ABSTRACT
Aqueous misdirection (AM) is a dreaded complication, but fortunately quite rare. It usually occurs after intervention for angle closure glaucoma. When pharmacotherapy and/or laser interventions are unsuccessful, then the surgical management hitherto most commonly undertaken is pars plana posterior vitrectomy. We describe the management of recurrent AM via the anterior route, when it occurred following relapse as pars plana posterior vitrectomy failed to result in long-term normalization of anterior chamber and intraocular pressure. Anterior vitrector with anterior vitrectomy settings was used by a glaucoma specialist to carry out the procedure.
ABSTRACT
PURPOSE: To investigate the effects of topical anesthesia combined with patient-controlled sedation analgesia for posterior vitrectomy. METHODS: All patients requiring vitrectomy from December 2003 to January 2004 at Seoul National University Hospital underwent surgery with topical anesthesia combined with patient-controlled sedation analgesia. The levels of intraoperative pain and sedation were recorded. The associations of operation time, combined vitreoretinal procedures, and age with intraoperative pain were investigated. Hemodynamic instability and respiratory depression were checked throughout the operation. RESULTS: Forty-three patients (53 eyes) underwent vitrectomy under topical anesthesia combined with patient-controlled sedation analgesia. The mean age was 51.75 +/- 13.68 years and the sex ratio was 25: 28 (male: female). The mean of VAS (visual analogue scale) was 53.61 (5 ~ 67). The level of intraoperative sedation was grade 1 (64%) or 2 (36%). No anesthesia-associated complications were found. CONCLUSIONS: In spite of relatively high VAS, there were no remarkable difficulties in performing posterior vitrectomy and appropriate levels of intraoperative sedation and cooperation were available without anesthesia-associated complications.