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¹Celal Bayar Üniversitesi Tıp Fakültesi, Göz Hastalıkları A.D., Manisa, Prof. Dr.
²Celal Bayar Üniversitesi Tıp Fakültesi, Göz Hastalıkları A.D., Manisa, Yard. Doç. Dr.
³Çanakkale Gelibolu Devlet Hastanesi, Göz Hastalıkları, Çanakkale, Uzm. Dr. Purpose: To report the outcomes of a series of patients with refractory glaucoma who have undergone combined pars plana vitrectomy and placement of a Molteno drainage implant.
Materials and Methods: The study was carried out in 6 eyes of 5 patients with refractory glaucoma to control the intraocular pressure (IOP). Molteno implant was placed through the pars plana due to the diffuse peripheric anterior synechia in all eyes. Surgical success was defined as an intraocular pressure greater than 5 mmHg and less than or equal to 21 mmHg without antiglaucoma medication. The surgical procedure consisted of a three-port 20 gauge vitrectomy followed by placement of a Molteno drainage implant in the superotemporal quadrant. A scleral flap was created to cover the tubes.
Results: The mean final postoperative IOP was reduced to 21.1±9.4 mmHg from 45:3±9.3 mmHg preoperatively. The mean number of intraocular pressure-lowering medications in use postoperatively was 0.6±1.03 reduced from 3.6±0.5 medications in use preoperatively. The mean follow up period was 13±7 months (6-24 months). Narrow anterior chamber, dense fibrinoid reaction in the anterior chamber, sudden IOP peak, haemorrhage in the anterior chamber and the vitreous cavity and hypotony were the most common complications postoperatively. A second surgical intervention was carried out because of sudden IOP peak in one patient while haemorrhage and hypotony were treated by medical means. Two eyes required a further procedure (transscleral diode laser cyclophotocoagulation) to control the IOP postoperatively.
Conclusion: Although this procedure is often a successful management option in selected patients with refractory glaucoma despite treatable complications, visual outcome may be poor because of severe underlying ocular diseases. Keywords : Glaucoma, glaucoma drainage implants, vitrectomy