| Silicone oil was applied to the treatment of complicated retinal detachment by cibis for the first time in 1961, which has been widely used all over the world as an adjunct to vitreoretinal surgery after the U.S. Federal Drug Authority passed the motion that allowed silicon oil to be used as intraocular tamponade. While providing good therapy for secondary serious proliferative vitreoretinopathies such as complicated rhegmatogenous retinal detachment, giant tear, vitreoretinal inflammation, serious ocular trauma, proliferative vitreoretinopathy and so forth, silicone oil has become one of the most important intraocular tamponades, but silicone oil glaucoma is a common complication after silicone oil injection, whose pathogenesis is still undefined. The clinical data of 20 patinents(25eyes) with proliferative diabetic vitreoretinopathy phaseVI who has undergone vitrectomy combined with silicone oil injection in our first department of fundus diseases were summarized retrospectively, in order to investigate variation of the anterior segment morphometry related to the intraocular pressure after pars plana vitrectomy combined with silicone oil injection.(PPV+SOI).In this study, a total of 20 patients (25 eyes) diagnosed of proliferative diabetic vitreoretinopathy phaseVI(except for primary glaucoma, familial history of glaucoma and neovascular glaucoma) who have been treated with vitrectomy combined with silicone oil injection (except for lens extraction) by the same operator were selected, valuated preoperatively and postoperatively in our first department of fundus diseases between March 2009 and March 2010. There were 8 males (10 eyes) and 12 females (15 eyes). The average age of the patients aging from 35 to 73 is 52 years old, and the average course of diabetes mellitus is 12.5 years.Preoperative and postoperative examinations were proceeded: the measure intraocular pressure, gonioscope examination and ultrasound biomicroscopy examination. IOP: the average of three IOPs measured by noncontact tonometer repeatedly was choosed as the final IOP. The evaluation criterion of intraocular hypertension is≥25mmHg. Gonioscope examination: the configuration and the neovascularization about anterior chamber angle was inspected by gonioscope. The exclusion criterion is a narrow angle or angle can be seen neovascularization, meanwhile the anterior chamber angle diagnostic classification based on Sheie's grading standards. Ultrasound biomicroscopy examination: five out of fifteen morphometric parameters defined by Pavlin et al were obtained preoperatively and postoperatively (one day and two weeks after operation), including:anterior chamber depth(ACD), angle opening distance(AOD500), trabecular meshwork-iris process angle(θ), scleral-ciliary process angle(SCPA) and iris-lens process distance(ILPD).Results: all of the preoperative IOPs were≤20mmHg, the mean IOP±standard deviation(SD) of the IOPs on the first day after PPV+SOI ranged from 15 to 40mmHg is 25.16±7.30mmHg. The mean IOP±standard deviation(SD) of the IOPs two weeks later ranged from 15 to 21mmHg was 18.76±1.92mmHg, as three months later the mean IOP±standard deviation(SD) of the IOPs ranged from 13 to 29mmHg was 15.52±1.40mmHg, in which≥25mmHg were a total of four (14.2%). There was mild inflammatory exudate can be seen in ocular anterior chamber and only minor changes of the anterior segment morphometric parameters in the normal-tension group while moderate to severe inflammatory exudate in anterior chamber and significantly changed of the anterior segment morphometric parameters which was significant statistical signifcance compared to the state before the surgery in the high-tension group examined by gonioscope and ultrasound biomicroscopy on the third day after operation. Two weeks of follow-up after surgery: UBM and slit-lamp examination revealed that all the five morphometric parameters had no statistical differences either between the two groups or between preoperative data and postoperative data.Conclusions: silicone oil glaucoma is a common complication after silicone oil injection in treatment of proliferative diabetic retinopathy. UBM is an effective approach to check anterior segment structure after pars plana vitrectomy combined with silicone oil injection. Early changes of postoperative anterior segment morphometric parameters after PPV+SOI such as ACD,θ, AOD500, SCPA, ILPD show a close relationship with the varieties of IOP as well as the inflammatory reaction in anterior chamber. After being treated with steroids eye drops and antiglaucoma drugs, the high IOPs of most patients return to normal within 2 weeks. Key words:... |
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