Abstract
The study analyses the causes of ineffective malignant glaucoma treatment applied in 4 patients (6 eyes). Glaucoma symptoms appeared immediately after cataract removal. The common feature of the applied therapies was the desire to lower eye pressure using various methods. The most important element of treatment, i.e. restoring the correct anatomical relations in the eye, was left out during treatment. The prolonged time in the implementation of effective therapy results in progressive visual impairment and appearance of irreversible lesions in the anterior segment of the eye. In addition, it puts the patient at risk of experiencing constant eye pain, even if the intraocular pressure is normalized. The key to therapeutic success is restoration of the physiological distribution of the aqueous humour. Nonsurgical methods of treating malignant glaucoma, if ineffective, should be replaced by surgery within several days. The procedure of choice is excision of the vitreous from the area of the lens and the ciliary body with its anterior capsule, performed from the posterior approach. This method seems to be the most effective in pseudophakic eyes, and the time of its implementation has a decisive impact on obtaining a beneficial effect of the procedure and reducing the risk of postoperative complications.
Highlights
Malignant glaucoma is one of the more serious complications of eye surgery that can lead to loss of vision
TSCPC, trabeculectomy f/77/right no Shallow yes yes trabeculectomy peripheral adhesions left yes peripheral adhesions yes trabeculectomy m/84/right yes ZHV -zonulo hyaloid-vitrectomy, PPV- pars plana vitrectomy, TSCPC – transscleral cyclophotocoagulation, During the consultation, each patient was diagnosed with three symptoms of malignant glaucoma, including significant shallowing of the anterior chamber (4 eyes) and complete loss of the anterior chamber (2 eyes) (Fig. 1)
During the subsequent two surgeries a viscoelastic was introduced into the anterior chamber, which prevented another deletion of the anterior chamber, but did not prevent partial recurrence of adhesions in the angle and shallowing of the chamber
Summary
Malignant glaucoma is one of the more serious complications of eye surgery that can lead to loss of vision. The incidence of malignant glaucoma after this procedure is 0.6-4% [2] This complication is even less common in the case of cataract removal. The abnormal aqueous humour flow leads to a significant increase in pressure in the posterior pole of the eye, causing a number of consequences. Increasing pressure in the posterior segment of the eye moves the iris-lens diaphragm towards the cornea, leading to the development of 4 main symptoms of malignant glaucoma: 1. Low intraocular pressure accompanying the symptoms of malignant glaucoma was exceptionally observed in patients after trabeculectomy [5,6]
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