IRIDOLENTICULAR BLOCK IN HEAVY SILICONE OIL TAMPONADE

Background: The purpose of this study was to report the adverse effect of iridolenticular block glaucoma after vitreoretinal surgery and endotamponade with heavy silicone oil in cases of complicated retinal detachment. Methods: A retrospective analysis of 23 eyes of 23 patients who underwent a pars plana vitrectomy and heavy silicone oil (Densiron 68) endotamponade for repair of complex inferior retinal detachment. Results: Two patients developed high intraocular pressure postoperatively. The mechanism of secondary glaucoma in both patients was a prolapse of heavy silicone oil into the anterior chamber. When lying in a supine position for a prolonged period, the heavy silicone oil occluded the pupil, causing an iridolenticular block. Conclusion: In the presence of heavy silicone oil in the anterior chamber, lying in a supine position causes the oil drop to sink, blocking the entire diameter of the pupil, and inducing an iridolenticular block with acute angle-closure glaucoma. We conclude that every case of heavy silicone oil migration into the anterior chamber should be regarded as an emergency. The possible treatment could include pupil dilation, anterior chamber irrigation, or an Nd YAG-laser iridotomy. RETINA 30: 516-520, 2010