Cornacel Catalin, Dumitrescu Otilia-Maria, Zaharia Alexandra Catalina, Pirvulescu Ruxandra Angela, Munteanu Mihnea, Tataru Calin Petru, Istrate Sinziana
Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, 010825 Bucharest, Romania.
Department of Ophthalmology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Diagnostics (Basel). 2022 Apr 16;12(4):1005. doi: 10.3390/diagnostics12041005.
Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods.
青光眼是接受玻璃体切割联合硅油填充术的眼部一种威胁视力且并不罕见的并发症。尽管大多数患者对青光眼药物治疗反应良好,但仍有难治性病例需要手术来控制眼压。本综述在对Medline数据库进行全面文献检索后,旨在介绍目前用于治疗与硅油填充相关青光眼的最重要手术技术,以及根据青光眼发病机制的手术指征。对于瞳孔阻滞病例,必须通过激光或手术确保存在有效的虹膜切开术或虹膜切除术。当硅油过量且视网膜状况允许时,应进行部分或完全硅油取出术。与其他适应证相比,小梁切除术在这些病例中显示出更高的失败率和更多并发症,因此需要采用其他方法。对于极高眼压,青光眼引流装置和经巩膜睫状体光凝术是最常用的选择,具有良好的疗效和安全性,尽管它们很少会出现严重并发症。Ex-PRESS微型分流器已显示出优异的效果和较低的并发症发生率。对于眼压轻度升高的情况,可单独或与其他方法联合使用微创青光眼手术和选择性激光小梁成形术。