Combined Surgical Techniques for the Management of Malignant Glaucoma

Abstract

Purpose To characterize new combined surgical techniques for the management of malignant glaucoma. Methods In a retrospective, interventional case series, goniosynechialysis, peripheral iridectomy, zonulo-hyaloidectomy, and anterior vitrectomy, with or without peripheral capsulectomy, were performed on nine eyes. If the patient was phakic, we performed both phacoemulsification and intraocular lens implantation. Results Resolution of malignant glaucoma was achieved in all cases with anterior chamber deepening. Topical antiglaucoma medications were used to control the intraocular pressure in one eye. No recurrence was observed after a median follow-up of 9 months. No complications occurred during surgery or the postoperative period. Conclusions The combined surgical methods can completely eliminate blockade and aqueous misdirection and represent a promising treatment for malignant glaucoma.

Evaluation of Two Different Anterior Vitrectomies for Fluid Misdirection Syndrome Secondary to Cataract Surgery Combined with Goniosynechialysis

“…Although VHZI via pars plana approach has three scleral incisions, while VHZI via anterior chamber approach has only two, previous studies did not show any significant difference in the comparative analysis of the rate of postoperative complications between the two methods [9,[12][13][14]21]. Recently, a retrospective study with a larger sample size showed that a very low postoperative complications of retinal detachment (2 eyes, 3%) and endophthalmitis (1 eye, 1%) after VHZI via pars plana approach [15], justifying the safety of this approach.…”

“…As a result, anterior vitrectomy remains as an important choice for FMS. Previous studies suggest that anterior vitrectomy combined with hyaloidotomy, zonulectomy, and iridectomy (VHZI) is effective in creating a permanent passage between the anterior chamber and the vitreous cavity [7,[9][10][11][12][13]. e anterior vitrectomy can be performed via anterior chamber approach or pars plana approach [7,[9][10][11][12]14].…”

Malignant glaucoma presenting with uncontrolled intraocular pressure and myopic refractive surprise after cataract surgery

“… 5 Additional surgical procedures, if not yet performed, including goniosynechialysis and peripheral iridectomy, often adjunctively, have shown varying success in treating malignant glaucoma. 12 Surgical interventions should be promptly planned to prevent permanent damage and reduce long‐term complications. Our patient was stabilized after irido‐zonulo‐hyalodo‐vitrectomy, which has also proven to be a successful procedure in prior cases of pseudophakic malignant glaucoma and also refractory cases.…”

Pars plana vitrectomy combined with hyaloido‐zonula‐iridectomy in treatment of patients with chronic aqueous misdirection: A systematic literature review and case series

“…If both medical and laser treatment fail, pars plana vitrectomy is thought to prevent aqueous humour from accumulating in the vitreous cavity and the hyaloido‐zonula‐iridectomy to ensure the communication between the anterior chamber and the vitreous cavity. A few studies have combined the vitrectomy and HZI with the removal of the lens and implantation of IOL if the patients were phakic (Debrouwere et al 2012; Dervenis, Mikropoulou & Dervenis 2017; Tang, Du & Li 2018; Raj et al 2019). We cannot determine whether vitrectomy with HZI combined with phacoemulsification gives a better result than vitrectomy with HZI alone.…”

“…Two studies did not consider cases treated with additional surgeries as relapses (Al Bin Ali et al 2017; Krėpštė, Žemaitienė & Miliauskas 2018). Studies using anterior, core or partial PPV with HZI had variable relapse rates (Bitrian & Caprioli 2010; Koukkoulli & Rahman 2013; Rękas, Krix‐Jachym & Zarnowski 2015; A Khan 2016; He et al 2016; Balekudaru et al 2017; Rani et al 2018; Tang, Du & Li 2018; Patel 2020; Raj et al 2019). One study based on one eye reported relapse that resolved with slit‐lamp needling (Mardelli & Mardelli 2018).…”