J Korean Ophthalmol Soc.  2012 Apr;53(4):602-606.

A Case of Vitreous Prolapse through Iridectomy Site after Trabeculectomy

• Kim MU
• Lee HK
• Kang SH
• Shin MC

Abstract

PURPOSE
To report the results of anterior vitrectomy for obstruction of the aqueous outflow shunt by prolapsed vitreous strands after trabeculectomy.
CASE SUMMARY
Trabeculectomy was performed on a pseudophakic primary open angle glaucoma patient with uncontrolled intraocular pressure under maximum tolerable medical therapy. Three months after trabeculectomy, the bleb flattened and the intraocular pressure elevated. On gonioscopic examination, vitreous strands prolapsed through the iridectomy site obstructing the inner ostium. The maximum tolerable medical therapy and Nd:YAG laser vitreolysis were attempted, but the intraocular pressure was not controlled. Anterior vitrectomy was performed to remove the prolapsed vitreous strands. After anterior vitrectomy, the bleb regained filtering function and the intraocular pressure was stabilized.
CONCLUSIONS
In a case with a prolapsed vitreous into the anterior chamber obstructing the outflow shunt of the aqueous humor after trabeculectomy, anterior vitrectomy showed therapeutic effects.

Keyword

Anterior vitrectomy; Trabeculectomy; Vitreous prolapse

MeSH Terms

Anterior Chamber
Aqueous Humor
Blister
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Iridectomy
Prolapse
Trabeculectomy
Vitrectomy

Figure

• 

  Figure 1 (A) POD#97, the intraocular pressure elevated and the height of bleb became flat. The anterior chamber was well maintained and the iridectomy site looked patent on slit lamp examination. (B) On gonioscopic examination, it was found that the inner ostium was obstructed by prolapsed vitreous strands through the iridectomy site (arrow).

• 

  Figure 2 (A) After anterior vitrectomy, the bleb recovered filtering function taking on a diffuse and prominent looking appearance. (B) Since the anterior vitrectomy, there have been no recurrences of vitreous prolapse into the anterior chamber for 11 months.

Reference

1. Beckers HJ, Schouten JS, Webers CA, et al. Side effects of commonly used glaucoma medications: comparison of tolerability, chance of discontinuation, and patient satisfaction. Graefes Arch Clin Exp Ophthalmol. 2008. 246:1485–1490.

2. Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy study after one year of follow-up. Am J Ophthalmol. 2007. 143:9–22.

3. The Fluorouracil Filtering Surgery Study Group. Fluorouracil Filtering Surgery Study one-year follow-up. Am J Ophthalmol. 1989. 108:625–635.

4. Three-year follow-up of the Fluorouracil Filtering Surgery Study. Am J Ophthalmol. 1993. 115:82–92.

5. The Fluorouracil Filtering Surgery Study Group. Five-year follow-up of the Fluorouracil Filtering Surgery Study. Am J Ophthalmol. 1996. 121:349–366.

6. Jampel HD, Musch DC, Gillespie BW, et al. Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol. 2005. 140:16–22.

7. Liebmann JM, Ritch R, DiSclafani M, Stock L. Early intraocular pressure rise after trabeculectomy. Arch Ophthalmol. 1990. 108:1549–1552.

8. Thomas R, Jay JL. Raised intraocular pressure with topical steroids after trabeculectomy. Graefes Arch Clin Exp Ophthalmol. 1988. 226:337–340.

9. Azuara-Blanco A, Katz LJ. Dysfunctional filtering blebs. Surv Ophthalmol. 1998. 43:93–126.

10. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. III. Early and late complications. Eye (Lond). 2002. 16:297–303.

11. Shaarawy TM, Sherwood MB, Hitchings RA, Croeston JG. Glaucoma. 2009. Vol. 2:1st ed. Philadelphia: Saunders Elsevier;111–150.

12. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968. 66:673–679.

13. Shirato S, Kitazawa Y, Mishima S. A critical analysis of the trabeculectomy results by a prospective follow-up design. Jpn J Ophthalmol. 1982. 26:468–480.

14. Panek WC, Holland GN, Lee DA, Christensen RE. Glaucoma in patients with uveitis. Br J Ophthalmol. 1990. 74:223–227.

15. Shigeeda T, Tomidokoro A, Chen YN, et al. Long-term follow-up of initial trabeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients. J Glaucoma. 2006. 15:195–199.

16. DeBry PW, Perkins TW, Heatley G, et al. Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol. 2002. 120:297–300.

17. Yaldo MK, Stamper RL. Long term effects of mitomycin on filtering blebs. Lack of fibrovascular proliferative response following severe inflammation. Arch Ophthalmol. 1993. 111:824–826.

18. Shin MK, Lee JE, Oum BS. Comparison between 20-gauge and 23-gauge vitrectomy system in primary vitrectomy for rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2009. 50:405–411.

19. Mossa F, Delaney YM, Rosen PH, Rahman R. Floaterectomy: combined phacoemulsification and deep anterior vitrectomy. J Cataract Refract Surg. 2002. 28:589–592.