Early diagnosis of primary open-angle glaucoma in patients after primary vitrectomy due to rhegmatogenous retinal detachment

INTRODUCTION Intraocular pressure (IOP) elevation is a common complication after vitreoretinal surgery and silicone oil implantation. In some cases, the IOP remains high even after removal of silicone. Risk factors such as higher preoperative values and family history of primary open-angle glaucoma are thought to be important. AIM The purpose of the study is to suggest that in treatment-refractory secondary glaucoma the presence of an underlying primary open-angle glaucoma is likely at an early preclinical stage. MATERIALS AND METHODS We followed up 88 consecutively operated patients, who underwent primary vitrectomy and silicone oil implantation for unilateral rhegmatogenous retinal detachment. All patients underwent a complete ophthalmological examination. We followed the dynamics in visual acuity, IOP values, and ophthalmoscopic appearance of the optic disc of the vitrectomised and fellow healthy eye. Standard automated perimetry was performed in patients with persistently elevated IOP. RESULTS In 34 patients (38.63%), during the post silicone oil implantation period, several (at least 2) IOP values above 21 mmHg were measured. Nineteen (21.59%) of the patients with secondary glaucoma showed a tendency to maintain high IOP after silicone oil removal. In 5 of them (5.68%), the pressure did not respond satisfactorily to the performed anti-glaucoma interventions. Computer perimetry showed glaucomatous visual field defects in both eyes of these patients, necessitating the inclusion of topical antiglaucoma therapy in the unoperated fellow eye, despite maintaining normal IOP. CONCLUSION In cases of treatment-refractory silicone glaucoma, when the IOP remains elevated after the evacuation of the silicone oil, computer perimetry is mandatory in order to timely diagnose and treat primary open-angle glaucoma in the healthy, unvitrectomised eye.