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El nanoftalmo es una anomalía del desarrollo, de condición rara, siempre bilateral. Comúnmente se presenta con un patrón hereditario autosómico recesivo. Se presenta una paciente femenina de 49 años de edad, atendida en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", con antecedentes de queratocono, glaucoma y nanoftalmo (16 mm). Se realizó cirugía del cristalino y posteriormente la paciente presentó complicaciones, por lo que tuvo que ser intervenida por los Servicios de Glaucoma y Retina. Describimos el caso con el fin de contribuir a enfrentar futuras situaciones similares(AU)
Nanophthalmos is a rare, always bilateral developmental anomaly. It commonly follows an autosomal recessive inheritance pattern. A case is presented of a female 49-year-old patient attending Ramón Pando Ferrer Cuban Institute of Ophthalmology with a history of keratoconus, glaucoma and nanophthalmos (16 mm). Crystalline lens surgery was performed, after which the patient developed complications leading to a new intervention at the Glaucoma and Retina Services. The case is described with the purpose of contributing to the solution of similar future situations(AU)
Subject(s)
Humans , Female , Middle Aged , Cataract Extraction/methods , Glaucoma/diagnosis , Phacoemulsification/methods , Keratoconus/etiologyABSTRACT
@#AIM: To investigate the short-term and mid-term effectiveness and safety of transscleral ciliary body photocoagulation in the treatment of high intraocular pressure after the removal of malignant glaucoma ciliary ring block.<p>METHODS: Retrospective study. A collection of 14 eyes of 14 patients with high intraocular pressure after ciliary ring block was lifted from 2016-10/2019-10 malignant glaucoma were treated with 810nm semiconductor diode laser transscleral ciliary photocoagulation. Follow-up 8.36±5.18mo, observation Best corrected visual acuity(BCVA), intraocular pressure and complications before and after surgery.<p>RESULTS: The intraocular pressure of 13.60±3.50mmHg at the last follow-up after treatment was different from 40.53±7.14mmHg before operation(<i>P</i><0.05); there was no difference between the BCVA at the last follow-up postoperative and preoperative(<i>P</i>>0.05). All patients had no difference to the last follow-up and serious complications.<p>CONCLUSION: The 810nm semiconductor diode laser transscleral ciliary body photocoagulation is effective in the treatment of malignant glaucoma. It is easy to operate, has fewer complications, can effectively reduce intraocular pressure, and has little damage to the best corrected vision after surgery.
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@#AIM: To study individualized treatment of malignant glaucoma.<p>METHODS: Totally 19 malignant glaucoma patients(19 eyes)admitted in Leshan Ophthalmological Center from January 2016 to October 2018 were retrospectively analyzed. Main outcomes of best corrected visual acuitv, intraocular pressure(IOP), anterior chamber depth and complications were closely observed.<p>RESULTS: IOP were recovered by drug treatments in 7 eyes to anterior chamber depth. 3 eyes were treated by peripheral iridectomy combined with posterior capsule of lens and anterior vitreous membrane excision with YAG laser. 5 eyes were treated by cataract phacoemulsification with foldable intraocular lens implantation combined with posterior capsule excision and anterior vitrectomy. 1 eye was treated by vitrectomy.1 eye developed to malignant glaucoma during operation was treated by trabeculectomy combined with cataract phacoemulsification after vitreous water-bag was punctured. The post-treatment IOP(14.43±3.46mmHg)significantly declined compared with pre-treatment IOP(31.25±5.19mmHg), the post-treatment anterior chamber depth(2.64±0.47mm)significantly deepened compared with that of pre-treatment(0.69±0.57mm). The best corrected visual acuity in LogMAR before treatment was 0.71±0.25, after the treatment of 0.34±0.19(<i>P</i><0.05). There were no serious complications except 1 case with low intraocular pressure and choroidal detachment.<p>CONCLUSION: It is necessary to fully evaluate the specific conditions of patients after the occurrence of malignant glaucoma and adopt individualized treatments according to patient's condition.
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@#AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.<p>METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded. <p>RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(<i>P</i><0.05). There was significant difference in intraocular pressure between different groups(<i>F</i>group=42.394, <i>P</i>group<0.001; <i>F</i>time=7.373, <i>P</i>time<0.001; <i>F</i>time×group=23.903, <i>P</i>time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(<i>P<</i>0.001)in intraocular pressure of 1, 3d and no significant difference(<i>P</i>>0.05)in 3, 7d between the two groups. There was no significant difference(<i>P</i>>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(<i>P</i>>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(<i>P</i>>0.05).<p>CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.
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@#AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.<p>METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded. <p>RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(<i>P</i><0.05). There was significant difference in intraocular pressure between different groups(<i>F</i>group=42.394, <i>P</i>group<0.001; <i>F</i>time=7.373, <i>P</i>time<0.001; <i>F</i>time×group=23.903, <i>P</i>time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(<i>P<</i>0.001)in intraocular pressure of 1, 3d and no significant difference(<i>P</i>>0.05)in 3, 7d between the two groups. There was no significant difference(<i>P</i>>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(<i>P</i>>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(<i>P</i>>0.05).<p>CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.
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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.
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Objective@#To evaluate the efficacy and outcome of 25 gouge (25G) minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma.@*Methods@#Retrospective cohort study was performed.Clinical data of 19 malignant glaucoma patients (19 eyes) who received 25G minimally vitrectomy from January 2012 to January 2017 in Wuxi People's Hospital were reviewed retrospectively.The operative methods were selected according to the predisposing cause.25G vitrectomy combined with cataract extraction and posterior capsulotomy were performed on the malignant glaucoma eyes after trabeculectomy, and 25G vitrectomy combined with cataract extraction, trabeculectomy and posterior capsulotomy were performed on the malignant glaucoma eyes after non-trabeculectomy.Best corrected visual acuity (BCVA) was examined by international visual acuity chart.The ocular axis length and intraocular pressure (IOP) were measured with A-mode ultrasonic apparatus and non-contact tonometer, respectively.The anterior chamber depth was measured with ultrasound biomicroscope (UBM). The study followed the declaration of Helsinki and all patients signed informed consent before surgery.@*Results@#The operation was successfully completed in 19 patients.All patients suffered moderate to severe anterior chamber inflammation after operation.The average age of onset in the patients was (58.00±6.20) years, and the mean ocular axial length was (20.81±0.56)mm.Malignant glaucoma occurred in 11 eyes after trabeculectomy, 2 eyes after combination of anti-glaucoma with cataract extraction, 2 eyes after laser iridotomy, 2 eyes after paracentesis of anterior chamber and 2 eyes with unknown causes.The visual acuity was significantly improved 3 months after operation in comparison with before operation (Z=-3.826, P<0.001). The mean IOP was (12.16±2.27)mmHg (1 mmHg=0.133 kPa) in postoperation, which was significantly lower than (38.84±5.97)mmHg in preoperation (t=17.68, P<0.05). The depth of anterior chamber was increased from preoperative (0.95±0.28)mm to postoperative (2.43±0.15) mm (t=20.06, P<0.05). UBM image showed that the position of ciliary body was normal without edema.@*Conclusions@#The combination procedure of 25G minimally invasive vitrectomy with relative surgery for malignant glaucoma is effective by lowing IOP, rescuing visual acuity and reducing surgical risk.
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@#AIM: To investigate the clinical features and stepwise treatment method of malignant glaucoma after phacoemulsification.<p>METHODS: A retrospective analysis was made on clinical data of 16 cases(18 eyes)with malignant glaucoma after phacoemulsification with in-the-bag IOL placemen from June, 2010 to May, 2018 in Gansu Provincial Hospital. Malignant glaucoma was treated by a stepwise treatment method. First, the combination of ciliary muscle paralysis and hypotensive drugs were used to treat malignant glaucoma, followed by laser iridozonulohyaloidotomy, then anterior chamber reformation, and finally with surgical iridozonulohyaloidovitrectomy. Data of diopter, anterior chamber depth, anterior chamber angle and intraocular pressure were analyzed before and after treatment.<p>RESULTS: Malignant glaucoma tends to occur after phacoemulsification and in-the-bag IOL placement 4.1±2.3wk. One eye received drug therapy alone,7 eyes received YAG laser crystal posterior capsule incision, 6 eyes received anterior chamber angioplasty, and 4 eyes received crystal posterior capsule incision+front vitrectomy. After treatment, the diopter was +0.48±0.89D, the anterior chamber depth was 3.14±0.33mm, the intraocular pressure was 15.3±4.7mmHg, 14 eyes with wide anterior chamber angle.<p>CONCLUSION: The stepwise treatment of malignant glaucoma after phacoemulsification showed a reduction in myopia, deepening of the central anterior chamber, opening of the anterior chamber, and decreased intraocular pressure.
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·AIM: To observe the efficacy of 25G+ vitrectomy surgery for malignant glaucoma after cataract surgery. · METHODS: Totally 18 eyes of 18 patients with malignant glaucoma after cataract surgery were analyzed retrospectively from January 2013 to June 2016. The visual acuity was between hand moving to 0. 5 before surgery, the intraocular pressure was between 18. 3-56. 8mmHg before surgery, an average of 35. 21 ± 10. 43mmHg. The length eye axis was between 19. 60-22. 46mm, an average of 20. 63 ± 0. 48mm. The depth of anterior chamber was between 0. 98 - 1. 86mm, an average of 1. 31 ± 0. 22mm. All the patients were performed with 25G + vitrectomy. The visual acuity, anterior chamber and intraocular pressure were studied after treatment. ·RESULTS: The patients were followed up for 6-18mo with an average of 9mo. BCVA at the last follow up improved to 0. 2-0. 8, and there was significant difference compared to that before operation (P<0. 01). IOP was from 12. 3-19. 8mmHg, an average of 16. 05±2. 46mmHg, there was significant difference compared to that before operation ( t = 7. 59, P<0. 01 ). The depth of anterior chamber was between 1. 89-3. 49mm, an average of 2. 42±0. 47mm, there was significant difference compared to that before operation(t=9. 07, P<0. 01). Only one case had IOP of 8mmHg, after treatment the IOP was 15mmHg. No complications such as corneal endothelium decompensation, intraocular lens ( IOL ) capture, intraocular hemorrhage, infection and uncontrolled IOP were observed. · CONCLUSION: The 25G + vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications compared with traditional vitrectomy.
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AIM:To investigate the risk factors for malignant glaucoma occurrence after the surgery for primary angleclosure glaucoma,and to provide theoretical basis for the prevention and treatment of malignant glaucoma.METHODS:The clinical data of 767 cases (965 eyes) of primary angle-closure glaucoma patients treated in our hospital from June 2012 to June 2016 were retrospectively analyzed.Patients were divided into two groups according to the postoperative investigation,patients with malignant glaucoma were divided into observation group,and 50 eyes without malignant glaucoma were randomly selected into control group.The gender,age,preoperative high intraocular pressure,chamber angle structure,axial length,crystal thickness,anterior chamber depth,diabetes mellitus,and hypertension of the patients in two groups were investigated.The risk factors were analyzed by single factor analysis,and the independent risk factors were analyzed by multivariate logistic regression analysis.RESULTS:Malignant glaucoma occurred in 30 eyes after the surgery of primary angle closure glaucoma in 965 eyes with an incidence rate of 3.1％.The single factor analysis showed that age,preoperative high intraocular pressure,axial length,anterior chamber depth,lense thickness,complete closure of atrial angle were the risk factors of malignant glaucoma after primary angle closure glaucoma surgery,comparison between groups showed statistical significance (P ＜ 0.05).Multivariate logistic regression analysis showed that age (OR=2.521,95％ CI=1.434-8.876),preoperative continuous high intraocular pressure (OR=2.483,95％ CI =2.123-11.543),axial length (OR=2.654,95％ CI=1.547-12.678),complete closure of atrial angle (OR=3.212,95％ CI=1.543-8.675) were the independent risk factors for malignant glaucoma after primary angle closure glaucoma surgery.CONCLUSION:The incidence rate of malignant glaucoma after primary angle-closure glaucoma surgery in our hospital is 3.1％.Age,preoperative high intraocular pressure,axialc length,complete closure of atrial angle can rise the risk of occurring malignant glaucoma,so special attention shall be payed for this kind of patients.
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El glaucoma maligno es una forma rara de glaucoma, que suele seguir a la cirugía en pacientes con ángulo cerrado y glaucoma primario de ángulo cerrado. En esta revisión bibliográfica se discuten las características clínicas, la clasificación, la patogenia y el manejo de esta afección. La revisión bibliográfica la efectuamos a partir de una búsqueda en Medline (los principales artículos de PubMed y en Internet) y bases Cochrane (The Cochrane Library). Las imágenes aportadas son propias y las hemos efectuado con tomografía de coherencia óptica SS-1000 de segmento anterior CASIA de Tomey ®. El objetivo de la revisión es revisar las evidencias sobre una afección rara y actualizar los protocolos diagnósticos y terapéuticos con las nuevas técnicas a nuestro alcance. Consideramos que el nombre de glaucoma maligno para esta patología debería evitarse, ya que actualmente con los medios disponibles el pronóstico es relativamente bueno. Es por esto, que preferimos nombres como el síndrome de misdirección del humor acuoso, o glaucoma por bloqueo ciliar(AU)
Malignant glaucoma is a rare form of glaucoma that typically follows surgery in patients with primary angle closure and primary angle-closure glaucoma. In this bibliographic review we discuss the clinical characteristics, classification, pathogenesis, and management. The literature review is based on a search in Medline (the main articles of PubMed, Internet) and Cochrane databases (The Cochrane Library). The images provided we have done them with SS-1000 Optical Coherence Tomography CASIA of Tomey ®. The aim of the review is to review the evidence for a rare condition and update the diagnostic and therapeutic protocols with the new techniques. In addition, the review authors thought that the name of malignant glaucoma for this pathology should be avoided, because of prognosis is relatively good. This is the reason, we prefer names such as misdirected aqueous humor syndrome, or ciliary blockage glaucoma(AU)
Subject(s)
Humans , Databases, Bibliographic/statistics & numerical data , Glaucoma, Angle-Closure/etiology , Review Literature as Topic , Tomography, Optical Coherence/adverse effectsABSTRACT
Objective To analyze the risk factors of malignant glaucoma for primary angle-closure glaucoma(PACG) patients after surgery.Methods Clinical data of elderly patients with PACG who had received surgical treatment at our hospital between 2013 and 2016 were retrospectively analyzed.Patients were divided into two groups according to whether they suffered (Group A) or not (Group B) from malignant glaucoma after surgery.Results A total of 238 patients (315 eyes) were retrospectively analyzed: 17 cases (22 eyes) in Group A and 221 cases (293 eyes)in Group B.The index of axial length, chamber depth and crystal thickness was lower in Group A than in Group B,and the difference was statistically significant(P<0.05).Univariate analysis showed that age under 50, continuous high intraocular pressure, axial length below 22 mm, chamber depth below 2 mm, crystal thickness below 4.5 mm, completely closed anterior chamber angle and chronic angle-closure type were the possible risk factors for malignant glaucoma after surgery (P<0.05).The logistic regression analysis showed that age under 50 and axial length below 22 mm were independent risk factors for malignant glaucoma for PACG patients after surgery.Conclusion PACG patients,especially those who are young or with short axial length,are more vulnerable to malignant glaucoma.
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@#AIM: To investigate the influence factors of phacoemulsification combined with anterior vitrectomy for treating malignant glaucoma.<p>METHODS: Totally 23 cases(25 eyes)of malignant glaucoma patients, who were in-patient in ophthalmology of Wuhan Tongji Hospital from June 2011 to June 2016, underwent phacoemulsification combined with anterior vitrectomy, were involved in this study. The intraocular pressure and related ocular anatomy parameter change and its correlation were analyzed pre-and post-operatively. <p>RESULTS: There were 15 cases(16 eyes), average 51±6.7 years old, had deepened anterior chamber and intraocular pressure within the normal range(reffered as effective)post-operatively, in the other 8 cases(9 eyes), average 45±7.8 years old, postoperative anterior chamber formation were poor(referred as ineffective). Surgery effective rate was 64%. As for the effective group, the postoperative anterior chamber depth(2.13±0.82mm), significantly deepened compared with preoperative(0.76±0.53mm), and postoperative intraocular pressure(15.4±4.5mmHg)significantly declined compared with preoperative(26.4±8.7mmHg). The effective group had larger preoperative scleral spur distance and ocular axial length than ineffective group, 11.25±0.39mm <i>vs</i> 10.86±0.49mm and 22.16±1.16mm <i>vs</i> 20.98±0.62mm respectively, and the difference was statistically significant(<i>P</i><0.05). Age and the ocular axial length were statistically significant between effective and ineffective group by using single factor analysis results(<i>P</i><0.05). By logistic regression analysis, age and ocular axial length were independent risk factors for poor postoperative treatment effect(<i>P</i><0.05).<p>CONCLUSION: The younger age and the ocular axial length is risk factors for poor postoperative treatment effect of malignant glaucoma by phacoemulsification combined with anterior vitrectomy.
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AIM: To investigate the efficacy of 23G minimally vitrectomy without irrigation in cataract phacoemulsification and trabeculectomy of malignant glaucoma, and to analyze such compound operative procedures for phakic malignant glaucoma. ●METHODS:A total of 21 phakic malignant glaucoma patients (21 eyes) underwent anterior vitrectomy without irrigation by using 23G vitrectomy. During surgical course phacoemulsification with anterior and posterior continuous circular capsulorhexis, trabeculectomy combined with iridectomy would be completed. lntraocular pressure, anterior chamber depth changes and postoperative complications were observed after the operation. ●RESULTS:ln the three-month follow-up, intraocular pressures were reduced from ( 57. 18 ± 6. 18 ) mmHg to (16. 15 ± 2. 43 ) mmHg, there was statistical difference compared with pre - operation ( P ● CONCLUSION: The compound surgical method of anterior vitrectomy combined with phacoemulsifier and trabeculectomy can effectively treat phakic malignant glaucoma. Early diagnosis and early compound surgery may effectively reduce the intraocular pressure of malignant glaucoma.
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Objective To explore the risk factors of malignant glaucoma of primary angle-closure glaucoma post operation.Methods The clinical data of 500 patients (705 eyes) with primary angle-closure glaucoma who received glaucoma surgery were retrospectivly analyzed.25 patients (30 eyes) with malignant glaucoma after surgery were selected as observation group,475 patients (675 eyes) with no malignant glaucoma after surgery were selected as the control group.The gender,age,type of glaucoma,preoperative intraocular pressure,anterior chamber depth,relative position of the lens , lens thickness , length of optic axis , corner structure and operation method of the two groups were recorded.Single factor analysis was conducted by chi-square test and t test,multiple factors analysis was conducted by Logistic regression analysis.Results Single factor analysis showed that there were significant differences in gender,age,glaucoma types,intraocular pressure and ocular axis length in the two groups (χ2 =5.394,4.785,6.475, 4.907,4.890,all P<0.05).Multivariable Logistic regression analysis results showed that age (OR=3.774,95%CI 1.765-3.774,P=0.004),and length of optic axis (OR=2.684,95% CI 1.363 to 6.953,P=0.005) were independent risk factors of primary angle -closure glaucoma post operation.Conclusion Women, younger age, chronic angle -closure glaucoma, continuous high intraocular pressure, corner completely closed, shallow anterior chamber,crystals thinner and shorter optic axis of primary angle -closure glaucoma patients prone to malignant glaucoma postoperation,especially younger age and optic axis short patients,should be given enough attention.
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Abstract?AlM:To investigate the choice of different treatments for malignant glaucoma.? METHODS: ln this retrospective case series, 21 malignant glaucoma patients ( 21 eyes ) admitted in Wuhan General Hospital of Guangzhou Military Command from May 2012 to May 2013 were analyzed. Sixteen eyes ( 76%) developed malignant glaucoma after filtration surgery, 3 eyes ( 14%) after EX - PRESS glaucoma filtration device, 2 eyes ( 10%) after glaucoma filtration Ahmed valve implantation. Main Outcome of corrected visual acuity, intraocular pressure ( lOP ) , anterior chamber depth and complications were detected.?RESULTS: lOP recovered by drug control in 13 eyes, anterior chamber depth. Four eyes were treated by vitreous water- bag aspiration combined with anterior chambers reconstructing. Two eyes were treated by cataract extraction and intraocular lens implantation. Two eyes were treated by posterior capsule excision combined with anterior vitrectomy. lOP before and after treatment was 29. 81±4. 98, 12. 71±3. 77mmHg, respectively (P=0. 00). Anterior chamber depth before and after treatment was 0.41± 0. 34, 2. 13 ± 0. 54mm, respectively (P = 0. 00). Corrected visual acuity before treatment was 0. 19 ± 0. 17, after treatment was 0. 20±0. 16 (P= 0. 36). Except for vitreous hemorrhage in 1 eye, there were no ocular or systemic adverse events observed in all patients.? CONCLUSlON: lt is good to diagnose malignant glaucoma in early period, and treated it step by step. For this can reduce lOP and restore anterior chamber.
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PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.
Subject(s)
Humans , Male , Middle Aged , Anterior Chamber , Corneal Edema , Endophthalmitis , Glaucoma , Intraocular Pressure , Lenses, Intraocular , Manometry , Posterior Capsulotomy , Tomography, Optical Coherence , VitrectomyABSTRACT
Purpose: To report long-term follow-up of zonulo-hyaloido-vitrectomy (ZHV) via anterior approach for pseudophakic malignant glaucoma refractory to medical treatment. Design: Noncomparative case-series. Materials and Methods: Medical records of 9 patients who sought treatment for aqueous humor misdirection refractory to medical treatment were reviewed. All patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy (PI) via an anterior approach. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination, and fundus findings. Results: 10 eyes of 9 patients (7 female, 2 male) who underwent ZHV for refractory pseudophakic malignant glaucoma between 2003 and 2010 were included in this case-series. The mean age of patients was 77.4 ± 9.0 years, mean follow-up duration 50.2 ± 27.2 months. Recurrence of malignant glaucoma was noted in 40% (four cases) after a successful ZHV on long-term follow-up. Conclusions: An anterior segment surgeon can treat malignant glaucoma refractory to medical treatment successfully by vitrectomy, hyaloido-zonulectomy, and PI. This can be done via an anterior approach and patients require long follow-up to rule out a relapse despite a successful outcome in the short term.
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PURPOSE: Malignant glaucoma is a rare complication of anterior segment surgery. The authors present a case of a malignant glaucoma-like phenomenon during cataract surgery in a primary open-angle glaucoma (POAG) patient. CASE SUMMARY: A 74-year-old man with POAG underwent a cataract surgery in his left eye. After phacoemulsificiation, sodium hyaluronate was used to form the capsular bag for intraocular lens implantation. Following this procedure, the capsular bag space and anterior chamber became shallow. Intraocular pressure (IOP) elevated, and the shallowing of the anterior chamber and capsular bag space continued to a dangerous level. The surgical procedure was stopped and postponed for two days. After two days, IOL was successfully implanted in the posterior bag. CONCLUSIONS: Although the preoperative ophthalmologic examination failed to reveal a zonular problem, there was a possibility for a small area of zonular defect. A malignant glaucoma-like phenomenon was suspected to have occurred due to leakage of sodium hyaluronate or balanced salt solution into the vitreous through a small area of zonular dialysis. If a similar condition, occurs delayed surgery for IOL implantation would be more effective than vitrectomy or laser treatment.
Subject(s)
Aged , Humans , Anterior Chamber , Cataract , Dialysis , Eye , Glaucoma , Glaucoma, Open-Angle , Hyaluronic Acid , Intraocular Pressure , Lens Implantation, Intraocular , VitrectomyABSTRACT
PURPOSE: Malignant glaucoma is a rare secondary glaucoma characterized by a flat anterior chamber with increased intraocular pressure (IOP). It may occur after intraocular surgery, trauma, inflammation, the use of miotic agents, and so on. We report a case of malignant glaucoma after uncomplicated phacoemulsification with foldable intraocular lens implantation (IOL) using scleral tunnel incision. METHODS: A 74-year-old woman underwent a phacoemulsification with foldable IOL implantation in her left eye. Ten days after cataract surgery, she had severe ocular pain, a high IOP, and a flat anterior chamber. Pupillary block was suspected, and a peripheral iridectomy was done. But she was referred to our hospital for evaluation of persistent IOP elevation with flat anterior chamber. A diagnosis of pseudophakic malignant glaucoma was made, and we performed a core vitrectomy through peripheral iridectomy site. The anterior chamber deepened postoperatively with control of IOP. On the fourth postoperative day, she developed flattening of the anterior chamber with IOP elevation. A recurrence of malignant glaucoma was diagnosed, and anterior vitrecomy with a widening of previous iridectomy wound was done. RESULTS: Postoperatively, the patient had normal IOP, a deep anterior chamber and improved visual acuity. We got successful results from a surgical anterior vitrecomy through peripheral iridectomy site.