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Abstract #10019 Published in IGR 5-3
Retinectomy for treatment of intractable glaucoma: long term results
Joussen AM; Walter P; Jonescu Cuypers CP; Koizumi K; Poulaki V; Bartz Schmidt KU; Krieglstein GK; Kirchhof BBritish Journal of Ophthalmology 2003; 87: 1094-1102
AIM: To report long-term efficacy and complications of retinectomy as an intraocular pressure (IOP) lowering procedure for intractable glaucoma. METHODS: This was a consecutive interventional case series. In 44 consecutive eyes (39 patients, 22 males, 17 females) retinectomy was performed to lower IOP in patients with uncontrolled IOP (>35 mmHg for more than four months) despite conventional filtering surgery and drug treatment. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by an intraocular gas tamponade of 20% C3F8. Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (three eyes), secondary glaucoma due to aphakia (13 eyes), severe ocular trauma (seven eyes), uveitis (seven), and glaucoma in Ehlers-Danlos syndrome (two). RESULTS: All patients underwent successful surgical retinectomy. All patients were followed for five years. Mean postoperative IOP after four years was 15.7 (SD 9.4) mmHg, representing a decrease of IOP by 61% compared to the preoperative level (41.2 (9.4) mmHg). In 52.3% of eyes long-term regulation of IOP could be achieved without complications. Retinectomy was least effective in neovascular glaucoma because of central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed a tendency towards low IOP levels with subsequent phthisis bulbi. The initial visual acuity of all patients was lower than 20/50 (mean 1.8 (0.8) logMAR) in the treated eye. Final visual acuity was 2.3 (0.6) logMAR. Twenty-one of 44 cases developed retinal complications (retinal detachment or proliferative vitreoretinopathy (PVR)) after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for PVR. Nine eyes developed phthisis, seven of which were enucleated during the follow up. CONCLUSIONS: Long-term results after retinectomy demonstrate its efficacy in otherwise intractable glaucoma. Efficacy and safety of retinectomy are dependent on the underlying disease.
Dr. A.M. Joussen, Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Cologne, Germany
Classification:
12.20 Other (Part of: 12 Surgical treatment)
