Malignant Glaucoma Following Argon Laser Release of Scleral Flap Sutures After Trabeculectomy

DiSclafani, Mark; Liebmann, Jeffrey M.; Ritch, Robert

doi:10.1016/0002-9394(89)90441-8

Cited by 39 publications

(18 citation statements)

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“…Complications of overflow may include flat anterior chamber, choroidal detachment, persistent hypotony, hypotony maculopathy, aqueous misdirection, cataract, and suprachoroidal haemorrhage. 1,4,5 There is variation in many of the surgical steps in trabeculectomy. 6 The UK National Trabeculectomy Survey 6 found that scleral flap shape is most often rectangular and most commonly secured with two 10-0 nylon sutures at the upper two corners.…”

Section: Resultsmentioning

confidence: 99%

“…If the scleral flap is poorly constructed or too loose, transclerostomy flow will be too great, which may commonly result in low IOP, loss of anterior chamber, blood aqueous barrier breakdown (with potential for increased healing response and failure by scarring), choroidal effusions, cataract, and thin focal drainage bleb; less commonly there may also be hyphaema, lens-cornea touch, catastrophic suprachoroidal hemorrhage, and aqueous misdirection. 1,4,5 If the scleral flap is too tight, the IOP will be too high, which places the patient at risk from sudden loss of remaining field if the glaucoma is advanced ('snuff out') or further ganglion cell loss and resultant worsening of glaucomatous optic neuropathy. Massage and suture release (or lysis) are the most commonly practiced methods of manipulating IOP in the early days after trabeculectomy.…”

Section: Discussionmentioning

confidence: 99%

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Flap and Suture Manipulation after Trabeculectomy with Adjustable Sutures: Titration of Flow and Intraocular Pressure in Guarded Filtration Surgery

Wells¹,

Bunce²,

Khaw³

2004

Journal of Glaucoma

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These results suggest that suture adjustment may be superior to both posterior lip massage and releasable sutures for managing IOP in the early phase following glaucoma surgery. Following clinical interventions that result in loss of anterior chamber volume, IOP checks should be made at least 40 minutes post-intervention or at a later time afterwards if there is a clinical risk of low aqueous production. Manipulation of the scleral flap and associated sutures may only lower the IOP for minutes to hours if the suture tension is not decreased.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Flap and Suture Manipulation after Trabeculectomy with Adjustable Sutures: Titration of Flow and Intraocular Pressure in Guarded Filtration Surgery

Wells¹,

Bunce²,

Khaw³

2004

Journal of Glaucoma

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“…These include laser treatment (peripheral laser iridotomy [26, 27], trabeculectomy scleral flap suture lysis [28, 29], and cyclophotocoagulation [30]); use of miotics [31, 32] and trabeculectomy bleb needling [33]. There are sporadic reports of malignant glaucoma in association with infection [34, 35], retinopathy of prematurity [36, 37], retinal detachment [38], retinal vein occlusion [39], and trauma [40].…”

Section: How Can Malignant Glaucoma Be Classified?mentioning

confidence: 99%

Malignant Glaucoma: A Review of the Modern Literature

Shahid

Salmon

2012

Journal of Ophthalmology

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Malignant glaucoma is a rare form of glaucoma that typically follows surgery in patients with primary angle closure and primary angle-closure glaucoma. In this paper, the clinical features, classification, pathogenesis, and principles of management are discussed. Despite a high prevalence of primary angle closure glaucoma in South-East Asia, the vast majority of cases of malignant glaucoma are reported in White populations. This may reflect differing mechanisms of angle closure in White and Asian patients, which somehow reduces the likelihood of an aberrant relationship developing between the lens, ciliary body, anterior hyaloid, and vitreous structures within the eye. Although the exact underlying pathogenic mechanism remains unclear, the prognosis is good with modern medical, laser, and surgical treatment modalities.

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“…[2][3][4][5] Because of this major complication, ''secure closure'' of the scleral flap replaced previously accepted concept of ''loose closure'' of the scleral trapdoor. [5][6][7][8][9][10] Before the addition of antimetabolites to the trabeculectomy procedure, the ophthalmic surgeon knew from the experience that suture release whether by ''releasable'' sutures 11 or ''laser suture lysis'' (LSL) had to be carried out within the first 2 weeks of the postoperative period to have a positive effect on aqueous flow. 6,12 There are some other reports that specifically mention about the effects of LSL on intraocular pressure (IOP) in weeks 3 and 4 after trabeculectomy.…”

mentioning

confidence: 99%