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M. P. Blair, R. Kapur, A. D. Birnbaum, D. A. Goldstein, H. H. Tessler, M. J. Shapiro, L. J. Ulanski; Treating Uveitis Associated Hypotony by Pars Plana Vitrectomy and Silicone Oil Injection. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6047.
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To determine the effect on intraocular pressure (IOP) and visual acuity (VA) by treating ocular hypotony in uveitis patients with vitrectomy and intravitreal silicone oil injection.
A retrospective study was conducted at the University of Illinois and patients (one or both eyes) with a history of ocular hypotony from uveitis that underwent pars plana vitrectomy and silicone oil injection for hypotony treatment were identified. Data collected included demographic characteristics, etiology of uveitis, VA, IOP, and corneal procedures performed. Descriptive analysis was used to characterize outcomes. IOP and VA was assessed at 1 month, 3 months, 6 months, and 1 year. The primary outcome was maintaining an IOP of ≥5 mmHg. VA improvement, the secondary outcome, was defined as an increase in at least 2 lines of Snellen Acuity.
Twelve eyes of 10 patients were identified for the study. The median duration of follow-up was 29 months (range 6-170 months). Median preoperative IOP was 2 mmHg (range: 0-7), and 2 of 12 eyes had an IOP of ≥5 mmHg at presentation. The percentage of eyes with IOP of ≥5 mmHg was 7 of 12 eyes (58%) at 1 month, 4 of 12 eyes (33%) at 3 months, 6 of 12 eyes (50%) at 6 months and 3 of 9 eyes (33%) at one year. 5 of 12 eyes (42%) were re-injected between 1 to 3 times with silicone oil for recurring hypotony. The median time to first repeat injection of silicone oil was 3.73 months. 4 of 6 eyes in which the anterior chamber was completely filled either at the initial surgery or on reoperation by the 6 month visit had an intraocular pressure of ≥5 mmHg at the 6 month visit. In those eyes with complete oil fill, the median duration from last injection to the 6 month visit was 5.5 months. 2 of the 6 eyes without complete fill at 6 months had an intraocular pressure of ≥5 mmHg at their 6 month visit. Median presenting Snellan visual acuity was counting fingers (range 20/125 to light perception). 3 of 12 eyes (25%) showed improvement of at least 2 lines of visual acuity at 3 months. 2 of 12 eyes (17%) maintained a 2 line improvement in visual acuity at 6 months. 1 of 9 eyes (11%) demonstrated visual improvement and 7 of 9 eyes (78%) maintained their preoperative vision at 1 year. Of the 4 of 12 of eyes that had corneal procedures (corneal transplant and chelation of band keratopathy), all maintained their preoperative VA at 6 months.
IOP was modestly elevated in most patients in this series. However, results were often transient and some eyes required repeated silicone oil injections. Although silicone oil is reasonable to consider for treatment and maintenance of IOP in patients with ocular hypotony secondary to uveitis, better treatments are needed.
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