Aqueous misdirection syndrome post silicone oil removal in a vitrectomized eye - a case report

PUROPSE

Aqueous misdirection syndrome (AMS) is an aggressive post-operative glaucoma unresponsive to conventional measures with grave outcomes. In this report, we describe a rare case of AMS following silicon oil removal in a vitrectomized eye.

METHODS

A diabetic patient with tractional retinal detachment underwent pars plana vitrectomy with silicon oil injection. Following retinal reattachment, silicon oil removal was performed at three months. Post oil removal she developed increased intraocular pressure with shallowing of both the peripheral and central anterior chamber suggestive of AMS.

RESULTS

Initial medical management with anti-glaucoma medications and cycloplegics was not beneficial. A pars plana lensectomy with complete anterior hyaloidectomy along with a surgical peripheral iridectomy helped relieve the aqueous misdirection.

CONCLUSION

AMS can rarely occur following vitrectomy and is likely secondary to intact anterior hyaloid. Lensectomy along with zonulo-hyaloido-iridectomy is essential. This report highlights the occurrence of this rare complication and its effective management.

Combining Perfluorobutylpentane (F4H5) with Glaucoma Drainage Device Implantation for Silicone Oil-Induced Glaucoma: A Pilot Study

Objectives

Our aim was to perform a perfluorobutylpentane (F4H5) washout in conjunction with glaucoma drainage device (GDD) placement in patients with silicone oil (SO)-induced glaucoma. In this report we present our preliminary results concerning the effectiveness in clearing the SO and the safety of the procedure.

Materials and Methods

Eight patients who previously underwent pars plana vitrectomy with SO tamponade due to retinal detachment were selected. Removal of SO was performed on average 10 months after initial surgery. All patients developed glaucoma with evidence of SO remnants in the anterior chamber (AC) and angle. Removal of the remaining SO with F4H5 washout was performed in all cases with concomitant insertion of a GDD to treat the refractory glaucoma. Intraocular pressure (IOP), SO remnants, endothelial cell count, and need for glaucoma medications were evaluated up to 12 months after the surgical procedure.

Results

All patients had uneventful surgery with no major complications 12 months postoperatively. A marked reduction of SO remnants in the AC and angle was observed in all cases after surgery. There was a 60.9% decrease in mean IOP 12 months postoperatively (p<0.05) and the need for glaucoma medication was lower in all patients (mean topical medicines: 4 preoperatively vs. 0.75±0.89 postoperatively; p<0.05). Endothelial cell density showed no significant change (mean 2012±129 cells/mm2 preoperatively vs. 1985±134 cells/mm2 postoperatively; p>0.05), and there were no signs of corneal edema.

Conclusion

F4H5 is an effective emulsifier for removing SO remnants and may be safely used in conjunction with GDD placement in order to control IOP in eyes with silicone oil-induced glaucoma.

Single-pass four-throw pupilloplasty for secondary angle-closure glaucoma associated with silicon oil tamponade

PURPOSE

To describe the feasibility and efficacy of performing single-pass four-throw pupilloplasty for secondary angle-closure glaucoma post silicon oil tamponade.

METHODS

The procedure was performed in five eyes of five patients. All the cases underwent silicon oil removal with single-pass four-throw pupilloplasty. Single-pass four-throw procedure involves a single pass of needle through the iris tissue that is to be apposed followed by taking four throws by passing the suture end through the loop that is withdrawn from the anterior chamber as in a modified Siepser's slip-knot technique. Both the suture ends are pulled and this leads to sliding of the loop into the anterior chamber. Surgical pupilloplasty stretches the peripheral iris tissue and helps in breaking the peripheral anterior synechia. Intraoperative gonioscopy and anterior segment optical coherence tomography were performed in all the cases.

RESULTS

Intraoperative gonioscopy and anterior segment optical coherence tomography demonstrated opening of the anterior chamber angles with breakage of peripheral anterior synechia. The mean preoperative and postoperative best-corrected visual acuity in logarithm of minimum angle of resolution was 1.24 ± 0.23 and 0.56 ± 0.18, respectively (p < 0.001). The mean preoperative and postoperative intraocular pressure was 38.2 ± 4.97 and 13.0 ± 2.35 mm Hg, respectively. There was a significant decrease in intraocular pressure and marked improvement in visual acuity in all the cases.

CONCLUSION

Surgical pupilloplasty helps to relieve the post-silicon oil-induced secondary angle-closure glaucoma by breaking peripheral anterior synechia and significantly opening the anterior chamber angles.