Rotation Flap of Tenon's Capsule for Treating Hypotony

PURPOSE: To report a case of rotational flap of Tenon's capsule for hypotony with choroidal detachment occurring after trabeculectomy and needle revision (NR) of a nonfunctioning bleb. METHODS: An 15-year-old female, suffering acute angle-closure glaucoma with lens dislocation into anterior chamber, underwent pars plana vitrectomy, lensectomy, and intraocular lens scleral fixation. Three months later, trabeculectomy with mitomycin C (MMC) and NR with MMC were performed to decrease intraocular pressure (IOP). After 5th NR, hypotony with choroidal detachment occurred. Consequently, bleb revision and rotation flap of the autologous Tenon's capsule were performed. RESULTS: One week after surgery, IOP was 18 mmHg, and a diffuse bleb was formed. Choroidal detachment improved with remaining vascular tortuisity and chorioretinal folds. At five months, best corrected visual acuity was 0.5, IOP was 20 mmHg, vascular tortuisity decreased, and chorioretinal folds disappeared in the macula. CONCLUSIONS: Hypotony with choroidal detachment occurring after needle revision was treated effectively with bleb revision and rotation at flap of autologous Tenon's capsule.

Effect of Cataract Extraction in Chronic Angle-closure Glaucoma Patients

PURPOSE: To investigate the effects of cataract extraction in chronic angle-closure glaucoma (CACG) patients. METHODS: Sixteen eyes from 14 patients with CACG underwent phacoemulsification with posterior chamber intraocular lens (PCL) implantation (group A), and 19 eyes from 17 patients with CACG underwent cataract surgery and additional trabeculectomy (combined surgery, group B) were evaluated for visual acuity, intraocular pressure (IOP), number of glaucoma medications and surgical complications. All patients had patent peripheral iridotomy holes before cataract surgery, and a minimum 6 month follow-up period was needed. RESULTS: The mean postoperative follow-up period was 15.6 months in group A, and 21.7 months in group B. After surgery, the IOP was significantly reduced in both groups [from 16.1 mmHg to 13.8 mmHg in group A (P=0.013), and from 16.7 mmHg to 13.2 mmHg in group B (P=0.005)], but the amount of IOP reduction was not significantly different between the two groups (P=0.401). The relative decrease in the mean number of postoperative glaucoma medications was 0.9 in group A and 1.8 in group B, but these were not significantly different (P=0.060). CONCLUSIONS: Simple cataract surgery was effective in reducing IOP as much as combined surgery in CACG patients. These results affirm that phacoemusification with PCL implantation may be considered as the first treatment in cataract and CACG patients.