Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract

Purpose Iridocorneal endothelial (ICE) syndrome is well known to cause refractory glaucoma in young adults. Commonly acclaimed mechanism for trabeculectomy failure in these cases include accelerated subconjunctival fibrosis, abnormal endothelial proliferation, and closure of ostium. In the following article, we present a case of Iridocorneal endothelial syndrome that presented with refractory glaucoma after trabeculectomy due to rapidly progressive peripheral anterior synechiae causing angle closure and corneal decompensation that mandated a tailored surgical approach of management. Methods: This is a descriptive case report based on electronic medical records, patient observation, surgical intervention, and follow-ups. Case description: A thirty-eight-year-old-male presented to us with signs suggestive of iridocorneal endothelial syndrome with gonioscopy revealing peripheral anterior synechiae (PAS) over four clock-hours temporally. Uncontrolled intraocular pressure (IOP) despite maximal medical therapy mandated augmented trabeculectomy with anti-fibrotics. The bleb failed within 3 weeks of trabeculectomy, with evidence of progressive crawling PAS causing endothelial decompensation and raised IOP. He underwent Ahmed glaucoma valve (AGV) implant surgery with viscosynechiolysis and sectoral iridectomy under antiviral cover. This helped control IOP and retain corneal clarity, with no recurrence of PAS in the affected area. Conclusion: Progressive peripheral synechiae in ICE syndrome can cause early bleb failure and refractory glaucoma. Careful viscosynechiolysis and sectoral iridectomy alongside a second implant surgery can help salvage visual functions and preserve corneal clarity while preventing further progression of PAS in these eyes.

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Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery for Patients With Refractory Glaucoma and Cataract

Highlights of Ophthalmology ◽

10.5005/highlights-45-4-9 ◽

2017 ◽

Vol 45 (4ENG) ◽

pp. 9-14

Author(s):

Felipe Valenzuela ◽

Miguel Srur ◽

Carlos Nieme ◽

Mario Zanolli ◽

Leonidas Traipe ◽

...

Keyword(s):

Refractory Glaucoma ◽

Implant Surgery

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Surgical outcomes associated with a sutureless drainage valve implantation procedure in patients with refractory glaucoma

Clinical Ophthalmology ◽

10.2147/opth.s186369 ◽

2018 ◽

Vol Volume 12 ◽

pp. 2607-2615 ◽

Cited By ~ 2

Author(s):

Caroline N. Pham ◽

Nathan M. Radcliffe ◽

Daniel M. Vu

Keyword(s):

Surgical Outcomes ◽

Refractory Glaucoma ◽

Valve Implantation ◽

Implantation Procedure

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Diode Laser Contact Transscleral Cyclophotocoagulation for Refractory Glaucoma in Asian Patients

American Journal of Ophthalmology ◽

10.1016/s0002-9394(14)71697-6 ◽

1997 ◽

Vol 124 (6) ◽

pp. 797-804 ◽

Cited By ~ 26

Author(s):

EDMUND Y.M. WONG ◽

PAUL T.K. CHEW ◽

CAROLINE K.L. CHEE ◽

JUN SHYAN WONG

Keyword(s):

Diode Laser ◽

Refractory Glaucoma ◽

Asian Patients ◽

Transscleral Cyclophotocoagulation

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Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma

10.21203/rs.3.rs-147374/v1 ◽

2021 ◽

Author(s):

Duri Seo ◽

Taek June Lee ◽

Joo Yeon Kim ◽

Wungrak Choi ◽

Sang Yeop Lee ◽

...

Keyword(s):

Clinical Outcomes ◽

Secondary Glaucoma ◽

Refractory Glaucoma ◽

Severance Hospital ◽

Asian Patients ◽

Common Diagnosis ◽

Minimum Angle ◽

Transscleral Cyclophotocoagulation ◽

The Mean ◽

First Time

Abstract This study evaluated the clinical outcomes of first-time micropulse transscleral cyclophotocoagulation (MP-TSCPC) performed in cases of refractory glaucoma. This retrospective study analysed the patients with refractory glaucoma who underwent MP-TSCPC rom February 2018 to February 2020 at Yonsei University Severance Hospital. A total of 45 eyes of 43 Asian patients (aged 55.71±16.84 years) who underwent MP-TSCPC for the first time, were included in this study. The mean baseline intraocular pressure (IOP) was 25.96±9.27 mmHg. The most common diagnosis was secondary glaucoma (44.4%) with a mean logarithm of the minimum angle of resolution (logMAR) visual acuity of 1.19±1.02. There was a significant reduction (P<0.05) in IOP on 1 day 1,to 18.03±5.99 mmHg;, at 1 week, to 13.29±5.24 mmHg;, at 1 month, to 14.98±4.55 mmHg;, at 3 months, to 17.05±5.52 mmHg;, 6 months to 17.78±6.37 mmHg; and 12 months, to 16.56±5.96 mmHg. There was also a reduction (P<0.05) in the number of topical anti-glaucoma medications required to control IOP from baseline (3.69±0.63) at 1, 3, and 6 months. MP-TSCPC is an effective procedure that offers good results in reducing IOP and decreases the use of anti-glaucoma medications in patients with refractory glaucoma.

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