Combining Perfluorobutylpentane (F4H5) with Glaucoma Drainage Device Implantation for Silicone Oil Induced Glaucoma: A Pilot Study

Objectives: Our aim was to perform a perfluorobutylpentane (F4H5) washout in conjunction with glaucoma drainage device placement in patients with silicone oil associated glaucoma. In this report we present our preliminary results concerning the effectiveness in clearing the silicone oil and the safety of the procedure.

Methods: Eight patients were selected, who previously underwent pars plana vitrectomy with silicone oil tamponade due to retinal detachment. Removal of silicone oil was performed on average 10 months after initial surgery. All patients developed glaucoma with evidence of silicone oil remnants in the anterior chamber and the angle. Removal of remaining silicone oil with F4H5 wash-out was performed in all cases with concomitant insertion of a glaucoma drainage device in order to treat the refractory glaucoma. Intraocular pressure, silicone oil remnants, endothelial cell count, and need for glaucoma medications were evaluated up to 12 months after the surgical procedure.

Results: All patients had uneventful surgery with no major complications 12 months postoperatively. The amount of silicone oil remnants was significantly lower in all cases as shown in the pre and post-operative pictures of the anterior chamber and angle. There was a 60.9% decrease in mean intraocular pressure 12 months postoperatively (p<0.05) and the need for glaucoma medication was lower in all patients receiving the procedure (mean preoperative topical medicine was 4 per patient while after surgery was 0.75 s(±0.89) per patient) (p<0.05). Endothelial cell density showed no significant changes, average preoperative ECD was 2012.375 cells/mm2 (± 129) and average postoperative ECD was 1985.125 cells/mm2 (± 134) (p>0.05), while no signs of corneal edema was present.

Conclusions: F4H5 is an effective emulsifier removing silicone oil remnants and may be safely used in conjunction with glaucoma drainage device placement in order to control intraocular pressure in eyes with silicone oil associated glaucoma.