Pars Plana Vitrectomy in the Management of Phakic and Pseudophakic Malignant Glaucoma

Harbour, J. William; Rubsamen, Patrick E.; Palmberg, Paul

doi:10.1001/archopht.1996.01100140275003

Cited by 86 publications

(85 citation statements)

References 18 publications

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“…25 The main reason for this higher success rate is thought to be the guaranteed disruption of the anterior hyaloid with removal of the lens. 26 In other studies, 27 lens extraction was also supported due to the risk of iatrogenic cataract formation during anterior hyaloid removal. We also postulated that compared with the crystalline lens, the artificial lens which is much smaller and thinner, is less likely to push the iris and the ciliary body forward.…”

Section: Discussionmentioning

confidence: 95%

Clinical efficacy of modified partial pars plana vitrectomy combined with phacoemulsification for malignant glaucoma

Qian

Liu

et al. 2016

Eye

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Objective The objective of this study was to evaluate the clinical effects of modified partial pars plana vitrectomy together with phacoemulsification, intraocular lens (IOL) implantation, posterior capsulectomy, and zonulohyaloidectomy for patients with malignant glaucoma after trabeculectomy or cataract surgery. Design Retrospective, cohort study. Participants Thirty consecutive patients (30 eyes) with malignant glaucoma after trabeculectomy surgery or ultrasonic phacoemulsification of cataract between January 2008 and September 2014 were enrolled. Methods A retrospective analysis of 30 eyes with malignant glaucoma after trabeculectomy surgery for angle-closure glaucoma or ultrasonic phacoemulsification of cataract was performed. All patients underwent modified partial pars plana vitrectomy with zonulohyaloidectomy. Phacoemulsification and IOL implantation was performed in 25 patients with no previous cataract surgery. Preoperative and post-operative ocular parameters were recorded in detail. Main outcome measures Clinical features, anterior chamber depth, best-corrected visual acuity, and intraocular pressure (IOP). Results In these 30 patients, 25 had undergone trabeculectomy surgery and 5 had undergone cataract surgery. The mean axial length was 21.3 ± 0.8 mm. After surgery, mean IOP decreased from 34 ± 8.3 mm Hg to 10.5 ± 4.1 mm Hg (Po0.001), and mean anterior chamber depth increased from 0.8 ± 0.4 mm to 2.7 ± 0.3 mm (Po0.001). No severe complications occurred. Conclusions Modified partial pars plana vitrectomy combined with phacoemulsification, IOL implantation, posterior capsulectomy, and zonulohyaloidectomy not only simplifies the process of traditional vitrectomy, but effectively resolves the ciliary block and corrects the misdirection of aqueous humor in malignant glaucoma.

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Section: Discussionmentioning

confidence: 95%

Clinical efficacy of modified partial pars plana vitrectomy combined with phacoemulsification for malignant glaucoma

Qian

Liu

et al. 2016

Eye

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“…Mean preoperative IOP was 37.7 ± 9.9 mm Hg and was reduced to 13.5 ± 2.7 at the end of follow-up (w 2 ANOVA ¼ 31.16; P ¼ 0.00002; range means ¼ 3.75, range sum ¼ 30.0; Po0.05). Mean CDVA (log MAR) improved from 0.99±0.73 to 0.88±0.91 at the end of follow-up (paired Wilcoxon's test, P ¼ 0.363).…”

Section: Resultsmentioning

confidence: 92%

“…In those cases that are refractory to medical and/or laser treatment, surgical treatment has to be used. 1,2 The conventional vitrectomy and Nd:YAG laser capsulotomy with hyaloidotomy also have short-term effect with a relapse rate of up to 75%. 3 Recently, some case reports or small case series suggest that combination of pars plana vitrectomy with zonulectomy and iridectomy might give promising results in pseudophakic eyes.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of a new surgical method to treat malignant glaucoma in pseudophakia

Żarnowski

Wilkos-Kuc

Tulidowicz-Bielak

et al. 2014

Eye

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Purpose To assess the efficacy and safety of a relatively new surgical method in pseudophakic malignant glaucoma patients. Methods This study is a retrospective, noncomparative, interventional case series. Ten eyes of nine pseudophakic malignant glaucoma patients with mean age of 63.3 years were analysed. All 10 eyes underwent a novel surgical technique, an anterior chamber capsulo-hyaloidectomy and anterior vitrectomy through the peripheral iridectomy. Main outcome measures were: reformation of the anterior chamber, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications. Results All 10 eyes with pseudophakic malignant glaucoma were treated successfully by using a new surgical technique. All cases had a relief of aqueous misdirection with anterior chamber deepening during and after the surgery and post-operative intraocular pressure (IOP) normalization. No relapses have been observed so far. There were no complications during surgery and in the post-operative period. Conclusion The presented surgical technique seems to be safe and effective in all cases of malignant glaucoma in pseudophakia.

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“…It most commonly occurs after glaucoma filtration surgery but can occur after cataract extraction, laser iridotomy, capsulotomy, miotic therapy and cyclophotocoagulation [2][3][4][5][6]. It is more common in patients who have a history of treatment for angle closure glaucoma [7].…”

Section: Introductionmentioning

confidence: 99%

“…The management for aqueous misdirection remains a challenge and numerous strategies have been described. Medical therapies with cycloplegics and aqueous suppressants, laser therapies with peripheral iridotomy and anterior hyaloidotomy and surgical therapy with pars plana vitrectomy have all been described [2,[10][11][12]. Unfortunately the failure rate for medical and laser therapy is high.…”

Section: Introductionmentioning

confidence: 99%

Case series: Zonulectomy in the treatment of aqueous misdirection

Khan¹

2016

New Front Ophthalmol

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Purpose: The management for aqueous misdirection remains a challenge and numerous strategies have been described. Unfortunately the failure rate for medical and laser therapy is high. Previous reports describe a technique of combined vitrectomy with hyaloido-zonulectomy for the treatment of aqueous misdirection. We report our case series of patients managed with a modified version of this technique. Methods:Seven consecutive cases of aqueous misdirection diagnosed between January 2006 and September 2010 (7 eyes of 5 patients) were included in the study. Five eyes underwent pars plana vitrectomy combined with peripheral zonulectomy, two patients underwent a peripheral zonulectomy from an anterior approach. Outcome measures included BCVA, IOP, medications and slit lamp findings.Results: All patients responded to surgery with reduction in IOP and deepening of the AC. One patient needed an additional proceedure after 4 months and one patient suffered from post operative endophthalmitis. Mean follow up 27 months (range 14-42 months). Conclusions:A reason for the high recurrence rate in patients who have had vitrectomy alone is due to difficulty in establishing unobstructed flow from the vitreous cavity to the anterior chamber. Our case series highlights the importance of the zonulectomy which we feel to be a crucial step as it establishes the unobstructed communication.Three port pars plana vitrectomy combined with hyaloido-zonulectomy is an effective treatment for the management of aqueous misdirection; experienced anterior segment surgeons may consider performing a peripheral iridectomy and zonulectomy from an anterior approach.

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Pars Plana Vitrectomy in the Management of Phakic and Pseudophakic Malignant Glaucoma

Cited by 86 publications

References 18 publications

Clinical efficacy of modified partial pars plana vitrectomy combined with phacoemulsification for malignant glaucoma

Clinical efficacy of modified partial pars plana vitrectomy combined with phacoemulsification for malignant glaucoma

Efficacy and safety of a new surgical method to treat malignant glaucoma in pseudophakia

Case series: Zonulectomy in the treatment of aqueous misdirection

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