25-Gauge Microincision Vitrectomy to Treat Vitreoretinal Disease in Glaucomatous Eyes after Trabeculectomy

Abstract

Purpose. To determine the feasibility of using 25-gauge microincision vitrectomy surgery (25GMIVS) to treat vitreoretinal disease in glaucomatous eyes which have previously undergone trabeculectomy (TLE). Methods. A consecutive, interventional case series. We performed 25GMIVS in 15 glaucomatous eyes that had undergone TLE. Follow-up period was 11.5 months. Results. 25GMIVS was successfully used and led to improvement in visual acuity (P < 0.01). We performed 25GMIVS for proliferative diabetic retinopathy with neovascular glaucoma in 53% of eyes (8 of 15). Although 3 eyes needed further TLE following 25GMIVS, final IOP was below 21 mmHg in all eyes except one eye (93%) and was comparable to pre-25GMIVS IOP (P = 0.20) without an increase in the number of glaucoma medications (P = 0.14). Conclusions. 25GMIVS is a feasible treatment for vitreoretinal disease in eyes with preexisting TLE, effective in both significantly improving BCVA and preserving the filtering bleb, while not excluding further glaucoma surgery.

Quarter-Shifted Microincisional Sutureless Vitrectomy in Patients with a Glaucoma Drainage Implant or Filtering Bleb

“…Patients whose eyes were treated previously with a glaucoma filtering bleb or GDI and require additional surgery are at risk of losing appropriate IOP control if an incision is required over a functioning bleb or GDI 2. In a previous study of 25-gauge microincision vitrectomies to treat vitreoretinal disease in glaucomatous eyes after trabeculectomy, the insertion point of the cannula was shifted so as to avoid disturbing the conjunctiva adjacent to the filtering bleb 3. A few previous reports have described the utility of a temporal approach during vitrectomy.…”

23-gauge transconjunctival vitrectomy in eyes with pre-existing functioning filtering blebs

“…There was a case in 2007 that reported successful outcome of 25G PPV in familial amyloid polyneuropathy patients with filtering bleb [ 11 ]. Kunikata et al recently reported the stable results of 25G microincision vitrectomy in eyes that received trabeculectomy [ 7 ]. Therefore, the authors evaluated 23G PPV for vitreoretinal disease in eyes with prior trabeculectomy.…”

“…In this study, 36 % of the subjects had open angle glaucoma for which trabeculectomy was performed, followed by 27 % with neovascular glaucoma. Kunikata et al reported 53 % neovascular glaucoma and 13 % open angle glaucoma cases, and Thompson et al, reported 57 % open angle glaucoma and 17 % angle closure glaucoma [ 4 , 7 ]. In the current study, 4 eyes (36 %) of the 11 subjects had epiretinal membrane and 3 eyes (27 %) of the 11 subjects had proliferative diabetic retinopathy.…”

“…In the current study, 4 eyes (36 %) of the 11 subjects had epiretinal membrane and 3 eyes (27 %) of the 11 subjects had proliferative diabetic retinopathy. According to Kunikata et al, 53 % of patients who received 25G PPV in eyes that received trabeculectomy were proliferative diabetic retinopathy patients, and only 1 eye (6.5 %) was from an epiretinal membrane patient [ 7 ]. Thompson et al, studied patients with 20G PPV in eyes that received trabeculectomy, of which 57 % had rhegmatogenous retinal detachment and 13 % each had proliferative diabetic retinopathy and epiretinal membrane [ 4 ].…”

“…Eyes with prior trabeculectomy would require microincision vitrectomy for preservation of the filtering bleb. Kunikata et al recently reported the good outcomes of 25-gauge (25G) microincision PPV in eyes that received prior trabeculectomy [ 7 ]. However, there are no such studies on outcome of 23-gauge (23G) PPV in eyes that received prior trabeculectomy.…”