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Surgical results in malignant glaucoma refractory to medical or laser therapy
J C Tsai1, K A Barton, M H Miller
1Glaucoma Unit, Moorfields Eye Hospital, London, UK.
Abstract:
We investigated the surgical results in 25 patients identified with malignant (ciliary block) glaucoma. Four of these patients (16%) had successful outcomes following laser treatment alone. Nineteen patients (76%) underwent microsurgery for glaucoma refractory to conventional medical and/or laser therapy and are the subjects of this study. Core vitrectomy was successful in 4 of 6 pseudophakic patients (67%) and in 1 of 4 phakic patients (25%). Combined cataract extraction and vitrectomy had a higher success rate in patients undergoing posterior capsulectomy at the time of surgery (5 of 6 patients; 83%) compared with those patients left with an intact posterior capsular bag (1 of 4 patients; 25%). Intracapsular cataract extraction was successful in 1 of 2 patients (50%). We conclude that surgical vitrectomy in the presence of an intact posterior capsule may preclude the surgical resolution of aqueous misdirection. In eyes with pre-existing cataract, we recommend combined lens extraction, primary posterior capsulectomy and surgical vitrectomy for the surgical management of phakic malignant glaucoma.
Insights
Surgical vitrectomy for malignant glaucoma shows varied success. Combined cataract extraction, posterior capsulectomy, and vitrectomy offer the best outcomes for phakic malignant glaucoma patients.
Area of Science:
- Ophthalmology
- Surgical Procedures
- Glaucoma Management
Background:
- Malignant glaucoma, also known as ciliary block glaucoma, is a rare and severe form of angle-closure glaucoma.
- It presents a significant surgical challenge, often refractory to conventional medical and laser therapies.
Purpose of the Study:
- To evaluate the surgical outcomes of various microsurgical techniques in patients with malignant (ciliary block) glaucoma.
- To identify factors influencing the success rates of these interventions.
Main Methods:
- Retrospective analysis of 25 patients diagnosed with malignant glaucoma.
- Review of surgical outcomes for procedures including laser therapy, core vitrectomy, combined cataract extraction and vitrectomy, and intracapsular cataract extraction.
- Comparison of outcomes based on patient's lens status (phakic vs. pseudophakic) and surgical technique variations (e.g., posterior capsulectomy).
Main Results:
- Four out of 25 patients (16%) achieved successful outcomes with laser treatment alone.
- Nineteen patients underwent microsurgery; core vitrectomy success was 67% in pseudophakic and 25% in phakic patients.
- Combined cataract extraction and vitrectomy with posterior capsulectomy yielded an 83% success rate, significantly higher than without (25%).
Conclusions:
- Surgical vitrectomy in the presence of an intact posterior capsule may hinder the resolution of aqueous misdirection in malignant glaucoma.
- For phakic malignant glaucoma patients with pre-existing cataracts, a combined approach including lens extraction, primary posterior capsulectomy, and surgical vitrectomy is recommended.