Quarter-Shifted Microincisional Sutureless Vitrectomy in Patients with a Glaucoma Drainage Implant or Filtering Bleb

Abstract

When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases.

Keywords: Filtering surgery; glaucoma; glaucoma drainage implants; vitrectomy.

Fig. 1. Surgical technique of quarter-shifted vitrectomy. (A) Conventional sites of the three sclerotomy incisions (dotted circle) are displaced. First, the infusion cannula is moved to the infranasal side. Second, the other two incision sites are shifted to a 45°-counterclockwise position, away from the original sites (arrows). (B) Changed surgeon's view of a supratemporally positioned vitrectomy. The glaucoma drainage implants are located away from the vitrectomy cannulas and are therefore undamaged (arrowheads).