Refractory Glaucomas. Types and Management

Abstract

Certain types of glaucomas do not respond to conventional trabeculectomy; they are named refractory glaucomas. They are notorious and often recurrent. Examples include: childhood, neovascular, uveitic, traumatic, glaucomas with wide conjunctival scars, post-vitrectomy, post-keratoprosthesis, post-keratoplasty, ciliary block, recurrent and glaucoma in aphakic and pseudophakic eyes. Some of those glaucomas require specific medical management like uveitic glaucoma. However, surgical intervention is ultimately needed in most of cases. Different surgical strategies include: antimetabolites-assisted trabeculectomy, drainage implants, cyclodestructive surgeries and other approaches. This review article will discuss the current management strategies for refractory glaucomas and the application of those treatment modalities to the specific glaucoma types.

Efficacy and Safety of Micropulse Transscleral Laser Therapy in Silicone Oil–induced Glaucoma

“…11 Invasive techniques are often needed. 2,18,19 Trabeculectomy in SOG has poor outcomes due to high inflammation related to SO emulsification in the subconjunctival space and the absence of naive conjunctiva due to scarring resulting from previous vitreoretinal surgery. 2,12,13,23 Drainage devices were suggested as a better solution.…”

“…2,18,19 Trabeculectomy in SOG has poor outcomes due to high inflammation related to SO emulsification in the subconjunctival space and the absence of naive conjunctiva due to scarring resulting from previous vitreoretinal surgery. 2,12,13,23 Drainage devices were suggested as a better solution. However, complications rate remains remarkable such tubes exposure, endophthalmitis, and failure due to SO migration into tubes.…”

“…However, complications rate remains remarkable such tubes exposure, endophthalmitis, and failure due to SO migration into tubes. 2,12,18,23 Finally, transscleral cyclodestructive techniques such as cyclocryotherapy and conventional laser cyclophotocoagulation were suggested as a final efficient technique but exposing to a high risk of complications. 4,24 Cyclocryotherapy is not any more commonly used nowadays due to the high risk of complications particularly inflammation, hypotony, and globe phthisis.…”

“…M icropulse laser technology is a novel technique dividing laser beams in short bursts. [1][2][3][4] It was developed to reduce side effects caused by continuous laser in treating retinal diseases and glaucoma. It was first introduced for the management of open angle glaucoma (OAG).…”

“…Studies were interested especially in primary open angle glaucoma (POAG). 2,3,[5][6][7][8][9][10] In current practice, secondary glaucoma such as silicone oil-induced glaucoma (SOG) are frequent, and their management may be very challenging. SOG is a main complication of intraocular tamponade.…”