Posters

An unusual cause of failure for trabeculectomy: unnoticed vitreous in the anterior chamber

Poster Details

First Author: S. Inan TURKEY

Co Author(s):    E. Cetinkaya   E. Ertan   U. Inan              

Abstract Details

Purpose:

Trabeculectomy as a filtering surgery is usually successful for reducing intraocular pressure (IOP) in glaucomatous eyes uncontrolled with maximal topical medication. Failure to reduce IOP after a trabeculectomy surgery can sometimes be challenging. The aim of this case report is to describe an unusual cause of failure to working of trabecular filtering surgery in a patient developed glaucoma after Nd:YAG capsulotomy.

Setting:

Kocatepe University Medical School Department of Ophthalmology, Afyon, Turkey

Methods:

A male patient with sixty-eight year-old was referred to our glaucoma department for surgery due to uncontrolled glaucoma despite maximal anti-glaucomatous medication with topical fixed preparation of prostaglandin analogue/beta blocker, brimonidine tartrate and carbonic anhydrase inhibitor (CAI). He had undergone Nd:YAG capsulotomy for posterior capsule opacification one month before his presentation. Systemic CAI was started four-times daily and surgery was planned. He underwent standard trabeculectomy procedure under local anaesthesia one week later. Secondary bleb revision was undertaken next week due to high IOP and corneal epithelial oedema. At the third intervention vitreous was noticed in the anterior chamber (AC).

Results:

The patients’ visual acuity was 20/32 at the presentation. His IOP was 43-mmHg despite maximal topical medication. He has cup-disc ratio of 0.6 and moderate glaucomatous visual field defect. One day after the trabeculectomy, his IOP was 50-mmHg and visual acuity was counting finger at 1 meter due to diffuse corneal epithelial oedema. Maximal topical medication was restarted. After the bleb revision, IOP failed to decrease with 34-mmHg. At the third intervention vitreous filling-up whole anterior chamber was stained with triamcinolone and removed by 25-gauge vitrectome through 23-g corneal side incisions. Next day, IOP was 3 mmHg. One week later, IOP was normalized to 11 mmHg.

Conclusions:

Existence of vitreous in the anterior chamber especially after the Nd:YAG laser capsulotomy should be kept in mind for a possible cause of resistance to standard filtering surgery in patients with glaucoma.

Financial Disclosure:

NONE