Micro Pulse Transscleral Cyclophotocoagulation for Refractory Silicone Oil–Induced Glaucoma Complicated by Toxic Keratopathy: A Case Report

Doi: 10.36351/pjo.v42i4.2383

Abstract

Silicone oil (SO) tamponade is often used in complex retinal detachment surgeries and can cause secondary glaucoma through various mechanisms, including pupillary block, trabecular obstruction, and chronic inflammation. We present a case of a 35-year-old man with refractory glaucoma in his right eye after the second procedure of pars plana vitrectomy with SO tamponade. His intraocular pressure (IOP) was elevated to 47 mmHg despite maximum medical therapy and unsuccessful laser peripheral iridotomy. MicroPulse Transscleral Cyclophotocoagulation was performedtwice with an interval of five months and the IOP gradually decreased to 16-22 mmHg. Long-term use of antiglaucoma medications containing preservatives causes toxic keratopathy with chronic epithelial defects. The patient required both ocular surface management and a medication switch to preservative-free antiglaucoma medication. This case highlights the therapeutic challenges in glaucoma management including ocular surface diseases especially after anti-glaucoma therapy and surgical intervention.