Clinical efficacy of modified partial pars plana vitrectomy combined with phacoemulsification for malignant glaucoma

Abstract

Objective The objective of this study was to evaluate the clinical effects of modified partial pars plana vitrectomy together with phacoemulsification, intraocular lens (IOL) implantation, posterior capsulectomy, and zonulohyaloidectomy for patients with malignant glaucoma after trabeculectomy or cataract surgery. Design Retrospective, cohort study. Participants Thirty consecutive patients (30 eyes) with malignant glaucoma after trabeculectomy surgery or ultrasonic phacoemulsification of cataract between January 2008 and September 2014 were enrolled. Methods A retrospective analysis of 30 eyes with malignant glaucoma after trabeculectomy surgery for angle-closure glaucoma or ultrasonic phacoemulsification of cataract was performed. All patients underwent modified partial pars plana vitrectomy with zonulohyaloidectomy. Phacoemulsification and IOL implantation was performed in 25 patients with no previous cataract surgery. Preoperative and post-operative ocular parameters were recorded in detail. Main outcome measures Clinical features, anterior chamber depth, best-corrected visual acuity, and intraocular pressure (IOP). Results In these 30 patients, 25 had undergone trabeculectomy surgery and 5 had undergone cataract surgery. The mean axial length was 21.3 ± 0.8 mm. After surgery, mean IOP decreased from 34 ± 8.3 mm Hg to 10.5 ± 4.1 mm Hg (Po0.001), and mean anterior chamber depth increased from 0.8 ± 0.4 mm to 2.7 ± 0.3 mm (Po0.001). No severe complications occurred. Conclusions Modified partial pars plana vitrectomy combined with phacoemulsification, IOL implantation, posterior capsulectomy, and zonulohyaloidectomy not only simplifies the process of traditional vitrectomy, but effectively resolves the ciliary block and corrects the misdirection of aqueous humor in malignant glaucoma.

Clinical Efficacy of Ciliary Ring Incision Combined with Modified Partial Pars Plana Vitrectomy for Malignant Glaucoma

“…Research data show that malignant glaucoma is associated with a short axial length, a shallow anterior chamber, hypertrophic pronation of the ciliary process, a relatively large lens size, a small equator of the ciliary process-lens, and abnormal attachment of the vitreous base and ciliary body [ 11 , 12 ]. We measured the mean axial length of the patients in this study at 21.45±0.88 mm, which was similar to that found by He et al (21.3±0.8 mm) [ 4 ] and Wang et al (21.56±0.84 mm) [ 13 ]. Thus, a short axial length may be a common feature of patients with malignant glaucoma.…”

“…Disease management with medication commonly focuses on the release of ciliary muscle spasm, inhibition of aqueous humor production, the introduction of systemic osmotic agents used to decrease vitreous volume, and the reduction of inflammation; when patients do not respond well to medication, surgery is necessary, but determining the optimal surgical management can be difficult. At present, one surgical treatment option involves the removal of the lens combined with anterior vitrectomy [ 4 , 8 , 14 ]. When patients with malignant glaucoma are relatively young, the lens is still transparent and it has a certain degree of accommodation.…”

“…There are currently limited treatments available for malignant glaucoma [ 2 ]. Several surgical techniques have been reported, such as ND: YAG laser capsulotomy, zonulo-hyaloido-vitrectomy (ZHV), and modified partial pars plana vitrectomy combined with phacoemulsification [ 1 , 3 , 4 ]. These techniques are all related to the operation of the lens.…”

Surgical management of malignant glaucoma: a retrospective analysis of fifty eight eyes

“…30 These observations reveal the importance of achieving a patent communication between the vitreous cavity and the anterior chamber. The various surgical modalities described since the year 2000 emphasize the importance of producing this communication by performing an adequate peripheral iridectomy, capsulotomy and hyaloido zonulotomy either by the anterior or by the pars (Table 3) [31][32][33][34][35] In addition, conventional vitrectomy, when performed alone, did result in a relapse rate as high as 75%, supporting the concept. 30 Hosada et al 36 describe two cases of malignant glaucoma which occurred following complete pars plana vitrectomy and ultimately resolved following peripheral iridectomy with or without local zonulectomy.…”

25-Gauge anterior vitrectomy via the scleral flap in phacoemulsification combined with trabeculectomy for glaucoma and cataract with extremely shallow anterior chamber

“…[12][13][14] Sharma et al [1] described vitrectomy-phacoemulsi cation-vitrectomy in management of malignant glaucoma. He et al [15] also con rmed that clinical e ccy of modi ed partial PPV and phacoemulsi cation for malignant glaucoma. Zhang et al veri ed that 23-gauge transconjunctival PPV and PPL was bene t to glaucoma and cataract patients with narrow anterior chamber.…”