Congenital ectropion uveae (CEU) with refractory glaucoma: Early trabeculectomy saves vision

Singh, Kehar; Bhattacharyya, Mainak; Gotmare, Nikhil; Joon, Annu; Aggarwal, Himshikha; Singh, Arshi

doi:10.1177/1120672119860379

Cited by 3 publications

(4 citation statements)

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“…In fact, a single surgical technique, even repeated, not always allows these patients to achieve good control of the IOL. The patients treated by Sethi et al 15 and more recently by Singh 13 and Kumari, 20 using trabeculectomy with antifibrotics (0.02% Mitomycin C) obtained an effective IOP control, as explained in their case reports; in other reports it was necessary to resort over time to various surgical procedures, associated or not with conservative therapies, to maintain adequate control of glaucoma. 3,6,8,12,18 For example, the case report by Hatami et al, despite sub-tenon MMC injection and bleb needling, six months after mitomycin-C-augmented trabeculectomy had to perform a shunt procedure to control the IOP.…”

Section: Discussionmentioning

confidence: 92%

“…6,9,10 Glaucoma is a known complication of CEU, ipsilateral to iris defect; this might be a consequence of the anteriorized insertion of the iris which leads to a dysgenesis of the angle and incomplete development of the trabecular meshwork. 3,6,[11][12][13] Glaucoma in these patients is often refractory to topical and laser therapy resulting in the need for filtering surgery. 3,6,[11][12][13][14][15][16][17][18][19][20] The only report we found about the use of ALT for CEU is from Ritch et al, 6 over four patients.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,[11][12][13] Glaucoma in these patients is often refractory to topical and laser therapy resulting in the need for filtering surgery. 3,6,[11][12][13][14][15][16][17][18][19][20] The only report we found about the use of ALT for CEU is from Ritch et al, 6 over four patients. In two cases they performed ALT after the failure of trabeculectomy, repeated ALT after six months and achieved IOP control by adding topical therapy (total follow-up length not reported, but greater than one year).…”

Section: Discussionmentioning

confidence: 99%

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Argon laser trabeculoplasty for congenital ectropion uveae: Case report and review of the literature

Incandela

Ferreri

Sisto

et al. 2023

European Journal of Ophthalmology

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A 18-year-old woman with unilateral glaucoma secondary to congenital ectropion uveae (CEU) in the right eye, without other systemic and ocular associations. Intraocular pressure (IOP) was uncontrolled under topical therapy. The visual field (VF) was within normal limits; retinal nerve fiber layer (RNFL) thickness, as evaluated by Optical Coherence Tomography (OCT), was reduced. The patient refused surgical intervention. After evaluation of the iridocorneal angle, ALT was performed as follows: 95 spots were applied for the 270 ° of visible trabecular meshwork using a laser beam diameter of 50 μm, an exposure time of 0.1 s and a power of 750 mw). Mean IOP in the right eye, as evaluated by diurnal tonometric curve, was 10 mmHg, 16 mmHg and 20 mmHg respectively one month, four months and eight months after ALT, with no additional topical therapy, and 18 mmHg twelve months after ALT with topical therapy. CEU is a rare, non-progressive anomaly characterized by the proliferation of iris pigment epithelium on anterior surface of iris; glaucoma, in this disorder, is often poorly controlled with medical therapy alone. In a phase of initial glaucomatous damage and with a not particularly high IOP, as in this case, ALT could be an alternative therapeutic option at least in the short-term, when surgery is not feasible immediately. In fact, given its limited effectiveness over time, ALT can be used as a temporary control measure of IOP, pending surgery to become feasible.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Argon laser trabeculoplasty for congenital ectropion uveae: Case report and review of the literature

Incandela

Ferreri

Sisto

et al. 2023

European Journal of Ophthalmology

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“…Dowling et al [ 1 ] reported performing six goniotomies in three patients with glaucoma associated with CEU that did not control IOP, after which they finally required trabeculectomy. Trabeculectomy appears to be largely successful in this condition [ 18 , 19 ]. Lim et al [ 18 ] described three children with isolated CEU, who could successfully control glaucoma over 5-15 years after trabeculectomy with MMC.…”

Section: Discussionmentioning

confidence: 99%

Unilateral advanced glaucoma in isolated congenital ectropion uveae with ipsilateral ptosis: A pictorial description of five children

Snehi

Kaur

Singh

et al. 2022

rjo

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CO2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review

Chen

Cheng

et al. 2022

Front. Med.

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IntroductionBilateral congenital ectropion uveae (CEU) is rare syndrome, usually accompanied by refractory glaucoma. Proper and timely treatment was very important for the prognosis. The report aims to compare the long-term outcomes and complications between the two eyes after different approaches of surgery in a case of bilateral CEU with advanced glaucoma.Case PresentationThe patient was a 20-year-old male with bilateral CEU and glaucoma. The intraocular pressure (IOP) was 48 mm Hg in the right eye (OD) and 52 mm Hg in the left eye (OS). The vertical cup-to-disc (C/D) ratio was nearly 1.0 in both eyes. Despite maximum medical therapy, the target IOP could not be achieved. Therefore, CO2 laser-assisted sclerectomy surgery (CLASS) was performed in OS, and the IOP was remarkably decreased. 1 month after the surgery, the IOP rebounded slightly and was controlled with a fixed-combination anti-glaucoma medicine. 3-month postoperatively, a YAG laser goniopuncture (LGP) was performed to enhance the IOP-lowing effect and the anti-glaucoma agent was discontinued. An ab externo microcatheter-assisted trabeculotomy (MAT) was performed in OD, and the IOP was also significantly decreased. During the follow-up period, the IOP was well controlled for both eyes without any medication. Shallow anterior chamber and complicated cataract developed in OS after CLASS, and there was no obvious late complication in OD after MAT.ConclusionsTo our knowledge, this was the first attempt to perform two different surgeries, CLASS and MAT, in both eyes of a single patient presented with bilateral CEU with glaucoma. Our results showed that the IOP was lower after CLASS, but there were potential complications such as shallow anterior chamber and complicated cataract. MAT could achieve a moderate IOP-lowing effect but had a higher safety. CLASS and MAT may be considered effective surgical options for the management of such patients.

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Congenital ectropion uveae (CEU) with refractory glaucoma: Early trabeculectomy saves vision

Cited by 3 publications

References 9 publications

Argon laser trabeculoplasty for congenital ectropion uveae: Case report and review of the literature

Argon laser trabeculoplasty for congenital ectropion uveae: Case report and review of the literature

Unilateral advanced glaucoma in isolated congenital ectropion uveae with ipsilateral ptosis: A pictorial description of five children

CO2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review

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