Trabeculectomy ab interno (trabectome): yet another possibility in the treatment of uncontrolled glaucomatocyclitic crisis under systemic valganciclovir therapy?

Abstract

Purpose To assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner-Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP). Patients/Methods Trabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months. Results Mean IOP before trabectome surgery was 40 ± 10 mm Hg (range 33-58 mm Hg). The mean number of antiglaucoma medication prior to surgery was 3.1 ± 0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13 ± 1 mm Hg) and their antiglaucoma medication was decreased to 0.8 ± 1.1. No recurring attack of glaucomatocyclitic crisis occurred. Discussion In addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.

XEN‐45 collagen implant for the treatment of uveitic glaucoma

“…Three eyes (12.5%) lost ≥2 lines of BCVA due to cataract progression after XEN‐45 stent implantation, likely secondary to the use of postoperative steroid eye drops. Despite the material of the XEN‐45 implant being soft and tissue‐conforming, implant exposure occurred in two eyes (8.3%) in our study and has also been reported previously …”

“…Despite the material of the XEN-45 implant being soft and tissue-conforming, implant exposure occurred in two eyes (8.3%) in our study and has also been reported previously. 25,28,29 Our study was limited by the small number of patients. There was insufficient statistical power to identify the predictors of failure.…”

Posner-Schlossman Syndrome

“…An affected individual's vision will be determined by the level of associated corneal edema, ranging from visual acuity as high as 20/20 to vision being limited to light perception [2]. The pupil will often be slightly dilated and sluggishly reactive to light [2,7]. The conjunctiva may demonstrate no abnormalities or can demonstrate ciliary flush [2].…”

“…The conjunctiva may demonstrate no abnormalities or can demonstrate ciliary flush [2]. On slit-lamp examination, discrete, round, white keratic precipitates on the endothelium can be noted [2,4,7,8]. PSS will usually have significantly elevated IOP, potentially leading to corneal epithelial edema [1,2,4,7,8].…”

“…However, there is a lack of strong evidence that treatment prevents or reduces recurrence [4,[8][9]. It has also been shown that PSS may resolve spontaneously within days to weeks, but despite this, treatment is still indicated to control IOP and inflammation [7]. In addition, topical non-steroidal anti-inflammatory agents can be used to decrease the inflammation associated with PSS [1][2].…”