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25-Gauge pars plana vitrectomy for ciliary block (malignant) glaucoma

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Abstract

To evaluate the efficacy of 25-ga pars plana vitrectomy (PPV) and 25-ga PPV combined with phacoemulsification surgery for managing ciliary block (malignant) glaucoma. The medical records of 11 eyes, in nine consecutive patients with malignant glaucoma were retrospectively reviewed to determine the efficacy of 25-ga PPV for alleviating this disease. All phakic eyes underwent phacoemulsification surgery during vitrectomy. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity (BCVA), and development of intra- and postoperative complications were evaluated during follow-up. Malignant glaucoma was promptly resolved, and recurrence was not observed during a mean follow-up period of 12.7 ± 3.2 (range 6–18) months. The mean IOP decreased from 35.9 ± 2.9 mmHg, preoperatively, to 16.0 ± 1.4 mmHg, measured at last visit (P = 0.013). Although IOP control was achieved in all eyes after surgery, two eyes required long-term topical antiglaucoma medication. The mean logarithm of the minimum angle of resolution BCVA improved from +0.69 ± 0.11, preoperatively, to +0.29 ± 0.07, postoperatively (P = 0.027). No severe intraoperative complications were observed. Postoperative complications mostly occurred during the first week after surgery, including transient corneal edema and Descemet’s membrane folds in three eyes, fibrotic exudation in 2, local iris posterior synechia in 1, and transient hypotony in 1, which were resolved spontaneously or with medication. The 25-ga PPV procedure seems to be safe and effective for treating malignant glaucoma. Combined vitrectomy with phacoemulsification surgery and a staged surgical approach may improve the success rate.

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References

  1. Shaffer RN, Hoskins HD (1978) Ciliary block (malignant) glaucoma. Ophthalmology 85:215–221

    Article  CAS  PubMed  Google Scholar 

  2. Burgansky-Eliash Z, Ishikawa H, Schuman JS (2008) Hypotonous malignant glaucoma: aqueous misdirection with low intraocular pressure. Ophthalmic Surg Lasers Imaging 39:155–159

    Article  PubMed  Google Scholar 

  3. Ng WT, Morgan W (2012) Mechanisms and treatment of primary angle closure: a review. Clin Exp Ophthalmol 40:218–228. doi:10.1111/j.1442-9071.2011.02604.x

    Article  Google Scholar 

  4. Quigley HA, Friedman DS, Congdon NG (2003) Possible mechanisms of primary angle-closure and malignant glaucoma. J Glaucoma 12:167–180

    Article  PubMed  Google Scholar 

  5. Luntz MH, Rosenblatt M (1987) Malignant glaucoma. Surv Ophthalmol 32:73–93

    Article  CAS  PubMed  Google Scholar 

  6. Ruben S, Tsai J, Hitchings RA (1997) Malignant glaucoma and its management. Br J Ophthalmol 81:163–167

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Little BC, Hitchings RA (1993) Pseudophakic malignant glaucoma: Nd: YAG capsulotomy as a primary treatment. Eye 7:102–104

    Article  PubMed  Google Scholar 

  8. Halkias A, Magauran DM, Joyce M (1992) Ciliary block (malignant) glaucoma after cataract extraction with lens implant treated with YAG laser capsulotomy and anterior hyaloidotomy. Br J Ophthalmol 76:569–570

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Byrnes GA, Leen MM, Wong TP, Benson WE (1995) Vitrectomy for ciliary block (malignant) glaucoma. Ophthalmology 102:1308–1311

    Article  CAS  PubMed  Google Scholar 

  10. Harbour JW, Rubsamen PE, Palmberg P (1996) Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol 114:1073–1078

    Article  CAS  PubMed  Google Scholar 

  11. Sato T, Emi K, Bando H, Ikeda T (2012) Faster recovery after 25-gauge microincision vitrectomy surgery than after 20-gauge vitrectomy in patients with proliferative diabetic retinopathy. Clin Ophthalmol 6:1925–1930. doi:10.2147/OPTH.S37864

    Article  PubMed Central  PubMed  Google Scholar 

  12. Galway G, Drury B, Cronin BG, Bourke RD (2010) A comparison of induced astigmatism in 20- vs 25-gauge vitrectomy procedures. Eye 24:315–317. doi:10.1038/eye.2009.81

    Article  CAS  PubMed  Google Scholar 

  13. Kunikata H, Nishida K (2010) Visual outcome and complications of 25-gauge vitrectomy for rhegmatogenous retinal detachment; 84 consecutive cases. Eye 24:1071–1077. doi:10.1038/eye.2010.41

    Article  CAS  PubMed  Google Scholar 

  14. Fine HF, Iranmanesh R, Iturralde D, Spaide RF (2007) Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology 114:1197–1200

    Article  PubMed  Google Scholar 

  15. Nam Y, Chung H, Lee JY, Kim JG, Yoon YH (2010) Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases. Eye 24:741–869. doi:10.1038/eye.2009.206

    Google Scholar 

  16. Sandali O, Sanharawi M, Lecuen N, Barale PO, Bonnel S, Basli E, Borderie V, Laroche L, Monin C (2011) 25-, 23-, and 20-gauge vitrectomy in epiretinal membrane surgery: a comparative study of 553 cases. Graefes Arch Clin Exp Ophthalmol 249:1811–1819. doi:10.1007/s00417-011-1752-3

    Article  PubMed  Google Scholar 

  17. Lewis SA, Miller DM, Riemann CD, Foster RE, Petersen MR (2011) Comparison of 20-, 23-, and 25-gauge pars plana vitrectomy in pseudophakic rhegmatogenous retinal detachment repair. Ophthalmic Surg Lasers Imaging 42:107–113. doi:10.3928/15428877-20101223-02

    PubMed  Google Scholar 

  18. Nagpal M, Wartikar S, Nagpal K (2009) Comparison of clinical outcomes and wound dynamics of sclerotomy ports of 20, 25, and 23 gauge vitrectomy. Retina 29:225–231. doi:10.1097/IAE.0b013e3181934908

    Article  PubMed  Google Scholar 

  19. Trope GE, Pavlin CJ, Bau A, Baumal CR, Foster FS (1994) Malignant glaucoma: clinical and ultrasound biomicroscopic features. Ophthalmology 101:1030–1035

    Article  CAS  PubMed  Google Scholar 

  20. Tello C, Chi T, Shepps G, Liebmann J, Ritch R (1993) Ultrasound biomicroscopy in pseudophakic malignant glaucoma. Ophthalmology 100:1330–1334

    Article  CAS  PubMed  Google Scholar 

  21. Morales MC, Araiz J, Herrera I, Castiella G, Corcóstegui I, Corcóstegui G (2012) Clinical outcomes of cataract surgery combined with 23-gauge vitrectomy. Arch Soc Esp Ofthalmol 87:353–362. doi:10.1016/j.oftal.2012.04.020

    Article  CAS  Google Scholar 

  22. Shahid H, Salmon JF (2012) Malignant glaucoma: a review of the modern literature. J Ophthalmol 2012:8526659. doi:10.1155/2012/852659

    Google Scholar 

  23. Quigley HA (2009) Angle-closure glaucoma—simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am J Ophthalmol 148:657–669. doi:10.1016/j.ajo.2009.08.009

    Article  PubMed  Google Scholar 

  24. Shen CJ, Chen YY, Sheu SJ (2008) Treatment course of recurrent malignant glaucoma monitoring by ultrasound biomicroscopy: a report of two cases. Kaohsiung J Med Sci 24:608–613. doi:10.1016/S1607-551X(09)70023-3

    Article  PubMed  Google Scholar 

  25. Herschler J (1980) Laser shrinkage of the ciliary processes: a treatment for malignant (ciliary block) glaucoma. Ophthalmology 87:1155–1159

    Article  CAS  PubMed  Google Scholar 

  26. Stumpf TH, Austin M, Bloom PA, McNaught A, Morgan JE (2008) Transscleral cyclodiode laser photocoagulation in the treatment of aqueous misdirection syndrome. Ophthalmology 115:2058–2061. doi:10.1016/j.ophtha.2008.05.026

    Article  PubMed  Google Scholar 

  27. Chandler PA (1964) A new operation for malignant glaucoma: a preliminary report. Trans Am Ophthalmol Soc 62:408–424

    CAS  PubMed Central  PubMed  Google Scholar 

  28. Spirn MJ (2009) Comparison of 25, 23 and 20-gauge vitrectomy. Curr Opin Ophthalmol 20:195–199. doi:10.1097/ICU.0b013e328329eaea

    Article  PubMed  Google Scholar 

  29. Greenfield DS, Tello C, Budenz DL, Liebmann JM, Ritch R (1999) Aqueous misdirection after glaucoma drainage device implantation. Ophthalmology 106:1035–1040

    Article  CAS  PubMed  Google Scholar 

  30. Tsai JC, Barton KA, Miller MH, Khaw PT, Hitchings RA (1997) Surgical results in malignant glaucoma refractory to medical or laser therapy. Eye 11:677–681

    Article  PubMed  Google Scholar 

  31. Chu TG, Green RL (1999) Suprachoroidal hemorrhage. Surv Ophthalmol 43:471–486

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was performed at Xi’an Aier Ancient City Eye Hospital without any funding.

Conflict of interest

The authors declare no conflict of interest. The authors have full control of all primary data, and they agree to allow the journal to review their data if requested.

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Authors and Affiliations

  1. Beijing Tong Ren Hospital, Capital Medical University, Beijing, 100730, China

    Li Meng & Wenbin Wei

  2. Xi’an Aier Ancient City Eye Hospital, Xi’an, Shaanxi, China

    Li Meng, Yanlong Li, Xiaoying Hui, Xiaodong Han & Xiaobo Shi

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  1. Li Meng
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  2. Wenbin Wei
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  3. Yanlong Li
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  4. Xiaoying Hui
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  5. Xiaodong Han
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  6. Xiaobo Shi
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Correspondence to Wenbin Wei.

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Meng, L., Wei, W., Li, Y. et al. 25-Gauge pars plana vitrectomy for ciliary block (malignant) glaucoma. Int Ophthalmol 35, 487–493 (2015). https://doi.org/10.1007/s10792-014-9974-0

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  • DOI: https://doi.org/10.1007/s10792-014-9974-0

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