Management of glaucoma after retinal
`detachment surgery
`Steven J. Gedde, MD
`
`Secondary glaucoma may complicate retinal detachment
`surgery. Intraocular pressure (IOP) elevation has been
`described after scleral buckling procedures and vitrectomy
`with intravitreal injection of gas or silicone oil. Angle-closure
`glaucoma after scleral buckling develops because of
`congestion and anterior rotation of the ciliary body. Medical
`therapy and laser iridoplasty are usually successful in
`controlling IOP, but the presence of conjunctival scarring and
`recession and retinal hardware after scleral buckling
`procedures can make surgical management challenging.
`Intravitreal injection of expansile gases like sulfur hexafluoride
`(SF6) and perfluoropropene (C3F8) may produce secondary
`angle-closure glaucoma with or without pupillary block.
`Aspiration of a portion of the intraocular gas may be needed,
`especially if IOP is elevated to a level that may compromise
`ocular perfusion. Glaucoma also can develop after intravitreal
`injection of silicone oil secondary to pupillary block,
`inflammation, synechial angle closure, rubeosis iridis, or
`migration of emulsified or nonemulsified silicone oil into the
`anterior chamber. A prophylactic inferior iridectomy at the time
`of surgery serves to prevent pupillary block. Patients with
`medically uncontrolled glaucoma after silicone oil injection may
`require oil removal with or without concurrent glaucoma
`surgery. Curr Opin Ophthalmol 2002, 13:103–109 © 2002 Lippincott Williams
`& Wilkins, Inc.
`
`Bascom Palmer Eye Institute, Miami, Florida, USA.
`
`Correspondence to Steven J. Gedde, MD, Bascom Palmer Eye Institute 900 NW
`17th Street Miami, Florida 33136, USA; e-mail: sgedde@med.miami.edu
`
`Current Opinion in Ophthalmology 2002, 13:103–109
`
`Abbreviations
`
`CSF8
`IOP
`GDI
`SF6
`
`perfluoropropane
`intraocular pressure
`glaucoma drainage implant
`hexaflouride
`
`ISSN 1040–8738 © 2002 Lippincott Williams & Wilkins, Inc.
`
`Glaucoma is not an infrequent occurrence after retinal
`detachment surgery. In some cases, the development of
`intraocular pressure (IOP) elevation after retinal detach-
`ment repair may be related to conditions that are present
`preoperatively. Eyes with pre-existing primary open-
`angle glaucoma experience retinal detachment at a
`higher rate than normal eyes. The prevalence of primary
`open-angle glaucoma in eyes with a retinal detachment
`has been reported to be 4 to 12 times higher than in the
`general population [1,2]. It is unclear why eyes with pri-
`mary open-angle glaucoma appear to be predisposed to
`retinal detachment. The prevalence of myopia as a com-
`mon risk factor for both disorders [3], and the use of
`miotics in glaucoma therapy producing retinal detach-
`ment [1,4,5] have been suggested as possible explana-
`tions. Patients with pigment dispersion syndrome with or
`without glaucoma also seem to have an increased inci-
`dence of retinal detachment [6,7]. As with primary open-
`angle glaucoma, the exact cause for this association has
`not been well established. Glaucoma also may occur as a
`direct consequence of surgical repair of a retinal detach-
`ment. Pressure elevation has been described postopera-
`tively after scleral buckling procedures, intravitreal gas
`injection, and silicone oil injection.
`
`Glaucoma after scleral buckling procedures
`Pathogenesis
`Clinical and experimental data suggest that angle-closure
`glaucoma is produced by impaired venous drainage from
`the vortex veins by the scleral buckle. Because blood from
`the ciliary body drains into the vortex veins, their obstruc-
`tion leads to congestion and swelling of the ciliary body.
`This change has been shown experimentally in monkeys
`and rabbits [8,9]. As the ciliary body swells, it rotates
`anteriorly and shifts the lens-iris diaphragm forward
`causing secondary angle-closure glaucoma. A similar
`pathophysiologic mechanism for angle-closure glaucoma
`related to anterior rotation of the ciliary body has been
`described with panretinal photocoagulation [10,11], cen-
`tral retinal vein occlusion [12,13], choroidal hemorrhage
`[14], uveal effusions [15], and sulfa medications [16].
`
`Incidence and risk factors
`The incidence of angle-closure glaucoma after scleral
`buckling procedures (Table 1) has been reported to
`range from 1.4% to 4.4% [1,17–20]. The incidence and
`extent of angle shallowing and closure has been related
`to a variety of factors including pre-existing narrow
`103
`
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`
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`

`

`104 Glaucoma
`
`Table 1. Incidence of angle-closure glaucoma after scleral
`buckling procedures
`
`Author/year
`
`Phelps & Burton, 1977 [2]
`Sebestyen et al., 1962 [17]
`Smith, 1967 [18]
`Kreiger et al., 1971 [19]
`Perez et al., 1976 [20]
`
`IOP, intraocular pressure.
`
`IOP criteria
`
`⬎21 mm Hg
`ⱖ24 mm Hg
`Not reported
`Not reported
`ⱖ24 mm Hg
`
`Number
`of eyes
`
`817
`160
`1000
`268
`1,558
`
`Incidence
`
`2.1%
`4.4%
`4.0%
`3.7%
`1.4%
`
`angles [17,19], use of an encircling band [20,21], place-
`ment of an encircling band anterior to the equator [17],
`high myopia [19], older patient age [19], and postopera-
`tive ciliochoroidal detachment [17].
`
`Medical therapy
`In most cases, angle-closure glaucoma after scleral buck-
`ling procedures will resolve spontaneously over a period
`of several days to weeks as the ciliary body congestion
`and swelling improve. Medical therapy includes cy-
`cloplegics to shift the lens-iris diaphragm posteriorly by
`relaxing the ciliary muscle, and topical corticosteroids
`to reduce inflammation and peripheral anterior syn-
`echiae formation. Aqueous suppressants are used to re-
`duce IOP including ß-blockers, carbonic anhydrase in-
`hibitors, and alpha adrenergic agonists. Miotics should be
`avoided, as they can worsen inflammation and produce
`further angle narrowing via forward movement of the
`lens-iris diaphragm.
`
`Laser therapy
`A laser iridotomy is generally not beneficial, as pupillary
`block does not typically play a role in the pathogenesis of
`angle-closure glaucoma after scleral buckling procedures.
`In contrast, laser iridoplasty is frequently useful in open-
`ing the angle [22].
`
`Surgical management
`Medical therapy and laser iridoplasty are usually success-
`ful in controlling glaucoma after scleral buckling proce-
`dures until its natural resolution over time. In some
`cases, however, the IOP remains uncontrolled or perma-
`nent synechial angle-closure glaucoma requires surgical
`treatment. These patients frequently present a surgical
`challenge because conjunctival scarring and recession
`from prior retinal surgery may make standard filtering
`surgery unlikely to be successful, even with the adjunc-
`tive use of an antimetabolite. Cyclodestructive proce-
`dures have been used in this clinical setting, however,
`the oftentimes unpredictable and irreversible effect of
`these procedures make them a less attractive option in
`eyes with good visual potential. Glaucoma drainage im-
`plants (GDIs) offer a useful alternative approach to the
`management of medically uncontrolled glaucoma after
`scleral buckling procedures.
`
`Sidoti et al. described the implantation of a silicone tube
`to shunt aqueous humor from the anterior segment to a
`pre-existing episcleral encircling element, thereby using
`the fibrous capsule around the buckle as the reservoir for
`aqueous collection [23]. Successful control of IOP with
`or without medication was ultimately achieved in 11 of
`13 (85%) of eyes. Smith et al. used a similar technique
`inserting a long-valved (plateless) Krupin-Denver tube
`into the scleral buckle of 7 patients who had undergone
`prior retinal detachment surgery [24]. Obstruction of the
`distal tube by fibrous tissue was a frequent complication
`following placement of an anterior chamber tube to an
`encircling band, occurring in 5 of 13 (38%) of patients in
`Sidoti’s series [23], and in 3 of 7 (43%) of Smith’s pa-
`tients [24]. Surgical revision was necessary in all cases to
`resolve the distal tube obstruction [23,24].
`
`In the case series of modified aqueous drainage implants
`in eyes with pre-existing episcleral bands reported by
`Smith et al., 4 patients had a 200-mm2 or 250-mm2
`Baerveldt glaucoma implant (Pharmacia & Upjohn,
`Kalamazoo, Michigan, USA) inserted underneath the en-
`circling band with the “wings” of the implant trimmed
`off [24]. The “wings” were trimmed because of concerns
`that a full-sized implant in the presence of retinal hard-
`ware might be unsafe because of a “crowding” effect.
`Most recently, Scott et al. described a technique of in-
`serting a full-sized 250-mm2 or 350-mm2 Baerveldt glau-
`coma implant in 16 eyes with pre-existing episcleral
`bands [25••]. The quadrant with the least amount of
`retinal hardware was selected for implantation, and suf-
`ficient posterior dissection was performed between
`sclera and Tenon’s capsule to allow the implant to seat
`comfortably over the recti muscles. The implant was po-
`sitioned over or behind the encircling band, depending
`on the location of the band, and an effort was made to
`excise the capsule overlying the band in the quadrant of
`surgical implantation. The authors hypothesized that
`this allowed contiguous encapsulation of both the encir-
`cling band and Baerveldt plate, providing a greater sur-
`face area and pressure reduction than a capsule around
`either the Baerveldt plate or episcleral band alone. All
`patients achieved successful control of IOP with or with-
`out medications during the follow-up period of 19.1 to
`45.5 months. Despite concern about implant exposure,
`implant migration, diplopia, and epithelial downgrowth,
`none of these complications were observed in the series
`reported by Scott et al. [25••].
`
`Glaucoma after intravitreal gas injection
`Pathogenesis
`Intraocular gas has been used increasingly in vitreoreti-
`nal surgery. Because of their surface tension, gases exert
`a tamponading effect on retinal breaks. The expansile
`properties of commonly used intraocular gases are shown
`
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`
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`
`

`

`Management of glaucoma after retinal detachment surgery Gedde
`
`105
`
`in Table 2. The disadvantages of sterile air are its inabil-
`ity to expand intraocularly and its rapid resorption time
`in 5 to 7 days before choriodal-retinal adhesions can de-
`velop [26,27]. Fluorinated hydrogen gases have the ad-
`vantage of being expansile and have a larger intraocular
`duration. When injected into the vitreous cavity, pure
`sulfur hexafluoride (SF6) expands to twice its original
`volume within 24 to 48 hours [26–28], and pure perfluo-
`ropropene (C3F8) expands to 4 times its original volume
`within 48 to 72 hours [27,29,30]. When gas is diluted,
`expansion occurs more slowly and is balanced by vitreous
`loss [31,32]. SF6 remains in the eye for 10 to 14 days
`[26–28], and C3F8 remains for 55 to 65 days [27]. Both
`gases have been associated with IOP elevation.
`
`An expansile gas can produce anterior displacement of
`the lens-iris diaphragm, even with the patient positioned
`face down. Secondary angle-closure glaucoma may result
`with or without pupillary block. The highest pressure
`elevation generally occurs during the period of maximum
`expansion of the gas, when the rate of egress of liquid
`vitreous and aqueous cannot keep pace with the increas-
`ing gas volume.
`
`Incidence and risk factors
`The incidence of IOP elevation after intravitreal injec-
`tion of SF6 (Table 3) has been reported to range from
`6.1% to 67% [33,34]. A significantly higher incidence of
`pressure elevation is observed when 100% SF6 is used,
`with an alarming rate of 11 of 101 (11%) patients devel-
`oping central retinal artery occlusion in one study [33].
`For this reason, a dilute mixture of SF6 is recommended.
`Postoperative IOP elevation has been described in
`18% to 59% of patients after the use of perfluorocarbon
`gas [35,36].
`
`Titrating the concentration and volume of these intraoc-
`ular gases intraoperatively is critical to preventing the
`development of glaucoma postoperatively. The Silicone
`Study Group found that only 3 of 49 (6.1%) patients had
`an IOP greater than 30 mm Hg using 20% SF6 [34], and
`12 of 67 (18%) patients had an IOP of more than 30 mm
`Hg when C3F8 in a concentration of 14% was used [36].
`Eyes with fibrinous anterior chamber exudates postop-
`eratively seem to be at greater risk of developing IOP
`elevation, as is commonly seen in diabetic eyes [33].
`
`Table 2. Expansile properties of intraocular gases
`
`Intraocular
`gas
`
`Maximal volume
`expansion (times)
`
`Time to maximal
`expansion (hours)
`
`Longevity*
`(days)
`
`Air
`SF6 [26–28]
`C3F8 [27–30]
`
`0
`2
`4
`
`Immediate
`24–48
`48–72
`
`5–7
`10–14
`55–65
`
`*Based on 1.0 cc of pure gas.
`C2F6, perfluoroethane; C3F8, perfluoropropane; SF6, hexafluoride.
`
`Table 3. Incidence of intraocular pressure elevation after
`intravitreal gas injection
`
`Author/year
`
`Type of gas
`
`IOP criteria
`
`Number
`of eyes
`
`Incidence
`
`Abrams et al.,
`1982 [33]
`
`The Silicone Study
`Group, 1992
`[34] (Report 1)
`Chang et al.,
`1985 [35]
`
`The Silicone Study
`Group, 1992
`[36] (Report 2)
`
`20–50% SF6 ⱖ30 mm Hg
`
`100% SF6
`20% SF6
`
`ⱖ30 mm Hg
`
`C2F6, C3F8
`
`⬎22 mm Hg
`
`14% C3F8
`
`⬎40 mm Hg
`ⱖ30 mm Hg
`
`80
`
`18
`49
`
`56
`
`67
`
`40%
`
`67%
`6.1%
`
`59%
`
`20%
`18%
`
`C2F6, perfluoroethane; C3F8, perfluoropropane; SF6, hexafluoride;
`IOP, intraocular pressure.
`
`Patient instructions
`The importance of maintaining a face down head posi-
`tion must be emphasized to patients to prevent forward
`lens-iris movement secondary to anterior pressure from
`the gas bubble. Changes in atmospheric pressure, as oc-
`curs with flying, can produce concomitant changes in
`intravitreal gas volume and IOP [37–40•]. Mills et al.
`recently investigated the safety of aircraft flight for pa-
`tients with a small volume of residual postoperative in-
`traocular gas [40•]. Intraocular pressure was tested in
`9 eyes with a 10% to 20% gas volume in the controlled
`environment of a hypobaric chamber simulating cabin
`depressurization with a typical commercial aircraft flight.
`The IOP rose by an average of 103% from baseline dur-
`ing ascent, and IOP dropped to an average of 37% above
`baseline during the cruise phase. The significant rise in
`IOP supports the current recommendation against air
`travel for most patients with intraocular gas bubbles.
`
`Medical therapy
`Aqueous suppressants may be used to provide pressure
`reduction. If IOP remains uncontrolled, and particularly
`if it is elevated to a level that may compromise ocular
`perfusion, aspiration of a portion of the intraocular gas
`may be performed to normalize the pressure.
`
`Laser therapy
`A laser iridotomy is indicated if pupillary block is thought
`to be involved in the mechanism of the glaucoma.
`
`Surgical management
`The conjunctiva may be in poor condition with signifi-
`cant scarring and/or recession from prior vitrectomy.
`GDIs provide an important surgical option when there is
`a high risk of failure with standard filtering surgery. In-
`sertion of the silicone tube of a GDI through a pars plana
`scleral fistula after complete vitrectomy has been de-
`scribed [41–48,49•,50•]. This approach is particularly
`valuable in patients with extensive peripheral anterior
`synechiae with inadequate space between the corneal
`
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`

`106 Glaucoma
`
`endothelium and iris to allow optimal positioning of the
`tube in the anterior chamber. Intraocular pressure con-
`trol is comparable to limbal tube insertion, and compli-
`cations such as tube-corneal touch are avoided [50•].
`However, the incidence of posterior segment complica-
`tion appears to be higher with pars plana tube insertion
`compared with limbal tube placement, including serous
`choroidal detachment, suprachoroidal hemorrhage, reti-
`nal detachment, and vitreous hemorrhage [50•]. Addi-
`tionally, immediate postoperative hypotony may result if
`the tube is inserted through a vitrectomy sclerostomy
`[48]. Creation of a new sclerostomy through the pars
`plana using a 23-gauge needle decreases leakage around
`the tube and reduces hypotony [48].
`
`Glaucoma after silicone oil injection
`Pathogenesis
`Intravitreal silicone oil is used as an adjunct in the sur-
`gical repair of complex retinal detachments. Like air and
`fluorinated hydrogen gases, silicone oil is lighter than
`aqueous or vitreous allowing it to act as a retinal tam-
`ponade. Mechanisms of glaucoma with silicone oil use
`include pupillary block [51–58,59•,60••,61•,62••], in-
`flammation [56,63], synechial angle closure [51,58,60••,
`63], rubeosis iridis [54,57,62••,63,64], migration of emul-
`sified and nonemulsified silicone oil into the anterior
`chamber [51,53,57,58,60••,62••,64–70,71•], and idio-
`pathic open-angle glaucoma [51,60••,62••].
`
`Because silicone oil is buoyant within the eye, a prophy-
`lactic inferior iridectomy should be performed in pseu-
`dophakic and aphakic eyes to prevent pupillary block.
`Although pupillary block angle-closure glaucoma after
`silicone oil injection has been well described in aphakic
`eyes, it occurs infrequently in phakic and pseudophakic
`eyes because the zonule-lens barrier prevents anterior
`
`migration of the silicone oil [53,59•,61•]. Zonular weak-
`ness may predispose to silicone oil migration and the
`development of pupillary block in phakic and pseudo-
`phakic eyes [53,59•,61•].
`
`Incidence and risk factors
`Secondary IOP elevation after silicone oil injection
`(Table 4) has been reported in 5.9% to 56% of eyes
`[51,54–58,62••,63–66,68,71•,72–74,75•]. Higher viscos-
`ity silicone oil (5,000 centistokes) has been noted to re-
`sult in fewer emulsified silicone droplets in the anterior
`chamber and a lower risk of glaucoma [76]. Risk factors
`for elevated IOP after silicone oil injection include pre-
`existing glaucoma [57,58,68] diabetes mellitus [57,58,
`77], and aphakia [57,78]. Care must be taken by the
`vitreoretinal surgeon to avoid overfilling the eye with
`silicone oil, as this may produce secondary glaucoma.
`
`Medical therapy
`Should IOP elevation develop after silicone oil injection,
`medical therapy is initiated with cycloplegics and corti-
`costeroids to decrease inflammation. Aqueous suppres-
`sants are used to reduce the pressure.
`
`Laser therapy
`While a prophylactic inferior iridectomy at the time of
`surgery lessens the risk of angle-closure glaucoma after
`silicone oil injection, the iridectomy may close in an es-
`timated 14% of cases [55]. Usually a Nd:YAG laser can
`be used to reopen an iridectomy closed by fibrin, blood,
`or retroiridal membrane.
`
`Transcleral cyclophotocoagualtion has been used to treat
`glaucoma secondary to silicone oil. Successful IOP con-
`trol has been reported in 74% to 82% of patients at 1 year
`[79,80]. Multiple treatments may be required to attain
`
`Table 4. Incidence of intraocular pressure elevation after injection of silicone oil
`
`Author/year
`
`IOP criteria
`
`Number of eyes
`
`Incidence
`
`Leaver et al., 1979 [51]
`Billington et al., 1986 [72]
`Chan & Okun,1986 [65]
`de Corral et al., 1987 [63]
`Laqua et al., 1987 [66]
`Burk et al., 1988 [54]
`Federman & Schubert, 1988 [55]
`Punnonen et al., 1989 [64]
`Riedel et al., 1990 [56]
`Nguyen et al., 1992 [68]
`
`Barr et al., 1993 [73]
`Fisk & Cairns, 1995 [74]
`Henderer et al., 1999 [58]
`
`Honavar et al., 1999 [57]
`
`Flaxel et al., 2000 [75]
`Jonas et al., 2001 [62]
`La Heij et al., 2001 [71]
`
`⬎22 mm Hg
`⬎22 mm Hg
`Not reported
`ⱖ10 mm Hg over preoperative level
`Not reported
`Not reported
`Not reported
`⬎25 mm Hg
`⬎30 mm Hg
`ⱖ25 mm Hg and ⱖ10 mm Hg over
`preoperative level
`⬎25 mm Hg
`Not reported
`⬎25 mm Hg or glaucoma surgery
`
`ⱖ24 mm Hg and ⱖ10 mm Hg over
`preoperative level
`Not reported
`⬎21 mm Hg
`⬎25 mm Hg or >20 mm Hg with glaucoma
`medications
`
`IOP, intraocular pressure; CMV, cytomegalovirus.
`
`93
`53
`407
`48
`500
`100
`150
`25
`415
`50
`
`120
`127
`532
`
`150
`
`62
`198
`58
`
`15%
`29%
`16.8%
`56%
`11%
`50%
`10%
`48%
`13%
`48%
`
`8%
`43%
`29.5% without CMV
`5.9% with CMV
`40%
`
`18%
`20%
`12%
`
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`
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`

`Management of glaucoma after retinal detachment surgery Gedde
`
`107
`
`pressure control. Unfortunately, visual loss is not uncom-
`mon after cyclophotocoagulation. For this reason, cy-
`clodestructive procedures are a less desirable treatment
`option in patients with good visual potential.
`
`Surgical management
`Although most patients who develop secondary glau-
`coma after silicone oil injection can be controlled medi-
`cally, some require surgical management. Silicone oil re-
`moval with or without concurrent glaucoma surgery has
`been performed to lower IOP, but oil removal carries
`some risk of retinal detachment. Budenz et al. retrospec-
`tively reviewed the outcomes of surgical intervention for
`secondary glaucoma in 43 eyes that had pars plana vit-
`rectomy with silicone oil injection [60••]. Success, de-
`fined as IOP less than or equal to 21 mm Hg and greater
`than or equal to 5 mm Hg with avoidance of reopera-
`tions for glaucoma, was achieved in 69%, 60%, 56%, and
`48% of eye at 6, 12, 24, and 36 months respectively.
`Surgical treatment consisted of silicone oil removal alone
`in 32 of 43 (74%) patients, and 11 of 12 failures in this
`group were due to uncontrolled IOP. Glaucoma surgery
`was performed with silicone oil removal in 8 of 43 (19%)
`patients, and 3 of 4 failures occurred because of hy-
`potony. Only 3 of 43 (7%) were treated with glaucoma
`surgery alone, and 1 failed because of hypotony. It was
`concluded that patients who undergo silicone oil removal
`alone to control IOP are more likely to have persistent
`IOP elevation and possibly require reoperation for glau-
`coma, while patients who undergo concurrent silicone oil
`removal and glaucoma surgery are more likely to develop
`hypotony. The authors acknowledged that their study
`was limited by its retrospective design and lack of ran-
`domization, and it is impossible to generalize which sur-
`gical approach is best for management of glaucoma after
`silicone oil injection.
`
`The benefit of silicone oil removal in treating patients
`with elevated IOP remains controversial. Jonas et al.
`found that most patients with a secondary increase in
`IOP after silicone oil endotamponade had normalization
`of IOP after removal of the oil [62••]. It was concluded
`that oil removal may be preferred to glaucoma surgery to
`reduce pressure in patients with elevated IOP associated
`with silicone oil. Flaxel et al. reported that elevated IOP
`persisted in all eyes after silicone oil removal [75•].
`
`It would seem logical to modify the surgical management
`of patients with silicone oil glaucoma according to the
`individual clinical presentation. Patients with complete
`synechial angle closure would not be expected to have
`normalization of IOP with silicone oil removal alone, in
`the absence of retinal redetachment. Glaucoma surgery
`would seem indicated in such cases, and the decision as
`to whether to concomitantly remove the silicone oil de-
`pends on an assessment of the relative risk of redetach-
`ment with oil removal. When emulsified or nonemulsi-
`
`fied oil blocks the trabecular meshwork directly, it is
`reasonable to proceed with silicone oil removal alone if
`the retina is completely attached with closure of all tears
`and release of all areas of traction. Patients should be
`warned, however, of the possible need for subsequent
`glaucoma surgery. Glaucoma drainage implants offer a
`good surgical option in cases of refractory glaucoma as-
`sociated with silicone oil. If silicone oil remains in the
`eye, the GDI should be positioned in one of the inferior
`quadrants. With the tube located inferiorly, any migra-
`tion of oil into the anterior chamber is less likely to drain
`through the tube into the subconjunctival space where it
`can incite an inflammatory reaction [81].
`
`References and recommended reading
`Papers of particular interest, published within the annual period of review,
`have been highlighted as:
`(cid:127)
`Of special interest
`(cid:127)(cid:127)
`Of outstanding interest
`
`1
`
`2
`
`3
`
`4
`
`5
`
`6
`
`7
`
`8
`
`9
`
`Becker B: Discussion of Smith JL: Retinal detachment and glaucoma. Trans
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`
`Phelps CD, Burton TC: Glaucoma and retinal detachment. Arch Ophthalmol
`1977, 95:418–422.
`
`Podos SM, Becker B, Morton WR: High myopia and primary open angle
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`Pape LG, Forbes M: Retinal detachments and miotics. Am J Ophthalmol
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`Beasley H, Fraunfelder FT: Retinal detachments and topical ocular miotics.
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`Brachet A, Chermet M: Association glaucome pigmentaire et decollement de
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`Scheie HG, Cameron JD: Pigment dispersion syndrome: A clinic study. Br J
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`Copyright© Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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`Novartis Exhibit 2319.005
`Regeneron v. Novartis, IPR2021-00816
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`

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