Surgical Management of Pseudophakic Malignant Glaucoma via Anterior Segment-Peripheral Iridectomy Capsulo-Hyaloidectomy and Anterior Vitrectomy

Paşaoğlu, Işıl; Altan, Çiğdem; Bayraktar, Şükrü; Şatana, Banu; Başarır, Berna

doi:10.1155/2012/794938

Cited by 13 publications

(16 citation statements)

References 21 publications

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“…In this way, one could make a unicameral eye with a less aggressive procedure. [ 15 16 22 24 ] In this study, we performed triamcinolone-assisted anterior vitrectomy through a clear corneal incision and performance of iridectomy and zonulohyaloidectomy. Lois and colleagues first described zonulo-hyaloido-vitrectomy through an existing peripheral iridotomy.…”

Section: Discussionmentioning

confidence: 99%

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Mini-vitrectomy; a Simple Solution to a Serious Condition

Pakravan

Esfandiari

Amouhashemi

et al. 2018

J Ophthalmic Vis Res

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Purpose:To evaluate the safety and efficacy of clear corneal approach irido-zonulo-hyaloido-vitrectomy, which we named “mini-vitrectomy,” in the management of pseudophakic aqueous misdirection.Methods:In this retrospective, non-comparative interventional case series, 24 eyes with diagnosis of pseudophakic aqueous misdirection were enrolled. Medical therapy with cycloplegics and laser therapy, including posterior capsulotomy and hyaloidotomy, was not effective in the management of the condition. The eyes underwent mini-vitrectomy, a simple technique in which iridotomy, zonulectomy, hyaloidectomy, and limited anterior vitrectomy were performed via a clear cornea incision. The main outcome measure was reformation of the anterior chamber, which was evaluated at day 1 and months 1, 3, 6, and 12.Results:The mean age of patients was 75.3 ± 11.3 years (range, 47 to 90), and 13 (54.2%) patients were women. Anterior chamber was deep in 22 patients (91.7%) at the last follow-up visit. The mean intraocular pressure (IOP) was 30.31 ± 1.9 mm Hg at presentation on 2.67 ± 1.09 glaucoma medications. IOP decreased significantly to 14.5 ± 4.6 mm Hg at 12-month follow-up. (P = 0.001). The number of glaucoma medications at final visit was 2.2 ± 0.9 (P = 0.21).Conclusion:Mini-vitrectomy is a simple, safe, and effective procedure in the management of pseudophakic aqueous misdirection, and it can be adopted by all ophthalmologists who are involved in glaucoma management and are not comfortable with the pars plana vitrectomy approach.

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Section: Discussionmentioning

confidence: 99%

“…Small study series of anterior approach consisting of an iridectomy, zonulohyaloidectomy, and anterior vitrectomy have demonstrated high success and low relapse rate in pseudophakic patients with aqueous misdirection. [ 15 16 ] This alternative technique can be performed instead of pars plana core vitrectomy.…”

Section: Introductionmentioning

confidence: 99%

Mini-vitrectomy; a Simple Solution to a Serious Condition

Pakravan

Esfandiari

Amouhashemi

et al. 2018

J Ophthalmic Vis Res

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“…Although the exact mechanism of malignant glaucoma remains unclear, an alteration in the anatomical relationship of the lens, ciliary body, and anterior hyaloid face causing aqueous misdirection and blockade has been suggested in the pathogenesis. The aqueous is thought to be entrapped inside the vitreous cavity as aqueous pockets, resulting in forward movement of the iris-lens diaphragm, which causes the secondary angle closure glaucoma (1,9).…”

Section: Introductionmentioning

confidence: 99%

“…The goal is to decrease aqueous humor production, shrink the vitreous body, and move the iris-lens diaphragm backward. Approximately 50% of cases respond to medical therapy, but recurrence is common following cessation of cycloplegics (1,9,10).…”

Section: Introductionmentioning

confidence: 99%

“…We have already reported our surgical approach in 2 cases of pseudophakic malignant glaucoma, which consisted of peripheral iridectomy, zonulectomy, hyaloidectomy, and anterior vitrectomy successfully performed by an anterior segment surgeon using a vitreous cutter inserted through a clear corneal incision (9). This technique creates a permanent passage between the anterior chamber and the vitreous cavity by eliminating the aqueous misdirection and helps us to understand the pathogenesis of the disease better.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Malignant Glaucoma

Altan¹

2017

Beyoglu Eye J

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Acute and chronic fluid misdirection syndrome: pathophysiology and treatment

Grzybowski

Kanclerz

2017

Graefes Arch Clin Exp Ophthalmol

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PurposeTo summarize our current understanding of the specific pathogenic mechanisms of the fluid misdirection syndrome and possible treatment methods.MethodsWe used the PubMed web platform to find relevant studies using the following keywords: infusion misdirection syndrome, aqueous misdirection syndrome, ciliary block, ciliovitreal block, capsular block, intraoperative fluid misdirection, subcapsular fluid entrapment, acute intraoperative rock-hard eye syndrome, positive vitreous pressure glaucoma, and malignant glaucoma. Other publications were also considered as a potential source of information when referenced in relevant articles.ResultsWe collected and analyzed 55 articles dated from 1951 to 2016. Acute intraoperative rock-hard eye syndrome is characterized by a very shallow anterior chamber with the absence of suprachoroidal effusion or hemorrhage and no noticeable pathology of the iris–lens diaphragm. It usually occurs during uneventful phacoemulsification, particularly in hyperopic eyes. The pathophysiology of acute fluid misdirection syndrome is based on inappropriate movement of balanced salt solution via the zonular fibers. This syndrome has also been described as occurring from hours to months, or years, after the initial surgery. The pathophysiology of malignant glaucoma is based on similar mechanisms of cilio-lenticular block of aqueous flow leading to the misdirection of aqueous posteriorly into or besides the vitreous gel. Faced with these situations, vitreous decompression is required, preferably with hyaloido-capsulo-iridectomy. In phakic eyes, concomitant cataract extraction would be desirable.ConclusionsWe believe both of these clinical conditions should be considered as one syndrome. We suggest the term acute fluid misdirection syndrome for the cascade of events during phacoemulsification surgery. Chronic fluid misdirection syndrome better describes the nature of malignant glaucoma.

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Surgical Management of Pseudophakic Malignant Glaucoma via Anterior Segment-Peripheral Iridectomy Capsulo-Hyaloidectomy and Anterior Vitrectomy

Cited by 13 publications

References 21 publications

Mini-vitrectomy; a Simple Solution to a Serious Condition

Mini-vitrectomy; a Simple Solution to a Serious Condition

Treatment of Malignant Glaucoma

Acute and chronic fluid misdirection syndrome: pathophysiology and treatment

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