Evaluation of the Effectiveness of Surgical Treatment of Malignant Glaucoma in Pseudophakic Eyes through Partial PPV with Establishment of Communication between the Anterior Chamber and the Vitreous Cavity

Abstract

Purpose. Determination of partial posterior vitrectomy (PPV) in the proposed modification for treatment of malignant glaucoma. Methods. The prospective, consecutive, single-center case series study involved patients in whom symptoms of malignant glaucoma occurred after combined cataract and glaucoma surgery or after glaucoma surgery in pseudophakic eye. When medical and laser treatment were not successful, partial PPV with establishment of communication between the anterior chamber and the vitreous cavity was performed. Efficacy measures were intraocular pressure (IOP) reduction, corrected distance visual acuity (CDVA), AND the number of antiglaucoma medications. Surgical success and occurring complications were also evaluated. Results. The study enrolled 20 eyes of 17 patients. Average IOP was reduced from 30.4 ± 14.2 (SD) mmHg to 14.6 ± 3.2 (SD) mmHg one year after surgery (P < 0.00001). A statistically significant reduction of the number of antiglaucoma medications was obtained from 3.3 ± 1.1 (SD) preoperatively to 1.2 ± 1.1 (SD) at the end of follow-up. Statistically significant improvement of CDVA was observed 3, 6, and 12 months after surgery. Conclusions. Partial PPV with establishment of communication between the anterior chamber and the vitreous cavity enables effective IOP control over a 12-month observation; however, in most cases, it is necessary to use antiglaucoma medications for IOP control.

Evaluation of Two Different Anterior Vitrectomies for Fluid Misdirection Syndrome Secondary to Cataract Surgery Combined with Goniosynechialysis

“…Fluid misdirection syndrome, as first described by Von Graefe in 1869, is characterized by elevated IOP and a very shallow anterior chamber with the absence of pupillary Journal of Ophthalmology block, choroidal effusion or hemorrhage and no noticeable pathology of the iris-lens diaphragm [8,16]. FMS secondary to a different glaucoma treatment is extremely rare, with the incidence rate from 0.03% to 6% [7,17,18]. e exact pathophysiology of fluid misdirection syndrome is still unclear.…”

“…Previously, VHZI has been considered effective in reestablishing the aqueous flow between the anterior chamber and vitreous chamber [7,[9][10][11][12]14], which could be achieved through anterior chamber or pars plana approach. However, most studies only reported the results of VHZI using one of the two methods.…”

“…Current treatment options for FMS primarily include (1) medications, (2) neodymium:yttrium-aluminum-garnet (Nd:YAG) laser iridotomy with anterior hyaloidotomy in phakic eyes, (3) Nd: YAG laser iridotomy with posterior capsulotomy and hyaloidotomy in pseudophakic eyes, (4) transscleral cyclophotocoagulation, and (5) anterior vitrectomy. However, previous studies showed that the success rate of both medications and laser therapy is low [5][6][7]. While transscleral cyclophotocoagulation helps to achieve optimum eye resolution in most cases, but it may also damage tissues such as the ciliary processes, sclera, and conjunctiva [8,9].…”

“…Previous studies suggest that anterior vitrectomy combined with hyaloidotomy, zonulectomy, and iridectomy (VHZI) is effective in creating a permanent passage between the anterior chamber and the vitreous cavity [7,[9][10][11][12][13]. e anterior vitrectomy can be performed via anterior chamber approach or pars plana approach [7,[9][10][11][12]14]. However, a comparative analysis of their efficacy and safety is currently lacking.…”

Pathophysiological features of development, clinical features and treatment of malignant glaucoma

“…Длительное время для хирургического лечения ЗГ рекомендовалось проведение ленсэктомии, хотя она оказывалась эффективной только при условии выпадения стекловидного тела во время операции. В настоящее время с целью декомпрессии стекловидного тела проводится витрэктомия (передняя или через плоскую часть цилиарного тела) [35,[38][39][40]. Во время операции в одной локализации, через иридэктомию, одновременно выполняется также гиалоидотомия и капсулотомия для создания прямой полноценной связи между передней и задней камерами глаза, поскольку простое проведение витрэктомии часто не приводит к желаемому результату [41,42].…”