gms | German Medical Science

In secundary angle closure glaucoma the occuring changes are difficult to predict. Due to iris neovascularisation and anterior synechiae insertion of a drainage tube into the anterior chmaber is difficult and complications like haemorrhages may arise. Aqueous drainage via the posterior segment after vitrectomy seems to be a secure alternative.

Six consecutive patients with uncontrolled secundary angle closure glaucoma were prospectively studied. All eyes were treated by pars-plana vitrectomy and shaving of the vitreous base and a Baerveldt glaucoma drainage implant adapted for pars-plana insertion was placed. If patients were phakic, cataract surgery by phacoemulsification and IOL implantation was done firstly. Postoperative follow-up included a minimum period of six months.

No complications were observed intraoperatively. Mean visual acuity remained stable at 0,2 (SD=0,18). Mean intraocular pressure decreased from 41 mmHg (SD=5) to 11 mmHg (SD=9). Postoperative complications included temporary haemorrhagic choroidal detachment in one eye and a retinal detachment due to PVR three months after surgery in a case with pre-existing retinitis. In two patients the use of antiglaucomatous eye drops is still necessary.

By employing the pars plana adapted Baerveldt glaucoma drainage implant intraocular pressure can successfully be controlled in complicated angle closure glaucoma. In addition, underlying vitreoretinal pathology may be treated simultaneously. Drawbacks are the need of an extensive vitrectomy with vitreous shaving and the long-lasting surgery with high-prized equipment.