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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Single-port transconjunctival vitrectomy for malignant glaucoma.

Shikha Gupta1, Subodh Lakra, Abhijeet Beniwal

  • 1From the Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India (S. Gupta, Lakra, Beniwal, Chawla, V. Gupta); Iclinix Advanced Eye Care, New Delhi, India (Gogia).

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Summary
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This study introduces a modified surgical technique for malignant glaucoma, simplifying the procedure and achieving successful anterior chamber deepening and intraocular pressure normalization in most patients. The modified approach avoids the need for posterior iridectomy or zonulectomy.

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Area of Science:

  • Ophthalmology
  • Surgical Innovation

Background:

  • Malignant glaucoma management traditionally involves complex procedures like anterior vitrectomy with zonulectomy and iridectomy or 3-port core pars plana vitrectomy (PPV).
  • Existing methods require specialized surgical expertise and can be associated with significant complications.

Purpose of the Study:

  • To present a modified surgical technique for malignant glaucoma management.
  • To evaluate the efficacy and safety of a single-port vitrector approach for anterior vitrectomy and posterior capsulotomy.

Main Methods:

  • A modified technique involving synechiolysis and anterior chamber irrigation through a limbal incision.
  • Introduction of a single-port 23- or 25-gauge vitrector via pars plana vitrectomy (PPV) for anterior vitrectomy and central posterior capsulotomy.
  • The procedure was adapted for both pseudophakic and phakic eyes, continuing vitrectomy until anterior chamber deepening.

Main Results:

  • Successful optimization of anterior chamber depth in all 9 treated eyes.
  • Intraocular pressure normalization achieved in 8 out of 9 eyes.
  • No recurrence of malignant glaucoma observed during a mean follow-up of 8.6 months.

Conclusions:

  • The proposed modified surgical technique offers a potentially simpler and effective approach to malignant glaucoma management.
  • This method successfully deepens the anterior chamber and normalizes intraocular pressure, bypassing the need for posterior iridectomy/zonulectomy.
  • The procedure demonstrates favorable outcomes and a low recurrence rate, suggesting its clinical utility.