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Limited vitrectomy in phacomorphic glaucoma.

ABSTRACT: One of the challenging situations for a cataract surgeon is phacoemulsification in the shallow anterior chamber like cases of phacomorphic glaucoma. Some of the main concerns of operating in a narrow space include endothelial decompensation, descemet's detachment, and posterior capsular rents. High vitreous pressure predisposes to posterior capsular rents owing to a reduced concavity of the posterior capsule and increasing the proximity of phaco-tip to the posterior capsule. We describe a technique of limited vitrectomy in such cases. A small gauge 23-G/25-G trocar cannula is passed transconjunctivally, and the liquefied vitreous is allowed to egress. Vitrectomy is done extraocularly till the vitreous pressure lowers down. This technique helps to debulk the vitreous and decompress the globe in a controlled manner. The resultant posterior displacement of iris-lens diaphragm causes a deepening of the anterior chamber to facilitate phacoemulsification.

SUBMITTER: Sachdev R

PROVIDER: S-EPMC5742974 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Limited vitrectomy in phacomorphic glaucoma.

Sachdev Ritika R Gupta Avnindra A Narula Ritesh R Deshmukh Rashmi R

Indian journal of ophthalmology 20171201 12

One of the challenging situations for a cataract surgeon is phacoemulsification in the shallow anterior chamber like cases of phacomorphic glaucoma. Some of the main concerns of operating in a narrow space include endothelial decompensation, descemet's detachment, and posterior capsular rents. High vitreous pressure predisposes to posterior capsular rents owing to a reduced concavity of the posterior capsule and increasing the proximity of phaco-tip to the posterior capsule. We describe a techni ...[more]

PMID: 29208826

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Project description:BackgroundThis study aims to describe outcomes of posteriorly-placed glaucoma drainage devices (GDD) with concurrent endoscopic vitrectomy in pediatric patients with glaucoma and corneal opacification.MethodsThis retrospective case series identified patients under 18 years of age who underwent posteriorly-placed GDD implantation with concurrent endoscopic vitrectomy between 2012 and 2021. Data collected included ocular diagnoses, prior intraocular surgeries, type and position of GDD, surgical complications, and additional surgeries. Preoperative and final visual acuity, intraocular pressure (IOP), number of glaucoma medications, and exam findings were also recorded. Surgical data included type and position of GDD, Success was defined as IOP between 5-21 mmHg without visually devastating complication or need for additional glaucoma surgery.ResultsTen patients (14 eyes) with sclerocornea (6), Peters Anomaly (4), corneal decompensation from increased IOP (3), and corneal scar (1) underwent combined endoscopic vitrectomy with posteriorly-placed GDD (Baerveldt (10 eyes), Ahmed (4 eyes)) at 4.6 ± 5.8 years of age. Four eyes of 3 patients remained successful at final follow-up, while 10 eyes of 7 patients required 2.4 ± 1.3 additional surgeries for glaucoma (7) or hypotony (3). Kaplan Meier analysis demonstrated 1- and 2-year survival rates of 36% and 18%, respectively. At final follow-up (3.7 ± 2.4 years), after an average of 4.4 ± 2.4 glaucoma surgeries, 13 of 14 eyes had obtained IOP control on significantly fewer (p<0.0001) IOP-lowering medications. Additional complications included retinal detachment (2), chronic corneal graft failure (2), phthisis (1) and band keratopathy (1).ConclusionsManagement of glaucoma in pediatric eyes with corneal opacification is challenging and often requires multiple surgeries. A combined endoscopic vitrectomy and posteriorly placed GDD is a viable technique to establish aqueous humor outflow. Although the success rate is low, this surgical approach may be useful in ultimately obtaining IOP control and preserving vision in these complex eyes.

Project description:PurposeTo establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor (VEGF) injection, pars plana vitrectomy (PPV), endoscopic pan-retinal photocoagulation (PRP), and endoscopic cyclophotocoagulation (ECP) surgery for neovascular glaucoma (NVG) patients.MethodsThis retrospective study included 30 patients (30 eyes) who were suffering from NVG and treated with PPV & PRP & ECP (ECP group, 16 eyes), or Ahmed glaucoma valve implantation (Ahmed group, 14 eyes). The intraocular pressure (IOP), number of postoperative anti-glaucoma medications, best-corrected visual acuity (BCVA), successful rate of surgery, and postoperative complications were recorded and statistically analyzed at the time points of preoperative, 1-day, 1-month, 3-months, 6-months, and 12-months after operation.ResultsAn obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation (P < 0.05), and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months (P = 0.014) and 12-months (P = 0.047) postoperative time points, while there was no significant difference of medication number between the two groups except for 1-day after surgery. The BCVA showed no marked difference between the two groups preoperatively and postoperatively (P > 0.05), while it was significantly improved in ECP group at 3-months (P = 0.001), 6-months (P = 0.004), and 12-months (P = 0.010) time points comparing with preoperative BCVA. The surgical success rates in ECP group were also slightly higher than Ahmed group. And the complications after operation showed no marked differences.ConclusionsThe comprehensive treatment of PPV, endoscopic PRP, and ECP surgery for NVG patients after anti-VEGF injection can control IOP effectively and be friendly to patients' BCVA without obvious serious complications throughout a 12-months follow-up period.

Dataset Information

Limited vitrectomy in phacomorphic glaucoma.

Publications

Limited vitrectomy in phacomorphic glaucoma.

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