscle and shift the lens-iris diaphragm posteriorly, and topical corticosteroids to reduce inflammation and peripheral anterior synechiae formation. Aqueous suppressants are used to reduce IOP. Miotics should be avoided, as they can worsen inflammation and exacerbate angle narrowing via forward movement of the lens-iris diaphragm.

Laser therapy

Laser iridotomy is generally not useful, as pupillary block does not typically play a role in the pathogenesis of angle-closure glaucoma after scleral buckling procedures. Laser iridoplasty, however, may result in reopening of the angle and reduction in IOP [13].

Surgical management

Medical therapy and laser iridoplasty are usually successful in controlling glaucoma after scleral buckling procedures. However, some develop permanent synechial angle-closure glaucoma with uncontrolled IOP requiring surgical intervention. These patients often present a surgical challenge because conjunctival scarring and recession from prior retinal surgery may make standard filtering surgery technically difficult and unlikely to succeed, even with the adjunctive use of antimetabolites. Cyclodestructive procedures have been used, but their irreversible and frequently unpredictable IOP-lowering effects make them a less attractive option in eyes with good visual potential.

Glaucoma drainage devices (GDDs) offer a useful alternative in the management of medically uncontrolled glaucoma after scleral buckling procedures. Sidoti et al. [14] described the implantation of a silicone tube to shunt aqueous humor from the anterior segment to a preexisting episcleral encircling element, thereby using the fibrous capsule around the buckle as a reservoir for aqueous collection. Successful control of IOP with or without medication was achieved in 11 of 13 (85%) of eyes. Another technique described by Smith et al. [15] involved inserting a long-valved (plate-less) Krupin-Denver tube into the scleral buckle of seven patients with prior retinal detachment repair. Obstruction of the distal tube by fibrous tissue was a frequent complication following placement of an anterior chamber tube to an encircling band, occurring in five of 13 (38%) patients in Sidoti’s series and in three of seven (43%) patients in Smith’s series, and surgical revision was necessary in all cases to resolve the obstruction [14,15].

In the case series of modified aqueous drainage implants in eyes with preexisting episcleral bands described by Smith et al. [15], a 200-mm2 or 250-mm2 Baerveldt glaucoma implant (Pharmacia & Upjohn, Kalamazoo, Michigan, USA) was inserted in four eyes underneath the encircling band, with the ‘wings’ of the implant trimmed off. This was done out of concern that a full-sized implant might be unsafe in the presence of retinal hardware because of a ‘crowding’ effect. Scott et al. [16] described the technique of inserting a full-sized 250-mm2 or 350-mm2 Baerveldt glaucoma implant (BGI) in 16 eyes with preexisting episcleral bands. The quadrant with the least amount of retinal hardware was selected for implantation, and the implant was placed over or behind the encircling band with an effort to excise the capsule overlying the band. The authors hypothesized that this allowed for contiguous encapsulation of the encircling band and Baerveldt plate, providing a greater surface area and subsequent reduction in IOP. All patients achieved successful IOP control during the follow-up period of 19.1–45.5 months with no reports of implant migration, diplopia, or epithelial downgrowth [16].

GLAUCOMA AFTER PARS PLANA VITRECTOMY

Incidence, risk factors, and pathogenesis

Par plana vitrectomy (PPV) is one of the most frequently performed ophthalmic surgeries [17] and is used in the treatment of many vitreous and retinal diseases. There are few studies that report the incidence of glaucoma after uncomplicated PPV, but estimates range from 15 to 20% [17]. Koreen et al. [18] observed an overall 11.6% incidence of late-onset open angle glaucoma among 285 vitrectomized eyes, although rates were higher in eyes that had undergone cataract extraction (15.0%) versus phakic eyes (1.4%). These rates are similar to those reported by Luk et al. [19], who reported an overall incidence of 7.9% (eight eyes) with a higher rate in pseudophakic (13%) compared with phakic (2%) eyes. More recently, a retrospective study by Wu et al. [20▪▪] examined 198 patients who underwent PPV for idiopathic epiretinal membrane. The incidence of elevated IOP was 19.2% in vitrectomized eyes, compared with 4.5% in the unoperated fellow eye. As a result of these findings, PPV has been suggested as a risk factor for the development of secondary open-angle glaucoma [17–19,20▪▪]. Other studies, however, have not found a link between open-angle glaucoma or IOP elevation and uncomplicated PPV [21,22].

The exact pathogenesis of late-onset glaucoma after vitrectomy is unknown. Chang postulated that the main reason for the late development of glaucoma relates to the diffusion of oxygen from the vitreous cavity to the anterior chamber [17]. This could cause alterations in the trabecular meshwork by inducing oxidative stress, ultimately leading to reduced aqueous outflow, and a resultant increase in IOP [23–26].

Medical therapy

If IOP elevation develops after PPV, aqueous suppressants are generally used as treatment.

Surgical management

Depending upon the surgical indication for PPV, filtering and GDD surgery may be indicated if medical therapy does not adequately control IOP. Trabeculectomy with mitomycin C is a widely performed glaucoma surgery, but success depends on bleb survival, and conjunctival scarring after ocular surgery is a major risk factor for surgical failure [27]. In a recent study by Inoue et al. [28], higher preoperative IOP and neovascular glaucoma were identified as prognostic factors for surgical failure of trabeculectomy with mitomycin C in vitrectomized eyes. This study, however, was limited by the relatively slanted patient profile (67.2% eyes with neovascular glaucoma), and the results may thus reflect poor prognostic factors in neovascular glaucoma rather than previous vitrectomy. Additionally, nonproliferative vitreoretinal diseases requiring vitrectomy, such as retinal detachment or macular disease, were not included because of the small sample size.

The decision to use a GDD may be especially appropriate for eyes with complicated ocular disorders or previously failed surgery. Rososinski et al. [29▪] evaluated the efficacy of Baerveldt glaucoma implantation into the pars plana compared to the anterior chamber. The indications for Baerveldt implantation (34 eyes) were glaucoma or grossly elevated IOP uncontrolled on maximal medical therapy, history of previously failed trabeculectomy, or when trabeculectomy carried a particularly high risk of failure. Pars plana tubes (29 eyes) were placed for corneal edema or corneal graft, and PPV was performed either prior to or concurrent with tube placement. After 2 years, the mean average decrease in IOP was 57% in the pars plana and 60% in the anterior chamber groups. The major surgical complications included one retinal hemorrhage, one retinal detachment, and one case requiring tube replacement; all occurred in the anterior chamber group. No complication related to PPV or corneal decompensation was noted. Although the study population was heterogenous with respect to ocular disorder, it did suggest that pars plana tube placement was not associated with an increased risk of complications compared with conventional anterior chamber placement in this population.

GLAUCOMA AFTER INTRAVITREAL GAS INJECTION

Incidence, risk factors, and pathogenesis

Expansile gases, such as sulfur hexafluoride (SF6) and perfluoropropane (C3F8), have been widely used in pneumatic retinopexy, as well as vitrectomy and scleral buckling procedures. Compared with air, intraocular gases have the advantage of providing a prolonged tamponade of retinal breaks to promote chorioretinal adhesions [30]. When injected into the vitreous cavity, the volume of SF6 doubles within 24–48h [30–32], whereas C3F8 can expand to four times its original volume within 48–72 h [30,33,34].

The incidence of IOP elevation after SF6 injection has been reported to range from 6.1 to 67% [35,36], and a significantly higher incidence is observed when 100% SF6 is used, with an alarming rate of 11 of 101 (11%) of patients developing a central retinal artery occlusion in one study [35]. Postoperative IOP elevation has been described in 18–59% of patients after the use of perfluorocarbon gas [36,37]. Titrating the concentration and volume of these intraocular gases is critical to prevent the development of glaucoma postoperatively. The Silicone Study Group found that only three of 49 (6.1%) patients had an IOP greater than 30 mmHg using 20% SF6 [36], and 12 of 67 (18%) patients had an IOP of more than 30 mmHg, when C3F8 at a concentration of 14% was used [38].

Injection of expansile gases into the vitreous cavity can produce an anterior displacement of the lens-iris diaphragm, even with the patient positioned face down. Secondary angle-closure glaucoma may result with or without pupillary block. The greatest pressure elevation generally occurs during the period of maximum gas expansion, when the rate of liquid vitreous and aqueous egress cannot keep pace with the increasing gas volume. Patients should always be advised to maintain a face down position to avoid forward displacement of the lens-iris diaphragm secondary to anterior pressure from the gas bubble. Changes in atmospheric pressure can produce an expansion of the intraocular gas volume and result in an acute IOP increase [39–42]. Therefore, patients with intravitreal gas should be discouraged from traveling to high altitudes. IOP measurements should be performed with Goldmann applanation tonometry or Perkins tonometry, since pneumatic and Schiøtz indentation tonometry may underestimate IOP in gas-filled eyes [43– 45].

Medical therapy

Mild IOP elevations may occur during the early postoperative period and usually responds to aqueous suppressants. If IOP remains uncontrolled, particularly if it is elevated to a level that may compromise ocular perfusion, aspiration of a portion of the intraocular gas may be performed to normalize the pressure.

Laser therapy

If pupillary block is thought to be involved in the mechanism of glaucoma, a laser iridotomy is indicated.

Surgical management

The conjunctiva may be in poor condition with significant scarring and/or recession from prior vitrectomy. GDDs provide an important surgical option, when there is a high risk of failure with standard filtering surgery. Insertion of the silicone tube of a GDD through a pars plana scleral fistula after complete vitrectomy has been described [46–55]. This technique is particularly valuable in patients with extensive peripheral anterior synechiae and inadequate space between the corneal endothelium and iris to allow optimal positioning of the tube within the anterior chamber. IOP control is comparable to limbal tube insertion, and complications such as tube-corneal touch are avoided [55].

The incidence of posterior segment complications appears to be higher with pars plana tube insertion compared with limbal tube placement, including serous choroidal detachment, suprachoroidal hemorrhage, retinal detachment, and vitreous hemorrhage [55]. Additionally, immediate postoperative hypotony may result if the tube is inserted through a vitrectomy sclerostomy [53]. Creation of a new sclerostomy through the pars plana using a 23-gauge needle decreases leakage around the tube and reduces hypotony [53].

GLAUCOMA AFTER SILICONE OIL INJECTION

Incidence, risk factors, and pathogenesis

Intravitreal silicone oil is used as an adjunct in the surgical repair of complex retinal detachments, especially in eyes with proliferative vitreoretinopathy. Like air and fluorinated hydrogen gases, silicone oil is lighter than aqueous or vitreous allowing it to act as a retinal tamponade. IOP increases can occur postoperatively at any time, ranging from mild and transient to severe and permanent. The true incidence of glaucoma after silicone oil injection is difficult to ascertain. The rates of elevated IOP or glaucoma range from 2.2% at 6 months to 56% at 8 months [56–75], with more recent studies reporting lower rates, likely as a result of improvements in surgical techniques and materials. Higher viscosity silicone oil (5000 centistokes) has been noted to result in fewer emulsified silicone droplets in the anterior chamber and a lower risk of glaucoma [76].

Risk factors for elevated IOP after silicone oil injection include preexisting glaucoma [58,59,65], diabetes mellitus [58,59,77], and aphakia [58,78]. Care must be taken by the vitreoretinal surgeon to avoid overfilling the eye with silicone oil, as this may produce secondary glaucoma. Mechanisms of glaucoma with silicone oil use include pupillary block [57–60,71–73,79–83], inflammation [58–61,73,79–81], synechial angle closure [57,59,61,80], rubeosis iridis [58,60–62,71], migration of emulsified and nonemulsified silicone oil into the anterior chamber [57–60,62–66,80,83–86], and idiopathic open-angle glaucoma [57,60,80].

Because silicone oil is buoyant within the eye, a prophylactic inferior iridectomy should be performed in pseudophakic and aphakic eyes to prevent pupillary block. Although pupillary block angle-closure glaucoma after silicone oil injection has been well described in aphakic eyes, it occurs infrequently in phakic and pseudophakic eyes because the zonule-lens barrier prevents anterior migration of the silicone oil. However, the presence of zonular weakness may predispose these eyes to silicone oil migration and the development of pupillary block [79,81,83].

Medical therapy

Should IOP elevation develop after silicone oil injection, medical therapy is initiated with cycloplegics and corticosteroids to decrease inflammation. Aqueous suppressants are used to reduce IOP. In a study by Al-Jazzaf et al. [75], 78% of patients (40 of 51) with glaucoma after PPV and silicone oil injection were treated successfully with medications alone. The IOP was controlled in most eyes with topical beta-blockers and prostaglandin analogues.

Laser therapy

Although a prophylactic inferior iridectomy at the time of surgery lessens the risk of angle-closure glaucoma after silicone oil injection, the iridectomy may close in an estimated 11% to 32% of cases [58,72,73,87,88]. Usually, a neodymium-doped yttrium aluminum garnet laser can be used to reopen an iridectomy closed by fibrin, blood, or a retroiridal membrane.

In a recent pilot study by Alkin et al. [89▪], selective laser trabeculoplasty (SLT) was performed in 11 patients with glaucoma secondary to emulsified silicone oil and resulted in a mean IOP decrease from 25 to 16.2 mmHg at 6 months. Although this study was limited by a short duration of follow-up, a small cohort, and the lack of a control group, SLT may play a role in managing open angle glaucoma associated with silicone oil.

Cyclodestructive procedures

Transscleral cyclophotocoagulation has been used to treat glaucoma secondary to silicone oil. 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. Multiple treatments may ultimately be required to achieve adequate pressure control. Unfortunately, visual loss is not uncommon after cyclophotocoagulation. For this reason, cyclodestructive procedures are a less desirable treatment option in patients with good visual potential.

Surgical management

Although most patients who develop secondary glaucoma can be managed medically, some require surgical intervention. Silicone oil removal with or without concurrent glaucoma surgery has been performed to lower IOP, but oil removal carries some risk of retinal detachment. The benefit of silicone oil removal in patients with elevated IOP remains controversial. Jonas et al. [60] found that 93.4% (185 of 198) of patients with a secondary increase in IOP after silicone oil endotamponade had normalization of IOP after oil removal, and concluded that oil removal was the preferred glaucoma surgery to reduce pressure in these patients. However, Flaxel et al. [70] reported that elevated IOP persisted in all eyes (62 eyes) after silicone oil removal. Furthermore, silicone oil removal itself can cause IOP elevation by splitting oil droplets into smaller bubbles, which are more likely to obstruct the trabecular meshwork [94].

Budenz et al. [80] retrospectively reviewed the outcomes of surgical intervention for secondary glaucoma in 43 eyes that had PPV with silicone oil injection. Success was achieved in 69, 60, 56, and 48% of eyes at 6, 12, 24, and 36 months, respectively. Surgical treatment consisted of silicone oil removal alone in 32 of 43 (74%) patients, and 11 of 12 failures in this group were because of uncontrolled IOP. Glaucoma surgery was performed with silicone oil removal in eight of 43 (19%) patients, and three of four failures occurred because of hypotony. Only three of 43 (7%) were treated with glaucoma surgery alone, and one failed because of hypotony. It was concluded that patients who undergo silicone oil removal alone to control IOP are more likely to have persistent IOP elevation and possibly require reoperation for glaucoma, whereas patients who undergo concurrent silicone oil removal and glaucoma surgery are more likely to develop hypotony.

The surgical management of patients with silicone oil glaucoma should be modified according to the individual clinical presentation. Patients with complete synechial angle closure would not be expected to have normalization of IOP with silicone oil removal alone. Glaucoma surgery would seem to be indicated in such cases, and the decision as to whether to concomitantly remove the silicone oil depends on an assessment of the relative risk of redetachment with oil removal. When emulsified or nonemulsified oil blocks the trabecular meshwork directly, it is reasonable to proceed with silicone oil removal alone if the retina is completely attached with closure of all tears and release of all areas of traction. Patients should be warned, however, of the possible need for subsequent glaucoma surgery. GDDs offer a good surgical option in cases of refractory glaucoma associated with silicone oil, but there is also a possibility of oil escape via the drainage tube [95]. If silicone oil remains in the eye, the GDD should be positioned in one of the inferior quadrants. With the tube located inferiorly, any migration of oil into the anterior chamber is less likely to drain through the tube into the subconjunctival space, where it can incite an inflammatory reaction [96].

CONCLUSION

Vitreoretinal surgery is a known risk factor for IOP elevation and progressive glaucomatous damage, and therefore, clinicians must closely monitor these patients postoperatively. Depending on the procedure performed, patients may respond to medical therapy, but laser or glaucoma surgery may be required in some cases. GDDs are an important treatment modality for these patients, although the surgical technique may need to be modified. Prompt diagnosis and treatment of elevated IOP after retinal surgery can prevent further ocular damage and improve patient outcomes.

KEY POINTS.

  • Vitreoretinal surgery is a known risk factor for IOP elevation and progressive glaucomatous damage.

  • Although medical therapy is usually first-line treatment, some patients require laser or surgical therapy to manage IOP elevation.

  • GDDs provide an important surgical option when there is a high risk of failure with standard filtering surgery.

  • These cases may be especially challenging to diagnose and treat if IOP measurements are difficult to obtain or assessments of the optic nerve and visual field are not possible because of the underlying retinal disorder.

Acknowledgments

None.

Financial support and sponsorship

Supported by National Institutes of Health Center Core Grant P30EY014801 and Research to Prevent Blindness Unrestricted Grant.

Footnotes

Conflicts of interest

There are no conflicts of interest.

REFERENCES AND RECOMMENDED READING

Papers of particular interest, published within the annual period of review, have been highlighted as:

▪ of special interest

▪▪ of outstanding interest

  • 1.Phelps CD, Burton TC. Glaucoma and retinal detachment. Arch Ophthalmol. 1977;95:418–422. doi: 10.1001/archopht.1977.04450030060003. [DOI] [PubMed] [Google Scholar]
  • 2.Becker B. Discussion of Smith JL: retinal detachment and glaucoma. Trans Am Acad Ophthalmol Otolaryngol. 1963;67:726–732. [PubMed] [Google Scholar]
  • 3.Podos SM, Becker B, Morton WR. High myopia and primary open-angle glaucoma. Am J Ophthalmol. 1966;62:1038–1043. [PubMed] [Google Scholar]
  • 4.Beasley H, Fraunfelder FT. Retinal detachments and topical ocular miotics. Ophthalmology. 1979;86:95–98. doi: 10.1016/s0161-6420(79)35529-4. [DOI] [PubMed] [Google Scholar]
  • 5.Pape LG, Forbes M. Retinal detachment and miotic therapy. Am J Ophthalmol. 1978;85:558–566. doi: 10.1016/s0002-9394(14)75255-9. [DOI] [PubMed] [Google Scholar]
  • 6.Kreiger AE, Hodgkinson BJ, Frederick AR, Jr, et al. The results of retinal detachment surgery. Analysis of 268 operations with a broad scleral buckle. Arch Ophthalmol. 1971;86:385–394. doi: 10.1001/archopht.1971.01000010387005. [DOI] [PubMed] [Google Scholar]
  • 7.Perez RN, Phelps CD, Burton TC. Angle-closure glaucoma following scleral buckling operations. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1976;81:247–252. [PubMed] [Google Scholar]
  • 8.Sebestyen JG, Schepens CL, Rosenthal ML. Retinal detachment and glaucoma. I. Tonometric and gonioscopic study of 160 cases. Arch Ophthalmol. 1962;67:736–745. [Google Scholar]
  • 9.Smith TR. Acute glaucoma developing after scleral buckling procedures. Am J Ophthalmol. 1967;63:1807–1808. [Google Scholar]
  • 10.Occlusion of the vortex veins. Hayreh SS, Baines JA. An experimental study. Br J Ophthalmol. 1973;57:217–238. doi: 10.1136/bjo.57.4.217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Diddie KR, Ernest JT. Uveal blood flow after 360 degrees constriction in the rabbit. Arch Ophthalmol. 1980;98:729–730. doi: 10.1001/archopht.1980.01020030723016. [DOI] [PubMed] [Google Scholar]
  • 12.Hartley RE, Marsh RJ. Anterior chamber depth changes after retinal detachment. Br J Ophthalmol. 1973;57:546–550. doi: 10.1136/bjo.57.8.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Burton TC, Folk JC. Laser iris retraction for angle-closure glaucoma after retinal detachment surgery. Ophthalmology. 1988;95:742–748. doi: 10.1016/s0161-6420(88)33114-3. [DOI] [PubMed] [Google Scholar]
  • 14.Sidoti PA, Minckler DS, Baerveldt G, et al. Aqueous tube shunt to a preexisting episcleral encircling element in the treatment of complicated glaucomas. Ophthalmology. 1994;101:1036–1043. doi: 10.1016/s0161-6420(94)31221-8. [DOI] [PubMed] [Google Scholar]
  • 15.Smith MF, Doyle JW, Fanous MM. Modified aqueous drainage implants in the treatment of complicated glaucomas in eyes with preexisting episcleral bands. Ophthalmology. 1998;105:2237–2242. doi: 10.1016/S0161-6420(98)91222-2. [DOI] [PubMed] [Google Scholar]
  • 16.Scott IU, Gedde SJ, Budenz DL, et al. Baerveldt drainage implants in eyes with a preexisting scleral buckle. Arch Ophthalmol. 2000;118:1509–1513. doi: 10.1001/archopht.118.11.1509. [DOI] [PubMed] [Google Scholar]
  • 17.Chang S. LXII Edward Jackson lecture: open angle glaucoma after vitrectomy. Am J Ophthalmol. 2006;141:1033–1043. doi: 10.1016/j.ajo.2006.02.014. [DOI] [PubMed] [Google Scholar]
  • 18.Koreen L, Yoshida N, Escariao P, et al. Incidence of, risk factors for, and combined mechanism of late-onset open-angle glaucoma after vitrectomy. Retina. 2012;32:160–167. doi: 10.1097/IAE.0b013e318217fffb. [DOI] [PubMed] [Google Scholar]
  • 19.Luk FO, Kwok AK, Lai TY, et al. Presence of crystalline lens as a protective factor for the late development of open angle glaucoma after vitrectomy. Retina. 2009;29:218–224. doi: 10.1097/IAE.0b013e31818ba9ca. [DOI] [PubMed] [Google Scholar]
  • 20▪▪.Wu L, Berrocal MH, Rodriguez FJ, et al. Intraocular pressure elevation after uncomplicated pars plana vitrectomy: results of the Pan American Collaborative Retina Study Group. Retina. 2014;34:1985–1989. doi: 10.1097/IAE.0000000000000189. IOP measurements in patients undergoing uncomplicated PPV for idiopathic epiretinal membranes were evaluated. The incidence of IOP elevation was 19% in vitrectomized eyes compared with 4.5% in the unoperated fellow eye. A family history of POAG and previous cataract surgery are possible risk factors. PPV, even if uncomplicated, warrants closely monitoring IOP. [DOI] [PubMed] [Google Scholar]
  • 21.Lalezary M, Kim SJ, Jiramongkolchai K, et al. Long-term trends in intraocular pressure after pars plana vitrectomy. Retina. 2011;31:679–685. doi: 10.1097/IAE.0b013e3181ff0d5a. [DOI] [PubMed] [Google Scholar]
  • 22.Yu AL, Brummeisl W, Schaumberger M, et al. Vitrectomy does not increase the risk of open-angle glaucoma or ocular hypertension: a 5-year follow-up. Graefes Arch Clin Exp Ophthalmol. 2010;248:1407–1414. doi: 10.1007/s00417-010-1409-7. [DOI] [PubMed] [Google Scholar]
  • 23.Sacca SC, Izzotti A, Rossi P, et al. Glaucomatous outflow pathway and oxidative stress. Exp Eye Res. 2007;84:389–399. doi: 10.1016/j.exer.2006.10.008. [DOI] [PubMed] [Google Scholar]
  • 24.Izzotti A, Bagnis A, Sacca SC. The role of oxidative stress in glaucoma. Mutat Res. 2006;612:105–114. doi: 10.1016/j.mrrev.2005.11.001. [DOI] [PubMed] [Google Scholar]
  • 25.Izzotti A, Sacca SC, Cartiglia C, et al. Oxidative deoxyribonucleic acid damage in the eyes of glaucoma patients. Am J Med. 2003;114:638–646. doi: 10.1016/s0002-9343(03)00114-1. [DOI] [PubMed] [Google Scholar]
  • 26.Sacca SC, Pascotto A, Camicione P, et al. Oxidative DNA damage in the human trabecular meshwork: clinical correlation in patients with primary open-angle glaucoma. Arch Ophthalmol. 2005;123:458–463. doi: 10.1001/archopht.123.4.458. [DOI] [PubMed] [Google Scholar]
  • 27.Broadway DC, Chang LP. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma. 2001;10:237–249. doi: 10.1097/00061198-200106000-00017. [DOI] [PubMed] [Google Scholar]
  • 28.Inoue T, Inatani M, Takihara Y, et al. Prognostic risk factors for failure of trabeculectomy with mitomycin C after vitrectomy. Jpn J Ophthalmol. 2012;56:464–469. doi: 10.1007/s10384-012-0171-2. [DOI] [PubMed] [Google Scholar]
  • 29▪.Rososinski A, Wechsler D, Grigg J. Retrospective review of pars plana versus anterior chamber placement of baerveldt glaucoma drainage device. J Glaucoma. 2013;24:95–99. doi: 10.1097/IJG.0b013e31829d9be2. Baerveldt glaucoma drainage tube insertion into the pars plana versus the anterior chamber were compared in this retrospective study. Postoperative mean IOP was reduced in both groups and qualified success at 2 years was 94% for the pars plana group and 91% for the anterior chamber group. Insertion of a GDD into the pars plana may be a well tolerated alternative to anterior chamber placement, which is particularly useful if there is coexisting corneal disorder. [DOI] [PubMed] [Google Scholar]
  • 30.Chang S. Intraocular gases. In: Ryan SJ, editor. Retina. St. Louis, MO: Mosby; 1994. pp. 2115–2129. [Google Scholar]
  • 31.Norton EW. Intraocular gas in the management of selected retinal detachments. Trans Am Acad Ophthalmol Otolaryngol. 1973;77:O85–98. [PubMed] [Google Scholar]
  • 32.Abrams GW, Edelhauser HF, Aaberg TM, et al. Dynamics of intravitreal sulfur hexafluoride gas. Invest Ophthalmol. 1974;13:863–868. [PubMed] [Google Scholar]
  • 33.Lincoff A, Haft D, Liggett P, et al. Intravitreal expansion of perfluorocarbon bubbles. Arch Ophthalmol. 1980;98:1646. doi: 10.1001/archopht.1980.01020040498023. [DOI] [PubMed] [Google Scholar]
  • 34.Peters MA, Abrams GW, Hamilton LH, et al. The nonexpansile, equilibrated concentration of perfluoropropane gas in the eye. Am J Ophthalmol. 1985;100:831–839. doi: 10.1016/s0002-9394(14)73376-8. [DOI] [PubMed] [Google Scholar]
  • 35.Abrams GW, Swanson DE, Sabates WI, et al. The results of sulfur hexafluoride gas in vitreous surgery. Am J Ophthalmol. 1982;94:165–171. doi: 10.1016/0002-9394(82)90071-x. [DOI] [PubMed] [Google Scholar]
  • 36.Writing Committee for the Silicone Study Group. Lean JS, Boone DC, Azen SP, et al. Vitrectomy with silicone oil or sulfur hexafluoride gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Silicone Study Report 1. Arch Ophthalmol. 1992;110:770–779. doi: 10.1001/archopht.1992.01080180042027. [DOI] [PubMed] [Google Scholar]
  • 37.Chang S, Lincoff HA, Coleman DJ, et al. Perfluorocarbon gases in vitreous surgery. Ophthalmology. 1985;92:651–656. doi: 10.1016/s0161-6420(85)33985-4. [DOI] [PubMed] [Google Scholar]
  • 38.Group TSS. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Silicone Study Report 2. Arch Ophthalmol. 1992;110:780–792. doi: 10.1001/archopht.1992.01080180052028. [DOI] [PubMed] [Google Scholar]
  • 39.Mills MD, Devenyi RG, Lam WC, et al. An assessment of intraocular pressure rise in patients with gas-filled eyes during simulated air flight. Ophthalmology. 2001;108:40–44. doi: 10.1016/s0161-6420(00)00515-7. [DOI] [PubMed] [Google Scholar]
  • 40.Dieckert JP, O’Connor PS, Schacklett DE, et al. Air travel and intraocular gas. Ophthalmology. 1986;93:642–645. doi: 10.1016/s0161-6420(86)33687-x. [DOI] [PubMed] [Google Scholar]
  • 41.Lincoff H, Weinberger D, Reppucci V, et al. Air travel with intraocular gas. I. The mechanisms for compensation. Arch Ophthalmol. 1989;107:902–906. doi: 10.1001/archopht.1989.01070010924042. [DOI] [PubMed] [Google Scholar]
  • 42.Kokame GT, Ing MR. Intraocular gas and low-altitude air flight. Retina. 1994;14:356–358. doi: 10.1097/00006982-199414040-00012. [DOI] [PubMed] [Google Scholar]
  • 43.Poliner LS, Schoch LH. Intraocular pressure assessment in gas-filled eyes following vitrectomy. Arch Ophthalmol. 1987;105:200–202. doi: 10.1001/archopht.1987.01060020054027. [DOI] [PubMed] [Google Scholar]
  • 44.Hines MW, Jost BF, Fogelman KL. Oculab Tono-Pen, Goldmann applanation tonometry, and pneumatic tonometry for intraocular pressure assessment in gas-filled eyes. Am J Ophthalmol. 1988;106:174–179. doi: 10.1016/0002-9394(88)90830-6. [DOI] [PubMed] [Google Scholar]
  • 45.Lim JI, Blair NP, Higginbotham EJ, et al. Assessment of intraocular pressure in vitrectomized gas-containing eyes. A clinical and manometric comparison of the Tono-Pen to the pneumotonometer. Arch Ophthalmol. 1990;108:684–688. doi: 10.1001/archopht.1990.01070070070037. [DOI] [PubMed] [Google Scholar]
  • 46.Lloyd MA, Heuer DK, Baerveldt G, et al. Combined Molteno implantation and pars plana vitrectomy for neovascular glaucomas. Ophthalmology. 1991;98:1401–1405. doi: 10.1016/s0161-6420(91)32120-1. [DOI] [PubMed] [Google Scholar]
  • 47.Gandham SB, Costa VP, Katz LJ, et al. Aqueous tube-shunt implantation and pars plana vitrectomy in eyes with refractory glaucoma. Am J Ophthalmol. 1993;116:189–195. doi: 10.1016/s0002-9394(14)71284-x. [DOI] [PubMed] [Google Scholar]
  • 48.Smiddy WE, Rubsamen PE, Grajewski A. Vitrectomy for pars plana placement of a glaucoma seton. Ophthalmic Surg. 1994;25:532–535. [PubMed] [Google Scholar]
  • 49.Luttrull JK, Avery RL. Pars plana implant and vitrectomy for treatment of neovascular glaucoma. Retina. 1995;15:379–387. doi: 10.1097/00006982-199515050-00002. [DOI] [PubMed] [Google Scholar]
  • 50.Sheppard JD, Shrum KR. Pars plana Molteno implantation in complicated inflammatory glaucoma. Ophthalmic Surg. 1995;26:218–222. [PubMed] [Google Scholar]
  • 51.Varma R, Heuer DK, Lundy DC, et al. Pars plana Baerveldt tube insertion with vitrectomy in glaucomas associated with pseudophakia and aphakia. Am J Ophthalmol. 1995;119:401–407. doi: 10.1016/s0002-9394(14)71224-3. [DOI] [PubMed] [Google Scholar]
  • 52.Kaynak S, Tekin NF, Durak I, et al. Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma. Br J Ophthalmol. 1998;82:1377–1382. doi: 10.1136/bjo.82.12.1377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Scott IU, Alexandrakis G, Flynn HW, Jr, et al. Combined pars plana vitrectomy and glaucoma drainage implant placement for refractory glaucoma. Am J Ophthalmol. 2000;129:334–341. doi: 10.1016/s0002-9394(99)00363-3. [DOI] [PubMed] [Google Scholar]
  • 54.Joos KM, Lavina AM, Tawansy KA, et al. Posterior repositioning of glaucoma implants for anterior segment complications. Ophthalmology. 2001;108:279–284. doi: 10.1016/s0161-6420(00)00521-2. [DOI] [PubMed] [Google Scholar]
  • 55.Sidoti PA, Mosny AY, Ritterband DC, et al. Pars plana tube insertion of glaucoma drainage implants and penetrating keratoplasty in patients with coexisting glaucoma and corneal disease. Ophthalmology. 2001;108:1050–1058. doi: 10.1016/s0161-6420(01)00583-8. [DOI] [PubMed] [Google Scholar]
  • 56.Unosson K, Stenkula S, Tornqvist P, et al. Liquid silicone in the treatment of retinal detachment. Acta Ophthalmol (Copenh) 1985;63:656–660. doi: 10.1111/j.1755-3768.1985.tb01576.x. [DOI] [PubMed] [Google Scholar]
  • 57.Leaver PK, Grey RH, Garner A. Silicone oil injection in the treatment of massive preretinal retraction. II. Late complications in 93 eyes. Br J Ophthalmol. 1979;63:361–367. doi: 10.1136/bjo.63.5.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Honavar SG, Goyal M, Majji AB, et al. Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments. Ophthalmology. 1999;106:169–176. doi: 10.1016/S0161-6420(99)90017-9. [DOI] [PubMed] [Google Scholar]
  • 59.Henderer JD, Budenz DL, Flynn HW, Jr, et al. Elevated intraocular pressure and hypotony following silicone oil retinal tamponade for complex retinal detachment: incidence and risk factors. Arch Ophthalmol. 1999;117:189–195. doi: 10.1001/archopht.117.2.189. [DOI] [PubMed] [Google Scholar]
  • 60.Jonas JB, Knorr HL, Rank RM, et al. Intraocular pressure and silicone oil endotamponade. J Glaucoma. 2001;10:102–108. doi: 10.1097/00061198-200104000-00006. [DOI] [PubMed] [Google Scholar]
  • 61.de Corral LR, Cohen SB, Peyman GA. Effect of intravitreal silicone oil on intraocular pressure. Ophthalmic Surg. 1987;18:446–449. [PubMed] [Google Scholar]
  • 62.Punnonen E, Laatikainen L, Ruusuvaara P, et al. Silicone oil in retinal detachment surgery. Results and complications. Acta Ophthalmol (Copenh) 1989;67:30–36. doi: 10.1111/j.1755-3768.1989.tb00719.x. [DOI] [PubMed] [Google Scholar]
  • 63.Chan C, Okun E. The question of ocular tolerance to intravitreal liquid silicone. a long-term analysis. Ophthalmology. 1986;93:651–660. doi: 10.1016/s0161-6420(86)33685-6. [DOI] [PubMed] [Google Scholar]
  • 64.Laqua H, Lucke K, Foerster M. Results of silicone oil surgery. Jpn J Ophthalmol. 1987;31:124–131. [PubMed] [Google Scholar]
  • 65.Nguyen QH, Lloyd MA, Heuer DK, et al. Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments. Ophthalmology. 1992;99:1520–1526. doi: 10.1016/s0161-6420(92)31771-3. [DOI] [PubMed] [Google Scholar]
  • 66.La Heij EC, Hendrikse F, Kessels AG. Results and complications of temporary silicone oil tamponade in patients with complicated retinal detachments. Retina. 2001;21:107–114. doi: 10.1097/00006982-200104000-00002. [DOI] [PubMed] [Google Scholar]
  • 67.Barr CC, Lai MY, Lean JS, et al. Postoperative intraocular pressure abnormalities in the Silicone Study. Silicone Study Report 4. Ophthalmology. 1993;100:1629–1635. doi: 10.1016/s0161-6420(93)31425-9. [DOI] [PubMed] [Google Scholar]
  • 68.Billington BM, Leaver PK. Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at 18 months. Graefes Arch Clin Exp Ophthalmol. 1986;224:7–10. doi: 10.1007/BF02144123. [DOI] [PubMed] [Google Scholar]
  • 69.Fisk MJ, Cairns JD. Silicone oil insertion. A review of 127 consecutive cases. Aust N Z J Ophthalmol. 1995;23:25–32. doi: 10.1111/j.1442-9071.1995.tb01641.x. [DOI] [PubMed] [Google Scholar]
  • 70.Flaxel CJ, Mitchell SM, Aylward GW. Visual outcome after silicone oil removal and recurrent retinal detachment repair. Eye (Lond) 2000;14:834–838. doi: 10.1038/eye.2000.232. [DOI] [PubMed] [Google Scholar]
  • 71.Burk LL, Shields MB, Proia AD, et al. Intraocular pressure following intravitreal silicone oil injection. Ophthalmic Surg. 1988;19:565–569. [PubMed] [Google Scholar]
  • 72.Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology. 1988;95:870–876. doi: 10.1016/s0161-6420(88)33080-0. [DOI] [PubMed] [Google Scholar]
  • 73.Riedel KG, Gabel VP, Neubauer L, et al. Intravitreal silicone oil injection: complications and treatment of 415 consecutive patients. Graefes Arch Clin Exp Ophthalmol. 1990;228:19–23. doi: 10.1007/BF02764284. [DOI] [PubMed] [Google Scholar]
  • 74.Tranos P, Asaria R, Aylward W, et al. Long term outcome of secondary glaucoma following vitreoretinal surgery. Br J Ophthalmol. 2004;88:341–343. doi: 10.1136/bjo.2003.028076. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75.Al-Jazzaf AM, Netland PA, Charles S. Incidence and management of elevated intraocular pressure after silicone oil injection. J Glaucoma. 2005;14:40–46. doi: 10.1097/01.ijg.0000145811.62095.fa. [DOI] [PubMed] [Google Scholar]
  • 76.Petersen J, Ritzau-Tondrow U. Chronic glaucoma following silicone oil implantation: a comparison of 2 oils of differing viscosity. Fortschr Ophthalmol. 1988;85:632–634. [PubMed] [Google Scholar]
  • 77.Ando F. Usefulness and limit of silicone in management of complicated retinal detachment. Jpn J Ophthalmol. 1987;31:138–146. [PubMed] [Google Scholar]
  • 78.Alexandridis E, Daniel H. Results of silicone oil injection into the vitreous. Dev Ophthalmol. 1981;2:24–27. doi: 10.1159/000395298. [DOI] [PubMed] [Google Scholar]
  • 79.Ardjomand N, El-Shabrawi Y. Pupillary block after silicone oil implantation in a phakic eye. Eye (Lond) 2001;15:331. doi: 10.1038/eye.2001.106. [DOI] [PubMed] [Google Scholar]
  • 80.Budenz DL, Taba KE, Feuer WJ, et al. Surgical management of secondary glaucoma after pars plana vitrectomy and silicone oil injection for complex retinal detachment. Ophthalmology. 2001;108:1628–1632. doi: 10.1016/s0161-6420(01)00658-3. [DOI] [PubMed] [Google Scholar]
  • 81.Jackson TL, Thiagarajan M, Murthy R, et al. Pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection. Am J Ophthalmol. 2001;132:414–416. doi: 10.1016/s0002-9394(01)00991-6. [DOI] [PubMed] [Google Scholar]
  • 82.McCuen BW, 2, de Juan E, Jr, Landers MB, 3rd, et al. Silicone oil in vitreoretinal surgery. Part 2: results and complications. Retina. 1985;5:198–205. doi: 10.1097/00006982-198500540-00002. [DOI] [PubMed] [Google Scholar]
  • 83.Zborowski-Gutman L, Treister G, Naveh N, et al. Acute glaucoma following vitrectomy and silicone oil injection. Br J Ophthalmol. 1987;71:903–906. doi: 10.1136/bjo.71.12.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Moisseiev J, Barak A, Manaim T, et al. Removal of silicone oil in the management of glaucoma in eyes with emulsified silicone. Retina. 1993;13:290–295. doi: 10.1097/00006982-199313040-00004. [DOI] [PubMed] [Google Scholar]
  • 85.Valone J, Jr, McCarthy M. Emulsified anterior chamber silicone oil and glaucoma. Ophthalmology. 1994;101:1908–1912. doi: 10.1016/s0161-6420(94)31084-0. [DOI] [PubMed] [Google Scholar]
  • 86.Yeo JH, Glaser BM, Michels RG. Silicone oil in the treatment of complicated retinal detachments. Ophthalmology. 1987;94:1109–1113. doi: 10.1016/s0161-6420(87)33328-7. [DOI] [PubMed] [Google Scholar]
  • 87.Beekhuis WH, Ando F, Zivojnovic R, et al. Basal iridectomy at 6 o’clock in the aphakic eye treated with silicone oil: prevention of keratopathy and secondary glaucoma. Br J Ophthalmol. 1987;71:197–200. doi: 10.1136/bjo.71.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 88.Madreperla SA, McCuen BW. Inferior peripheral iridectomy in patients receiving silicone oil. Rates of postoperative closure and effect on oil position. Retina. 1995;15:87–90. [PubMed] [Google Scholar]
  • 89▪.Alkin Z, Satana B, Ozkaya A, et al. Selective laser trabeculoplasty for glaucoma secondary to emulsified silicone oil after pars plana vitrectomy: a pilot study. Biomed Res Int. 2014:6. doi: 10.1155/2014/469163. Article ID 469163 Patients with open angle glaucoma secondary to emulsified silicone oil and on maximum antiglaucoma medical therapy were treated with SLT to lower IOP. IOP decreased significantly from 25mmHg at baseline to 16.2mmHg at 6 months. These results suggest that SLT is a promising treatment option for IOP control after silicone oil removal. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90.Bloom PA, Tsai JC, Sharma K, et al. ‘Cyclodiode’. Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology. 1997;104:1508–1519. doi: 10.1016/s0161-6420(97)30109-2. [DOI] [PubMed] [Google Scholar]
  • 91.Han SK, Park KH, Kim DM, et al. Effect of diode laser trans-scleral cyclophotocoagulation in the management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments. Br J Ophthalmol. 1999;83:713–717. doi: 10.1136/bjo.83.6.713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 92.Ghazi-Nouri SM, Vakalis AN, Bloom PA, et al. Long-term results of the management of silicone oil-induced raised intraocular pressure by diode laser cycloablation. Eye (Lond) 2005;19:765–769. doi: 10.1038/sj.eye.6701648. [DOI] [PubMed] [Google Scholar]
  • 93.Sivagnanavel V, Ortiz-Hurtado A, Williamson TH. Diode laser trans-scleral cyclophotocoagulation in the management of glaucoma in patients with long-term intravitreal silicone oil. Eye (Lond) 2005;19:253–257. doi: 10.1038/sj.eye.6701492. [DOI] [PubMed] [Google Scholar]
  • 94.Lin XF, Liang LY, Lin MK, et al. Treatment of glaucoma secondary to silicone oil retention. Retina. 2005;25:515–517. doi: 10.1097/00006982-200506000-00019. [DOI] [PubMed] [Google Scholar]
  • 95.Senn P, Buchi ER, Daicker B, et al. Bubbles in the bleb: troubles in the bleb? Molteno implant and intraocular tamponade with silicone oil in an aphakic patient. Ophthalmic Surg. 1994;25:379–382. [PubMed] [Google Scholar]
  • 96.Hyung SM, Min JP. Subconjunctival silicone oil drainage through the Molteno implant. Korean J Ophthalmol. 1998;12:73–75. doi: 10.3341/kjo.1998.12.1.73. [DOI] [PubMed] [Google Scholar]

RESOURCES