Combined Trabeculotomy-Trabeculectomy Versus Trabeculectomy for Treatment of Silicone Oil-induced Ocular Hypertension

Precis: Combined trabeculotomy-trabeculectomy (CTT) has a significantly better hypotensive effect than trabeculectomy and a higher success rate in cases of silicone oil-induced ocular hypertension. Purpose: To compare the ocular hypotensive effect of CTT with mitomycin-C (MMC) to that of trabeculectomy with MMC in cases of silicone oil-induced ocular hypertension. Patients and Methods: Thirty eyes of 30 patients with high intraocular pressure (IOP) after vitrectomy and silicone oil injection (followed by silicone oil removal) were randomly allocated to 2 groups in this randomized trial. Group A was composed of 15 cases who underwent combined CTT with MMC while group B cases contained 15 cases undergoing trabeculectomy with MMC. Patients were followed up for 12 months. We included patients above 18 years old, having performed vitrectomy and silicone oil injection followed by oil removal, and having IOP >21 mm Hg uncontrollable by antiglaucoma medications. Results: The postoperative IOP drop was significantly greater in group A than in group B at all follow up visits (P<0.05). Compared with preoperative IOP, both surgeries produced a significantly lower postoperative IOP at all follow-up visits (P<0.05). For group A, complete success rates (IOP <= 21 mm Hg without ocular hypotensive medications) and qualified success rates (IOP <= 21 mm Hg with or without ocular hypotensive medications) were both higher than for group B. Conclusion: Both surgeries effectively reduce IOP in cases of silicone oil-induced ocular hypertension, but CTT has a significantly better hypotensive effect and a higher success rate on the long-term.