Silicone Oil Removal and Transscleral Cyclophotocoagulation in Patient with Secondary Glaucoma

We all know that silicone oil is the agent of choice in complex cases, including retinal detachments with PVR, giant retinal tears, trauma etc.
In cases where patients are not local.
And Lately there’s been a lot of discussion about the abuse of silicone oil, we need to know what are the options to treat and resolve these type of complications.
The most frequent complications includes cataract formation, then increased intraocular pressure that is between 2-56%.
Among surgeons who perform many combined phaco and vitrectomy surgeries the number one complication is the increased intraocular pressure.
In a study that include almost 3,000 patients with newly diagnosed glaucoma, vitreoretinal surgery was found to be the most frequent cause of secondary glaucoma 73% had silicone oil and 60% of them had it for more than 3 months. They found that in the late postop period, glaucoma is most often the result of the emulsification of silicone oil in the anterior cheimber.
One of the treatments is to remove the silicone oil but In patients with moderate or high intraocular pressure, uncontrolled high IOP persists even when silicone oil is extracted. Fortunately this can be managed with medication drops but some cases will require other procedures.
Another procedure is trabeculectomy but usually fails due to damaged conjunctiva from previous surgeryes or emulsified silicon oil induces inflammation and fibrosis. And finally when everything goes well, failure still happens in most cases in the first 6 months.
Another option is to place a drainage device most frequent choice is Ahmed Glaucoma Valve this procedure has 62 to 80% success rate combined with silicone oil removal. However you need good candidates for these device specifically healthy conjunctiva and this is reserved for eyes with good visual potential and as you can see on the slide there are complications too.
Another treatment is transscleral cyclophotocoagulation the goal of this procedure is to reduce the introcular pressure by destroying the ciliary body. The advantages are: this type of surgery doesn’t depend on conjunctival integrity, its not influenced by the presence of silicone oil and retreatment is possible and simple.
The success rate is between 60 to 80%
The risk of hypotony is similar to other procedures
Loss of light perception frequently is the result of evolution of glaucomatous optic neuropathy.
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