Selective Laser Trabecuplasty in Treatment of Secondary Open Angle Silicone-induced Glaucoma


ABSTRACT

Selective Laser Trabeculoplasty (SLT) proved to be safe and effective in patients with primary open angle glaucoma, pseudoexfoliation glaucoma, glaucoma secondary to pigment dispersion syndrome. Among factors determining a development a silicone-induced glaucoma the most reasoning seems an impact of silicone oil on anterior chamber angle tissue as basis for hampering the intraocular liquid outflow.

Purpose:

To study the efficacy of the selective laser trabecuplasty in treatment of secondary open angle silicon-induced glaucoma.

Material & Methods:

Fifteen patients (15 eyes) with increased intraocular pressure (IOP) after the retinal detachment surgery with silicon tamponade were included in the study. Among them 9 eyes were combined with a myopia of high degree and 6 eyes had a refraction near emmetropia. Gonioscopic examination revealed the opened anterior chamber in all cases although in several cases very small fragments of emulsified silicon oil were seen. The SLT was performed using double Q-switched: YAG laser Optimis Fusion (Quantel Medical, France) with wavelength 532 nm, pulse duration 4 nsec and the beam diameter of 400 µm. IOP measurement was conducted with Goldman tonometer and electron tonography before SLT, 2 and 6 months after the treatment.

Results:

Prior to SLT the IOP over 21 mm Hg was registered in 9 cases and over 31 mm Hg in 4 cases. In 2 patients the IOP was about 19-20 mm Hg, however they bitterly complained in regard of necessity of using drops. Two months after SLT the IOP over 21 mm Hg was found in 6 patients and 5 of them had a myopia of high degree. After 6 months in one patient IOP remained increased which has been considered as indication for glaucoma surgery.

Conclusion:

As compared with different surgical methods of glaucoma treatment SLT may be related to low traumatic approaches. Positive result without complications, although not in all patients, should be considered positively. Our experience suggested that main factor for secondary open angle glaucoma after silicone oil tamponade is toxic action of the silicone on trabecular tissues, but not mechanical blockade of the anterior chamber angle. Myopic eyes are more inclined for development of the secondary glaucoma.


CONTACT DETAILS

 

Oleg Parkhomenko
Vinnitsa, Ukraine
Email : ophthalmos@mail.ru
Cell Phone: +380504420301
Work Phone: +380504420301