Introduction: Silicone oil is a widely used intraocular tamponade in complex retinal detachment surgery. However, its use may lead to secondary glaucoma, with reported incidence ranging from 5% to 56%. The pathogenesis is multifactorial, including pupillary block, emulsification, trabecular obstruction, and chronic inflammation. This report presents a case of secondary glaucoma and reviews available treatment strategies, including evolving cyclodestructive procedures.
Case Presentation: A 44-year-old pseudophakic male with bilateral megalocornea presented with chronic, recurrent retinal detachment in the right eye and vitreous haemorrhage accompanied by a dislocated intraocular lens in the left eye. Pars plana vitrectomy with silicone oil endotamponade was performed in the right eye, while the left eye underwent pars plana vitrectomy with SF6 gas tamponade and implantation of an Artisan aphakic intraocular lens. Postoperatively, right eye developed elevated intraocular pressure up to 47 mmHg, requiring intensive medical therapy. After silicone oil removal, intraocular pressure remained uncontrolled (35 mmHg), necessitating diode transscleral cyclophotocoagulation. The procedure achieved sustained intraocular pressure control (17 mmHg). Left eye also exhibited transient intraocular pressure elevation but stabilised with pharmacotherapy.
Discussion: Silicone oil-induced glaucoma remains a significant therapeutic challenge. While medical therapy is the first-line treatment, it often fails to achieve long-term control. Surgical options include silicone oil removal and cyclodestructive techniques. Transscleral cyclophotocoagulation, especially with slow coagulation or micropulse protocols, shows favourable outcomes in refractory cases by minimising collateral tissue damage while effectively reducing aqueous production.
Conclusions: Secondary glaucoma caused by silicone oil requires early detection and individualized management. When medical therapy is insufficient, timely silicone oil removal and transscleral cyclophotocoagulation – particularly newer protocols – offer promising results in achieving pressure control and preserving vision.