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Abstract #6810 Published in IGR 4-1
Glaucoma after extremely severe chemical and thermal eye burns: surgical possibilities
Kuckelkorn R; Keller GK; Redbrake COphthalmologe 2001; 98: 1149-1156
BACKGROUND: Late secondary glaucoma after severe chemical or thermal eye burns is associated with diagnostic and surgical difficulties. Routine filtering surgery (trabeculectomy) has a low success rate. In these eyes, aqueous shunt implantation and cyclophotocoagulation are alternative procedures. PATIENTS: In this retrospective study, the records of 12 patients with 14 severe eye burns (grade IV) were analyzed. Nine eyes were treated with an aqueous shunt device (six von Denffer and three Ahmed implants). Diode laser cyclophotocoagulation (Iris Medical Instruments) was performed in five eyes. The mean time interval between surgery and accident was 88.3 months (aqueous shunt) and 32.8 months (cyclophotocoagulation). RESULTS: The mean follow-up was 45 ± 36 months (von Denffer implant), 38 ± 5 months (Ahmed implant), and 11 ± 8 months (cyclophotocoagulation). Intraocular pressure (IOP) was reduced from 39 ± 7 to 23 ± 6 (von Denffer implants) and from 38 ± 3 to 8 ± 10 (Ahmed implants). Mean IOP before treatment with cyclophotocoagulation was 33 ± 8 and 18 ± 2 after treatment. Systemic carbonic anhydrase inhibitors were stopped in all patients. Visual acuity deteriorated in five of nine eyes treated with aqueous shunt devices and was unchanged or better in all eyes treated with cyclophotocoagulation. Multiple re-operations were necessary after aqueous shunt implantation. Severe complications leading to failure in these eyes were encapsulated bleb in four eyes, expulsive hemorrhage in one eye, and phthisis in one eye. Cyclophotocoagulation was repeated in two eyes. No severe complications were observed. CONCLUSIONS: IOP reduction was effective and comparable in both procedures. Because of the high incidence of severe complications after shunt surgery, the authors prefer cyclophotocoagulation for the treatment of intractable glaucoma after severe eye burns.LA: German
Dr. R. Kuckelkorn, Augenklinik des Universitatsklinikums der RWTH Aachen, Aachen, Germany
Classification:
9.4.20 Other (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)