Trauma z Surgical treatment of extremely complicated forms of glaucoma

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Presentation transcript:

Trauma z Surgical treatment of extremely complicated forms of glaucoma Tatsiana Imshenetskaya, Galina Vashkevich, Yauheni Milasheuski Surgical treatment of extremely complicated forms of glaucoma Belarusian Medical Academy of Post-Graduate Education, Department of Ophthalmology Minsk, Belarus PURPOSE To determine the safety and efficacy of glaucoma valve (GV) implantation in patients with extremely complicated forms of refractory glaucoma. Trauma Neovascular glaucoma Phakomatosis Uveitis Systemic disorders Silicon oil METHODS 92 eyes of 92 patients (54 males and 38 females) were identified as having undergone implantation of GV in one eye (89 eyes) and of a second GV (3 eyes) in the same eye. Primary open angle glaucoma (POAG) and primary close angle glaucoma (PACG) were diagnosed in 40 patients (36 eyes) and in 3 patients (3 eyes) respectively. In 21 patients (21 eyes), refractory glaucoma was secondary to neovascular glaucoma. 18 patients (18 eyes) had secondary glaucoma, 7 patients (7 eyes) had refractory glaucoma secondary to retinal detachment surgery. 78 patients (78 eyes) had previously failed incisional and laser surgery. For all eyes that underwent GV implantation data were collected on IOP, the best corrected visual acuity (BCVA) and glaucoma medications preoperatively and postoperatively. The average age of patients was 58,02 (± 11,26) years. The average value of preoperative IOP was 35,8 (± 5,83) mmHg. The average number of employed local antiglaucoma medications before surgery was 3,4 (± 0,18). RESULTS All patients underwent implantation of the GV, model FP7, surgery was performed using sub-Tenons anesthesia or general anesthesia in patient with single eye. A partial thickness scleral flap is created as large as possible so that the tube is covered. In patients with extremely thin sclera we used the combination of a limbal-based scleral flap with scleral patch graft to cover the tube. The IOP decreased from a mean preoperative value of 35,8 (± 5,83) mmHg to 15,8 (±1,5). The average number of employed local antiglaucoma medications postoperatively was 1,4 (± 0,2). No major intraoperative complications were recoded. We observed development of choroidal effusion and shallow anterior chambers in 4,2% in the early postoperative period in patients with previous failed incisional surgery. The most common late postoperative complications is corneal edema – 12 % in our patients. z SURGICAL PROCEDURE One – stage polypropylene AGV implantation Regional or general anesthesia Fornix-based conjunctival flap was fashioned in the best quadrant with minimal scar tissue. FEATURES Artificial iris Second GDD Simultaneous keratoplasty Simultaneous lensvitreoectomy CONCLUSIONS GV implantation may successfully reduce IOP and the number of medications required to control even of extremely complicated forms of refractory glaucoma. Previous intraocular surgery is a main risk factor for the early postoperative complications: choroidal effusion, shallow anterior chamber. Author to contact: Tatsiana Imshenetskaya E-mail: t.imshanetskaya@mail.ru Authors have no financial interest in this poster References: 1. Krupin T, Kaufman P, Mandell A, et al. (1980) 2. Melamed S, Fiore PM (1990) 3. Englert JA, Freedman SF, Cox TA (1999)