Post retina surgery hypotony

[johngoh]

I have a macular off rhegmatogenous retina detachment with lattice and multiple break (horse tear in the superotemporal quadrant, hole nasal to the tear & operculated hole in the attached retina in the nasal quandrants) in the left eye.

1. Scleral buckling (276 band in the inferior half) with pars plana virectomy - endolaser - cryopexy -
   C3F8 (15%) gass fill was done on 07/10/2010 for the left eye. I went for periodical follow-up and was
   noted to develop a redetachment with proliferative vitreoretinopathy and inferior quadrant breaks
   on 27/01/2010.

2. I underwent a phacoemulsification with intraocular lens implant - parsplana vitrectomy -
   endolaser - silicon oil fill (Oxane Hd) for the left eye on 02/02/2010. Best corrected visual
   acuity was 6/21 in the left eye and the retina was flat with good oil fill and an IOP of 13mm Hg.

3. A planned pars plana removal of silicone oil - SF6 (20%) fill was done on
   27/07/2010. Post operatively, I noticed a dark shadow since 14/08/2010 and was
   noted to have a total retinal detachment with a break in the temporal quadrant
   with fixed retinal fold and a macular hole.

4. A pasrplana vitrectomy - retinectomy (temporal quadrant 2 to 6-0'clock
   meridian)-internal limiting membrane peel - endolaser - intraocular lens explant -
   360 degree endolaser -octane (left in situ) was done on 20/08/2010. On 21/08/10
   morning IOP was 21 mm Hg. Interior chamber was very shallow.

5. On 02/09/2010 octane removal was done and a silicone oil (1300cs) refill was
   done along with an inferior peripheral iridotomy and endolaser top up. The retina
   was flat. Postoperatively, the retian was flat with good oil fill and a paten PI.
   IOP was 7 mm Hg. Best corrected visual acuity was 6/60 on 28/09/2010 with IOP
   of 5 mm Hg in the left eye. There were some peripheral synechiae in the superior
   quadrant. Reviewed on 11/10/2010, there was silicone oil in the anterior chamber
   and the IOP was 4 mm Hg in the left eye.

6. Slicon oil removal (anterior approach) was done on 13/10/2010. Last reviewed on
   11/11/2010 when the retina was flat. The eye was soft and the visual acuity was
   "counting finger @ 1 ft. I am currently aphakic.

7. My current IOP is very low (0 or 1 mm Hg).

May I ask if there is treatment available for my condition?

Best,
John Goh  

[johngoh]

Hi Dr. O,

First of all, thank you very much for your prompt reply.

I did some search on the Internet, and got to know of some available treatment for hypotony. To repair post-surgical leaks, few methods are listed:
• placement of an oversized contact lens
• patching
• various suturing techniques
• injecting blood to promote scarring
• drainage of fluid external to the choroid
• using a special kind of substance (called viscoelastics) that helps reshape the front inner part of the eye (the anterior chamber) if it has become shallow.

May I ask if any of these methods are suitable for my situation?

Best,
John Goh

[Ray T Oyakawa, MD]

Unfortunately there is little that can be done.  If there is anterior traction which is detaching the ciliary body then removal of this traction can restore pressure.  Other rare conditions such as an cleft in the angle which can be treated with argon laser in the office might be able to restore vision.  

Dr. O.