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September 1996

Pars Plana Vitrectomy in the Management of Phakic and Pseudophakic Malignant Glaucoma

Author Affiliations

From the Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, Fla. Dr Harbour is now with the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine and the Barnes Retina Institute, St Louis, Mo.

Arch Ophthalmol. 1996;114(9):1073-1078. doi:10.1001/archopht.1996.01100140275003

Objective:  To determine the indications for and out-come of pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma.

Design:  Retrospective review.

Setting:  Tertiary referral ophthalmic hospital.

Patients:  Twenty-two patients (24 eyes) who underwent pars plana vitrectomy in the management of malignant glaucoma.

Results:  Fourteen eyes were phakic and 10 were pseudophakic at the initial vitrectomy. The primary indication for vitrectomy was failure of other therapies. In phakic eyes, the initial vitrectomy was successful in terminating malignant glaucoma without further surgery in 7 (100%) of 7 eyes that underwent lensectomy and in 5 (71%) of 7 eyes that not did not undergo lensectomy. The primary indication for lensectomy was corneal edema caused by lens-corneal touch. In pseudophakic eyes, the initial vitrectomy was successful in 9 (90%) of 10 eyes. Removal of the intraocular lens was performed in 1 eye. Perioperative complications included transient serous choroidal detachment in 2 eyes, transient exudative retinal detachment in 1 eye, and suprachoroidal hemorrhage in 1 eye.

Conclusions:  Pars plana vitrectomy is effective in treating phakic and pseudophakic malignant glaucoma. Success is contingent on establishing a pathway for aqueous flow into the anterior chamber, which usually is accompanied by intraoperative deepening of the anterior chamber. In phakic eyes, lensectomy may be considered for marked corneal edema, for dense cataract, or when the anterior chamber will not deepen during vitrectomy.

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