25-gauge microincision vitrectomy to treat vitreoretinal disease in glaucomatous eyes after trabeculectomy

Abstract

Purpose. To determine the feasibility of using 25-gauge microincision vitrectomy surgery (25GMIVS) to treat vitreoretinal disease in glaucomatous eyes which have previously undergone trabeculectomy (TLE). Methods. A consecutive, interventional case series. We performed 25GMIVS in 15 glaucomatous eyes that had undergone TLE. Follow-up period was 11.5 months. Results. 25GMIVS was successfully used and led to improvement in visual acuity (P < 0.01). We performed 25GMIVS for proliferative diabetic retinopathy with neovascular glaucoma in 53% of eyes (8 of 15). Although 3 eyes needed further TLE following 25GMIVS, final IOP was below 21 mmHg in all eyes except one eye (93%) and was comparable to pre-25GMIVS IOP (P = 0.20) without an increase in the number of glaucoma medications (P = 0.14). Conclusions. 25GMIVS is a feasible treatment for vitreoretinal disease in eyes with preexisting TLE, effective in both significantly improving BCVA and preserving the filtering bleb, while not excluding further glaucoma surgery.

Figure 1

Representative example of proliferative diabetic retinopathy (PDR) complicated by neovascular glaucoma (NVG) (Patient 12; see Table 1). Fundus, anterior segment, and intraoperative photographs of the eye of a 61-year-old man with PDR/NVG. The eye underwent 25-gauge microincision vitrectomy surgery (25GMIVS) after trabeculectomy. (a) Preoperative photograph of the fundus. We could not visualize the posterior fundus due to vitreous hemorrhage (VH). (b) Intraoperative photograph of the anterior segment. 25GMIVS was being performed with 3 ports. The insertion placement of the cannulas was shifted to avoid disturbing the subconjunctival hemorrhage of the filtering bleb in the upper temporal region. (c) Postoperative photograph of the fundus. The VH has been removed and the retinal surface can be seen clearly. (d) One-day postoperative photograph of the anterior segment. There was no subconjunctival hemorrhage, including the filtering bleb, in the upper temporal region.

Figure 2

Representative example of rhegmatogenous retinal detachment (RRD) (Patient 1; see Table 1). Fundus, anterior segment, and intraoperative photographs of the eye of a 45-year-old man with RRD. The eye underwent 25-gauge microincision vitrectomy surgery (25GMIVS) after trabeculectomy. (a) Preoperative photograph of the fundus. There was focal retinal detachment with a peripheral retinal tear. (b) Intraoperative photograph of the anterior segment. 25GMIVS was being performed with 4 ports. The insertion placement of the cannulas was shifted to avoid disturbing the subconjunctival hemorrhage of the filtering bleb in the upper temporal region. (c) Postoperative photograph of the fundus. Retinal reattachment was achieved with 25GMIVS. The white retinal scars of endophotocoagulation can be seen. (d) One-day postoperative photograph of the anterior segment. There was no subconjunctival hemorrhage, including the filtering bleb, in the upper temporal region. An air-fluid level line of intraocular gas tamponade can be seen through the pupil.