Glaucoma and retinal detachment surgery

Abstract

AbstractPurpose Secondary transient or permanent elevation of intraocular pressure (IOP) is a quite common complication following vitreoretinal procedures.Methods This presentation will focus on different mechanisms, clinical diagnosis and management of the secondary glaucoma after scleral buckling, vitrectomy with or without gas or silicone oil tamponade, and application of steroids.Results In pre‐existing operated glaucoma with filtering surgery, maintenance of the bleb requires an approach for conjunctiva preservation with techniques such as small gauge vitrectomy. Secondary hypertension can occur after scleral buckling because of congestion and anterior rotation of the ciliary body. Medical therapy is usually successful in controlling IOP, however surgical intervention could also be needed. Intravitreal injection of gases (SF6, C3F8) may produce secondary angle‐closure glaucoma with or without pupillary block. Intraocular gas removal may be indicated. Secondary glaucoma can also develop after intravitreal injection of silicone oil due to pupillary block, inflammation, synechial angle closure, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. Patients with medically uncontrolled glaucoma after silicone oil tamponade, with an open inferior iridectomy, may require oil removal with or without concurrent glaucoma surgery.Conclusion Diode laser transcleral cyclophotocoagulation and drainage implants constitute approved methods for long‐term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial. Cooperation between vitreoretinal and glaucoma specialists may be helpful in successful treatment.