Abstract

BackgroundGlaucoma combined with an extremely shallow anterior chamber and cataracts remains as a complex condition to deal with. And the emergence of microincision vitrectomy surgery (MIVS) system may provide an ideal option for the treatment of that. We report a clinical study of surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy (PPV) combined with lensectomy in the treatment of glaucomatous eyes with extremely shallow anterior chamber and cataract.MethodsProspective, nonrandomized and noncomparative case series study. Consecutive patients with secondary glaucoma, extremely shallow anterior chamber and cataract were recruited to have combined surgeries of 23-gauge transconjunctival pars plana vitrectomy and lensectomy. The main outcomes were best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), number of anti-glaucoma medications and surgery-associated complications.ResultsSeventeen consecutive patients with secondary glaucoma, extremely shallow anterior chamber and cataract were recruited. The mean follow-up was 21.2 ± 8.8 months. Postoperatively, there was no significant improvement of BCVA (P = 0.25). The mean intraocular (IOP) decreased significantly from 43.14 ± 6.53 mmHg to 17.29 ± 1.80 mmHg (P < 0.001), and the mean depth of anterior chamber increased significantly from 0.507 ± 0.212 mm to 3.080 ± 0.313 mm (P < 0.001). The mean number of anti-glaucoma medications decreased from 4.1 ± 0.8 to 0.6 ± 0.8 (P < 0.001). No severe vision-threatening intra- or post-operative complications occurred.ConclusionsGlaucoma with an extremely shallow anterior chamber and cataract can be managed well with the combined surgeries of 23-gauge pars plana vitrectomy and lensectomy. The surgical procedure is an effective and safe method to resolve the pupillary block and deepen the anterior chamber.

Highlights

  • Glaucoma combined with an extremely shallow anterior chamber and cataracts remains as a complex condition to deal with

  • Glaucoma combined with an extremely shallow anterior chamber and cataracts is a complex condition often associated with malignant glaucoma, phacomorphic glaucoma, spherophakia or nanophthalmos

  • Previous studies have demonstrated the effectiveness of vitrectomy combined with lensectomy or phacoemulsification in the treatment of malignant glaucoma [6, 8]

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Summary

Introduction

Glaucoma combined with an extremely shallow anterior chamber and cataracts remains as a complex condition to deal with. The emergence of microincision vitrectomy surgery (MIVS) system may provide an ideal option for the treatment of that. We report a clinical study of surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy (PPV) combined with lensectomy in the treatment of glaucomatous eyes with extremely shallow anterior chamber and cataract. Glaucoma combined with an extremely shallow anterior chamber and cataracts is a complex condition often associated with malignant glaucoma, phacomorphic glaucoma, spherophakia or nanophthalmos. In such patients, the primary mechanism is anterior dislocation of lens-iris diaphragm resulted from pupillary or cilliary blockage [1,2,3,4,5]. MIVS system (23-gauge or 25-gauge) may be a feasible alternative to overcome the technical difficulties mentioned above [8,9,10,11]

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