An augmented trabeculectomy for neovascular glaucoma.

Abstract

BACKGROUND AND OBJECTIVE:

To report on a new surgical technique for neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy or retinal vein occlusion.

PATIENTS AND METHODS:

Fourteen eyes of 13 patients underwent an augmented trabeculectomy for NVG between January 2000 and February 2003. The augmented trabeculectomy consisted of a 7 × 5 × 5 mm trapezoidal scleral flap, a 6 × 4 × 4 mm deep sclerectomy, application of mitomycin C (MMC) 0.2% for 3 minutes in the deep scleral bed, a 2 × 1 mm trabeculectomy, and the use of a hydrophilic implant (T-flux; Carl Zeiss Meditec, Wetzlar, Germany) as a wick drain connecting the posterior chamber and the deep sclerectomy via a peripheral iridectomy. Whenever the intraocular pressure (IOP) rose above 20 mm Hg, the site of filtration was surgically revised and MMC 0.2% was reapplied in the deep scleral bed.

RESULTS:

IOP decreased from a mean of 38.7 ± 5.2 mm Hg preoperatively to a mean of 17.3 ± 5.2 mm Hg postoperatively after a mean follow-up of 32 ± 12 months (P = .001, Wilcoxon signed-ranked test, two related samples). Mean visual acuity improved from 20/350 to 20/170 (P = .034). Seven eyes (50%) needed one surgical revision and one eye (7%) needed two surgical revisions within 3 months from the first operation to maintain an IOP of less than 21 mm Hg.

CONCLUSION:

The modified trabeculectomy augmented by MMC 0.2% and the use of the T-flux as a wick drain can provide adequate IOP control in NVG caused by proliferative diabetic retinopathy or retinal vein occlusion. To maintain an IOP of less than 21 mm Hg without anti-glaucoma medications, surgical revisions of the filtration site are necessary in at least 50% of patients.

• Authors: Elie Dahan, Guy J Ben Simon
• Journal: Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye (Ophthalmic Surg Lasers Imaging) 2011 May-Jun Vol. 42 Issue 3 Pg. 196-201 ISSN: 1938-2375 [Electronic] United States
• PMID: 21563744 (Publication Type: Journal Article)
• Copyright: Copyright 2011, SLACK Incorporated.

Chemical References

• Alkylating Agents
• Mitomycin

Topics

• Aged
• Aged, 80 and over
• Alkylating Agents (administration & dosage)
• Diabetic Retinopathy (complications)
• Female
• Follow-Up Studies
• Glaucoma, Neovascular (etiology, physiopathology, surgery)
• Humans
• Intraocular Pressure (physiology)
• Male
• Middle Aged
• Mitomycin (administration & dosage)
• Postoperative Complications
• Retinal Vein Occlusion (complications)
• Sclerostomy
• Tonometry, Ocular
• Trabeculectomy (methods)