Abstract
PurposeTo investigate the effect of microincision vitreous surgery (MIVS) on intraocular pressure (IOP) control in glaucomatous eyes with functional filtering bleb.MethodsWe enrolled 18 patients (15 males; median age, 73 years) who previously had filtering surgery and underwent MIVS with functional filtering bleb. Kaplan–Meier method was used to calculate the survival rate with defined the failure as when more number of preoperative antiglaucoma medication was started or additional glaucoma surgery including bleb revisions were performed, and IOP increase of 20% (criteria 1) and 30% (criteria 2) from preoperative levels after 2 weeks of MIVS.ResultsThe median follow-up duration was 970 days. Preoperative IOP was 13.3 ± 3.8 mmHg (mean ± SD). Postoperative IOP were 14.7 ± 4.9 (P=0.365), 15.2 ± 3.5 (P=0.137), 16.4 ± 5.6 (P = 0.073), 17.6 ± 6.1(P = 0.020), and 14.5 ± 4.0 (P = 0.402) mmHg at 3, 6, 12, and 15 months and final visit, respectively (compared to preoperative IOP). The number of antiglaucoma medications was a median of 1.0 (range 0–4) preoperatively and 0 (0–4) at the final visit (P = 0.238). The survival rates were 55%/61% at 3 months, 50%/61% at 6 months, and 38%/55% at 12 months with criteria 1 and 2, respectively. Four eyes (22%) received additional glaucoma surgery during follow-up.ConclusionAfter several months of MIVS, IOP was likely to increase. We should focus on IOP control by conducting long-term follow-ups.
Highlights
Microincision vitreous surgery (MIVS) using 23-G, 25-G, and 27-G systems is much less invasive compared with vitreous surgery using a 20-G system and currently performed worldwide
Kaplan–Meier method was used to calculate the survival rate with defined the failure as when more number of preoperative antiglaucoma medication was started or additional glaucoma surgery including bleb revisions were performed, and intraocular pressure (IOP) increase of 20% and 30% from preoperative levels after 2 weeks of MIVS
We should focus on IOP control by conducting long-term follow-ups
Summary
Microincision vitreous surgery (MIVS) using 23-G, 25-G, and 27-G systems is much less invasive compared with vitreous surgery using a 20-G system and currently performed worldwide. After cataract surgery and vitrectomy, pO2 level increased in the vitreous cavity and anterior chamber angle, leading to oxidative damage of the trabecular meshwork cells, decreasing outflow facility (6). This implies that in a patient with filtering bleb after vitrectomy, careful considerations regarding IOP must be made even when performing MIVS. There are only two reports that have examined postoperative IOP control in patients with bleb who had undergone MIVS (7, 8) Both studies showed that there were some patients who needed more antiglaucoma medications and additional glaucoma surgeries after MIVS, mean IOP during follow-up had not significantly changed (7, 8). This study aims to evaluate the effect of MIVS on IOP control in patients that have functional filtering bleb
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