Clinical efficacy of inferior peripheral irido-capsulo-hyaloidotomy for pseudophakic malignant glaucoma

Abstract

Purpose The present research aimed to investigate the effects of Inferior peripheral irido-capsulo-hyaloidotomy for the management of pseudophakic malignant glaucoma. Method Ten pseudophakic eyes with aqueous misdirection were diagnosed between September 2017 and December 2018 (10 eyes of 8 patients), which were included in the prospective consecutive case series study. Seven eyes underwent Inferior laser peripheral irido-capsulo-hyaloidotomy, and three eyes underwent pars plana vitrectomy, zonulo-capsulo-hyaloidectomy, and inferior iridectomy. Results Eight eyes (80) had angle-closure glaucoma. The mean duration of the follow-up was 12.25 +/- 3.05 months (ranging from 10-18 months). The patients had a mean age of 69.25 +/- 6 years. The IOP at the onset of malignant glaucoma was found to be 33.8 +/- 5.5 mmHg, which was reduced to 13.9 +/- 2.7 mmHg at the final visit (P value = 0.002). The reduction in the number +/- SD of anti-glaucoma medications (3.3 +/- 0.48 to 1.4 +/- 0.51) and improvement in mean +/- SD LogMAR visual acuity (1.2 +/- 0.06 to 0.61 +/- 0.26) between the onset and final visit were significant (p = 0.004 and P = 0.005, respectively). All the patients responded to Inferior peripheral irido-capsulo-hyaloidotomy (with YAG laser or with the surgical procedure), which led to a significant reduction in intraocular pressure (IOP) and deepening of the anterior chamber. Conclusion The success rate of peripheral irido-capsulo-hyaloidotomy with laser or surgical procedure in the inferior quadrant was high regarding pseudophakic malignant glaucoma patients. The establishment of a patent inferior communication between the vitreous cavity and the anterior chamber was the main component in the treatment of pseudophakic malignant glaucoma patients.