Non-penetrating deep sclerectomy in the treatment of secondary silicone oil induced glaucoma (preliminary results)

Relevance Retinal detachment is a serious disease that can lead to irreversible blindness. The "gold standard" for the treatment of complicated forms of retinal detachment is tamponade of the vitreous cavity with silicone oil (SM). Early removal of SM is dangerous due to the risk of recurrent retinal detachment, so in most patients the tamponade period is prolonged. However, prolonged presence of SM in the vitreous cavity can lead to disruption of the outflow of intraocular fluid, increased intraocular pressure (IOP) and the development of secondary glaucoma. In refractory forms of hypertension, surgical antiglaucoma intervention is necessary. Unlike traditional penetrating glaucoma surgery, non-penetrating deep sclerectomy (NPDS) followed by laser descementogoniopuncture (LDGP) is highly effective with relatively low trauma [1–4]. Objective To evaluate the effectiveness of NDSE in secondary silicone-induced glaucoma. Material and methods A total of 13 patients (13 eyes) aged 38–79 years with secondary silicone-induced glaucoma were examined. Four of them had stages I–II of glaucoma, the rest had stages III–IV. Four patients had pseudophakia. Visual functions ranged from light perception to 1. One patient had a history of multiple glaucoma surgeries, for 11 patients this was the first antiglaucoma intervention, for one patient – ​​the second. The initial IOP varied from 17.7 to 35.1 mm Hg. Gonioscopically, all patients had silicone oil residues in the upper fornix. In all patients except one, the operation was performed at 18:00, in one – at 12:00. Results At discharge the next day, IOP varied from 6.2 to 10.1 mmHg. The observation period varied from 3 to 12 months. In 9 patients, LDGP was performed within 1.5 to 3 months, in 1 patient – ​​after 6 months, 1 patient is observed for 3 months with low IOP. In 1 patient, ciliochoroidal detachment developed, which was successfully treated conservatively, by the end of the observation period the patient was observed with normal IOP without LDGP. In one patient after LDGP, the surgical area was blocked by the iris root, which required laser reconstruction of the intervention area. Needling was required in four patients after LDGP. In all patients, surgical normalization of IOP was achieved by the end of the observation period, in 2 cases, one antihypertensive drug was required. Conclusion NDE in secondary silicone-induced glaucoma has high efficiency, relatively short rehabilitation period and minimal number of complications. Keywords: secondary glaucoma; silicone oil; intraocular pressure; non-penetrating surgery; laser descementogoniopuncture; needling