Efficacy of 25 gauge minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma

Authors: Sun Chao,  Tan Chengye,  Wang Qingru,  Bao Xun,  Zhuang Miao,  Yao Yong

DOI: 10.3760/cma.j.issn.2095-0160.2019.12.013
Published 2019-12-10
Cite as Chin J Exp Ophthalmol, 2019,37(12): 1000-1003.

Abstract

Objective

To evaluate the efficacy and outcome of 25 gouge (25G) minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma.

Methods

Retrospective cohort study was performed.Clinical data of 19 malignant glaucoma patients (19 eyes) who received 25G minimally vitrectomy from January 2012 to January 2017 in Wuxi People’s Hospital were reviewed retrospectively.The operative methods were selected according to the predisposing cause.25G vitrectomy combined with cataract extraction and posterior capsulotomy were performed on the malignant glaucoma eyes after trabeculectomy, and 25G vitrectomy combined with cataract extraction, trabeculectomy and posterior capsulotomy were performed on the malignant glaucoma eyes after non-trabeculectomy.Best corrected visual acuity (BCVA) was examined by international visual acuity chart.The ocular axis length and intraocular pressure (IOP) were measured with A-mode ultrasonic apparatus and non-contact tonometer, respectively.The anterior chamber depth was measured with ultrasound biomicroscope (UBM). The study followed the declaration of Helsinki and all patients signed informed consent before surgery.

Results

The operation was successfully completed in 19 patients.All patients suffered moderate to severe anterior chamber inflammation after operation.The average age of onset in the patients was (58.00±6.20) years, and the mean ocular axial length was (20.81±0.56)mm.Malignant glaucoma occurred in 11 eyes after trabeculectomy, 2 eyes after combination of anti-glaucoma with cataract extraction, 2 eyes after laser iridotomy, 2 eyes after paracentesis of anterior chamber and 2 eyes with unknown causes.The visual acuity was significantly improved 3 months after operation in comparison with before operation (Z=-3.826, P<0.001). The mean IOP was (12.16±2.27)mmHg (1 mmHg=0.133 kPa) in postoperation, which was significantly lower than (38.84±5.97)mmHg in preoperation (t=17.68, P<0.05). The depth of anterior chamber was increased from preoperative (0.95±0.28)mm to postoperative (2.43±0.15) mm (t=20.06, P<0.05). UBM image showed that the position of ciliary body was normal without edema.

Conclusions

The combination procedure of 25G minimally invasive vitrectomy with relative surgery for malignant glaucoma is effective by lowing IOP, rescuing visual acuity and reducing surgical risk.

Key words:

Malignant glaucoma/surgery; Biometry/methods; Outcome; Retrospective study; Minimally invasive vitrectomy

Contributor Information

Sun Chao
Department of Ophthalmology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
Tan Chengye
Wang Qingru
Bao Xun
Zhuang Miao
Yao Yong
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Updated: January 20, 2020 — 1:17 am