Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma

Abstract

Purpose:To report long-term follow-up of zonulo-hyaloido-vitrectomy (ZHV) via anterior approach for pseudophakic malignant glaucoma refractory to medical treatment.Design:Noncomparative case-series.Materials and Methods:Medical records of 9 patients who sought treatment for aqueous humor misdirection refractory to medical treatment were reviewed. All patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy (PI) via an anterior approach. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination, and fundus findings.Results:10 eyes of 9 patients (7 female, 2 male) who underwent ZHV for refractory pseudophakic malignant glaucoma between 2003 and 2010 were included in this case-series. The mean age of patients was 77.4 ± 9.0 years, mean follow-up duration 50.2 ± 27.2 months. Recurrence of malignant glaucoma was noted in 40% (four cases) after a successful ZHV on long-term follow-up.Conclusions:An anterior segment surgeon can treat malignant glaucoma refractory to medical treatment successfully by vitrectomy, hyaloido-zonulectomy, and PI. This can be done via an anterior approach and patients require long follow-up to rule out a relapse despite a successful outcome in the short term.

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

“…In our case series, 8 of 9 eyes were followed up for more than 6 months, and membrane covering peripheral iridectomy was observed in 2 cases with recurrence of FMS. We considered that the membrane might be formed by deposition of fibrin exudates on the front surface of the residual vitreous around the channel (Figures 2(c) and 2(d)), which was reported in the previous study [14].…”

“…However, only one of the four relapse cases was successfully treated with the Nd: YAG laser fibrinolysis and anterior hyaloidectomy in the study of Madgula and Anand. e others were resolved through repeated anterior vitrectomy and cyclodiode laser [14]. We hypothesize that Nd:YAG laser may be ineffective if the tunnel between anterior and posterior chambers is significantly blocked by residual vitreous.…”

“…FMS relapse rate after VHZI via pars plana incision varies significantly in different studies (0% by Sharma et al [11], Bitrian et al [9,12], 10.1% by Al Bin Ali et al [15], and 66% by Debrouwere et al [6]). Similarly, FMS relapse rate after VHZI via anterior chamber approach also varies significantly (0% by Lois et al [10], Zarnowski et al [21,22], and 40% by Madgula and Anand [14]). However, previous studies have failed to conclude if there is a difference in relapse rates when comparing the two surgical approaches.…”

“…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.…”

“…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.…”