Secondary silicone-induced glaucoma after vitrectomy for regmatogenic retinal detachment

Abstract

BACKGROUND: Retinal detachment is a leading cause of impaired vision and blindness, affecting 2–9% of individuals. Research has shown that local immune-inflammatory processes contribute significantly to the development of this condition. Polymethylsiloxane has long been used as a tamponade substance in the treatment of retinal detachment. It is currently utilized in various forms of retinal detachment as well as in the management of complications such as retinal edge folding and vitreous opacity. However, the use of silicone oil in the vitreous cavity can lead to the development of secondary ocular hypertension and glaucoma, with prevalence rates ranging from 2.2% to 64.2% according to studies. AIM: Conduct a comparative analysis of biochemical and morphometric indicators and justify the expediency of conducting immune therapy for patients with secondary silicone-induced glaucoma. METHODS: A prospective study included 22 patients (22 eyes) in the main group and 22 patients in the comparison group (22 eyes). The average age of the patients was 55±5.3 years (46–68 years), with 28 females and 16 males. Patients in the main group received anti-cytokine therapy (aminopropyldithioethylene-diamine sodium and anakinra). The primary endpoint of the study was the assessment of retinal nerve fiber layer thickness and perimetric indices. RESULTS: The results revealed an inverse relationship between cytokine levels and retinal nerve fiber layer thickness in patients who underwent vitrectomy with silicone tamponade. Additionally, a direct relationship was observed between the diameter of emulsified silicone in the anterior chamber and cytokine levels. The impact of mechanical fragmentation of polymethylsiloxane during nystagmus and direct toxic effects on optic nerve fibers requires further investigation. The study also highlighted the need for more accurate methods of selecting anterior chamber fluid for evaluating the effectiveness of immune therapy. Determining the appropriate dosage, duration, and administration method of anti-cytokine drugs also requires further research. Evaluation of ophthalmotonometric indicators, retinal nerve fiber layer thickness, and mean deviation revealed significantly better outcomes in patients receiving anti-cytokine therapy compared to the control group. CONCLUSION: The findings of this study support the use of anti-cytokine therapy to normalize biochemical parameters in the anterior chamber and reduce clinical manifestations of secondary silicone-induced glaucoma.

Keywords

• secondary glaucoma
• silicone oil
• vitrectomy
• retinal detachment
• cytokines