Pars-plana vitreous aspiration during combined trabeculectomy, phacoemulsification, and intraocular lens implantation in eyes with very shallow anterior chamber

Abstract

Aim The aim of this study was to evaluate the outcome of pars-plana vitreous aspiration during combined trabeculectomy, phacoemulsification, and intraocular lens (IOL) implantation in eyes with shallow anterior chamber (AC) to prevent its associated complications. Patients and methods Fifty-four eyes of 46 patients were included in this study. All eyes were indicated for combined trabeculectomy, phacoemulsification and IOL implantation. All eyes had very shallow AC and injection of a viscoelastic substance through AC paracentesis failed to deepen the AC. Vitreous aspiration was performed with a 27 G needle on a 3 ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. The cases were followed up for 12 months. The main outcome measures were the volume of aspirated vitreous, and intraoperative and postoperative complications. Results Intraoperative deepening of the AC occurred in all cases after vitreous aspiration. Aspirated vitreous volume varied from 0.3 to 0.7 ml (average 0.47 ml). There was no evidence of positive vitreous pressure during surgery in any case. No intraoperative complications occurred in all cases. Postoperative complications were detected in the form of shallow AC with hypotony in 5.5% of the cases (3 out of 54 cases) and shallow AC with high intraocular pressure was reported in 3.7% of the cases (2 out of 54 cases). All cases were managed without the need for a second surgery. Complications related to vitreous aspiration like vitreous hemorrhage, retinal tear, or detachment were not observed in any case. Conclusion Pars-plana vitreous aspiration is a safe procedure to prevent intraoperative shallow AC and its associated complications during combined trabeculectomy, phacoemulsification, and IOL implantation.