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Abstract #5306 Published in IGR 1-2
Ultraschallbiomikroskopie und Therapie des malignen Glaukoms(Malignant glaucoma: Examination with ultrasound biomicroscopy and therapy)
Schroeder W; Fischer K; Erdmann I; Guthoff RKlinische Monatsblätter für Augenheilkunde 1999; 215: 19-27
BACKGROUND: Malignant glaucoma is a rarely diagnosed condition though it has been known for over 100 years and has been understood to be based on a ciliary blockage for 30 years. Now it is possible to visualize pathomechanism of ciliary block by ultrasound biomicroscopy. PATIENTS AND METHODS: Between January 1994 and November 1998, 13 patients with ciliary block glaucoma were observed. Four underwent ultrasound biomicroscopy. RESULTS: Ciliary block glaucoma is caused by obliteration of the posterior chamber. Ultrasound biomicroscopy showed that, in phakic eyes the lens, in pseudophakic eyes the capsule together with the anterior vitreous membrane, and in aphakic eyes the vitreous alone, are the blocking agents. Hyperopia, a narrow iridocorneal angle and ciliary sulcus, as well as plateau iris configuration and a history of miotics, are the predisposing risks for ciliary block glaucoma, especially after addition surgery such as cataract extraction, iridotomy, iridectomy and trabeculectomy. Clinical features are always raised intraocular tension accompanied by flattening of the anterior chamber, which should be differentiated from angle-closure glaucoma. This is easy if iridectomy, irido-capsulovitreotomy or pseudophakia are present, but difficult in very rare spontaneous cases. Cycloplegics and YAG laser iridectomy may break the ciliary block, but the preferable therapy is lensectomy (phakic eyes) and partial removal of the anterior vitreous and a peripheral sector of the lens capsule combined with iridectomy. This is easily performed with the vitrector via the pars plana. CONCLUSIONS: Ultrasound biomicroscopy starts to confirm the theories on ciliary block glaucoma and allows assessment of the different modes of treatment. The most successful treatment is lens extraction and partial vitreo-capsulo-iridectomy via the pars plana. (German)
W. Schroeder, Klinikum Nord/Heidelberg, Augenabteilung, Tangstedter Landstrasse 400, D-22417 Hamburg; Germany
Classification:
6.12 Ultrasonography and ultrasound biomicroscopy (Part of: 6 Clinical examination methods)
9.4.11.1 Ciliary block (malignant) glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)