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A.J. Mendoza, C.F. Fernandez, J. Arevalo; Glaucoma after Pars Plana Vitrectomy and Silicone Oil Injection for Complicated Retinal Detachments . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3314.
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Purpose: To determine the incidence of glaucoma in patients who underwent silicone oil injection for the management of complicated retinal detachment. Methods: The postoperative course of 80 eyes (78 consecutive patients) that underwent pars plana vitrectomy and silicone oil injection (PPV+ SOI) for the management of complicated retinal detachment was reviewed retrospectively. The outcomes of patients who underwent silicone oil removal were evaluated. Results: The main indications for PPV+ SOI were proliferative vitreoretinopathy (PVR) (29 eyes, 36.2%), trauma (13 eyes, 16.2%), proliferative diabetic retinopathy (PDR) (7 eyes, 8.7%), and cytomegalovirus (CMV) related retinal detachment (5 eyes, 6.2%). The mean overall intraocular pressure (IOP) before vitreo-retinal surgery was 10.9 mm Hg (range: 0 to 27 mm Hg). Patients had a mean follow-up of 12.5 months (range: 6 to 48 months) after vitreo-retinal surgery with silicone oil. Twenty-two (27.5%) eyes had postoperative IOPs of at least 24 mmHg, and IOP elevations of at least 10 mm Hg above the preoperative levels (glaucoma). Nineteen (23.7%) eyes underwent complete removal of silicone oil for IOP control. The IOPs were controlled to 21 mm Hg or less (but > 5 mm Hg) in 16 of 19 eyes that underwent removal of silicone oil alone. Anatomic failure was not an independent predictive factor for glaucoma. Of the risk factors predictive of glaucoma by the univariate analysis only high pre-operative IOP (P = 0.02, Odds Ratio [OR] = 1.14) was statistically significant as determined by the stepwise logistic regression multivariate analysis. Systemic hypertension (P = 0.05, OR = 5.01) showed a trend towards being statistically significant. Conclusions: Intraocular pressure elevation is a common occurrence after intravitreal silicone oil injection. The underlying mechanism may often be multifactorial in nature. Patients in whom uncontrolled IOP develops may benefit from aggressive medical and/or surgical treatment with silicone oil removal.
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