A Case of Rhegmatogenous Retinal Detachment in Congenital Glaucoma

Hiroshi Nakao, Kyutaro Ito, Takeshi Kumagami, Sayo Tsunematsu, Masao Nagata and Akihiko Tamai

Department of Ophthalmology, Faculty of Medicine, Tottori University, Yonago 683, Japan

A 14-year-old boy with bilateral congenital glaucoma, who had undergone goniotomy and trabeculectomy simultaneously in both eyes 2 months after birth, presented with rhegmatogenous retinal detachment in the right eye and phthisis bulbi in the left eye. Encircling procedure with a 2-mm silicone rod was effective for the treatment of retinal detachment, but trabeculectomy was necessary to correct postoperative severe ocular hypertension (50 mmHg) in the right eye. Pneumatic retinopexy with 100% sulfur hexafluoride gas was performed owing to the recurrence of retinal detachment after the glaucoma surgery. Retinal reattachment occurred after 2 additional scleral buckling procedures using a silicone implant once with the gas tamponade. Thereafter partial silicone rod-induced scleral necrosis occurred. One year after cutting the encircled rod, a tiny flat retinal detachment remained with no increase in size. The ocular tension in the right eye was well-controlled by medical therapy within 22 mmHg, but the corrected preoperative vision (0.07) decreased to 0.02 postoperatively. Retinal detachment is one of the most unfavorable late complications which may produce an extremely poor prognosis in buphthalmic eyes. Long-term follow-up is required so as not to lose the remaining postoperative vision in this case.

Key words: congenital glaucoma; retinal detachment surgery; rhegmatogenous retinal detachment; silicone rod-induced scleral necrosis

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