Aim and objective: To report a case with emulsified silicone oil (SO) droplets in the Schlemm\'s canal (SC), encountered during prolene hemi-gonioscopy-assisted transluminal trabeculotomy (hemi-GATT).
Background: In cases with a history of previous pars plana vitrectomy (PPV) with SO tamponade and then SO removal; glaucoma might occur secondary to the presence of emulsified SO droplets. Minimal invasive glaucoma surgeries targeting trabecular meshwork such as GATT surgery might be an ideal treatment option in these cases.
Case description: A 57-year-old man presented with uncontrolled intraocular pressure (IOP) and topical anti-glaucoma drug intolerance in his left eye. The patient had a history of PPV with SO tamponade and then intravitreal SO removal 5 years ago. He had a history of Ahmed glaucoma valve (AGV) implantation 2 years ago for the treatment of secondary glaucoma but he was still using topical anti-glaucoma medication. However, IOP was measured as 17 in the left eye. Hemi-gonioscopy-assisted transluminal trabeculotomy was performed successfully to get the patient off medication. During the surgery, SC was full of SO droplets.
Conclusion: The presence of SO droplets in the SC might contribute to the development of secondary glaucoma after PPV and SO removal. This might be another surgical indication for GATT surgery in these risky eyes.
Chang S. LXII Edward Jaackson lecture: open angle glaucoma after vitrectomy. Am J Ophthalmol 2006;141(6):1033–1043. DOI: 10.1016/j.ajo.2006.02.014.
Koreen L, Yoshida N, Escariao P, et al. Incidence of, risk factors for, and combined mechanism of late-onset open-angle glaucoma after vitrectomy. Retina 2012;32(1):160–167. DOI: 10.1097/IAE.0b013e318217fffb.
Alkin Z, Satana B, Ozkaya A, et al. Selective laser trabeculoplasty for glaucoma secondary to emulsified silicone oil after pars plana vitrectomy: a pilot study. Biomed Res Int 2014;2014:469163. DOI: 10.1155/2014/469163.
Honavar SG, Goyal M, Majji AB, et al. Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments. Ophthalmology 1999;106(1):169–176. DOI: 10.1016/S0161-6420(99)90017-9.
Cardascia N, Cantatore F, Ferreri P, et al. Ex-press mini-implant in the management of ocular hypertension secondary to silicone oil tamponed. Med Hypothesis Discov Innov Ophthalmol 2016;5(1): 10–14.
Quan AV, Yannuzzi NA, Chen J, et al. Gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with secondary open-angle glaucoma following vitreoretinal surgery. J Glaucoma 2020(4):e23–e25. DOI: 10.1097/IJG.0000000000001461.
Grover DS, Godfrey DG, Smith O, et al. Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology 2014;121(4):855–861. DOI: 10.1016/j.ophtha.2013.11.001.
Grover DS, Fellman RL. Gonioscopy assisted transluminal trabeculotomy (GATT) for the treatment of adult and developmental glaucomas. In: Aref AA, Varma R, ed. Advanced glaucoma surgery. Switzerland: Springer International Publishing; 2015. pp. 41–50.
Grover DS, Smith O, Fellman RL, et al. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol 2015;99(8):1–5. DOI: 10.1136/bjophthalmol-2014-306269.
Al-Jazzaf AM, Netland PA, Charles S. Incidence and management of elevated intraocular pressure after silicone oil injection. J Glaucoma 2005;14(1):40–46. DOI: 10.1097/01.ijg.0000145811.62095.fa.
Petersen J, Ritzau-Tondrow U. Chronic glaucoma following silicone oil implantation: a comparison of 2 oils of differing viscosity. Fortschr Ophthalmol 1988;85(6):632–634.
Ichhpujani P, Jindal A, Jay KL. Silicone oil induced glaucoma: a review. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 2009;247(12):1585–1593. DOI: 10.1007/s00417-009-1155-x.
Valone J, McCarthy M. Emulsified anterior chamber silicone oil and glaucoma. Ophthalmology 1994;101(12):1908–1912. DOI: 10.1016/s0161-6420(94)31084-0.
Madanagopalan VG, Velis G, Devulapally S. Emulsified silicone oil droplets in the canal of Schlemm. Int Ophthalmol 2019;39(4):925–926. DOI: 10.1007/s10792-018-0877-3.
Senn P, Büchi ER, Daicker B, et al. Bubbles in the bleb: troubles in the bleb? Molteno implant and intraocular tamponade with silicone oil in an aphakic patient. Ophthalmic Surg 1994;25(6):379–382.
Hyung SM, Min JP. Subconjunctival silicone oil drainage through the Molteno implant. Korean J Ophthalmology 1998;12(1):73–75. DOI: 10.3341/kjo.19184.108.40.206.