Iris prolapse after non-penetrating trabeculectomy with sinusotomy and mitomycin C

Area of Science:

• Ophthalmology
• Surgical Techniques
• Glaucoma Management

Background:

• Non-penetrating trabeculectomy (NPT) is a glaucoma surgery aimed at reducing intraocular pressure (IOP) while minimizing complications.
• Modifications to NPT, such as combining it with sinusotomy and mitomycin C, enhance IOP reduction but may compromise globe integrity.
• Understanding the risks associated with these enhanced surgical modifications is crucial for patient safety.

Observation:

• A case report details a 68-year-old male who developed iris prolapse 28 days after undergoing NPT with sinusotomy and mitomycin C treatment.
• The complication occurred subsequent to blunt ocular trauma to the left eye.
• Iris prolapse manifested through the sinusotomy site, necessitating further surgical intervention.

Findings:

• Iris prolapse is an uncommon complication following standard NPT but may be more likely after combined procedures.
• The combination of NPT with sinusotomy and mitomycin C appears to render the globe more susceptible to trauma-induced complications.
• Post-surgical intervention included iridectomy, scleral suturing, and pars plana vitrectomy, with absence of the filtration bleb post-re-operation.

Implications:

• Modified NPT techniques, while effective for IOP control, increase the risk of globe structural compromise.
• Iris prolapse following such procedures can lead to secondary infections and loss of the filtration bleb.
• Enhanced postoperative monitoring and protective measures are essential for patients who have undergone modified NPT.