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AbstractDO.14.14 Vitrectomy under echographic control in opaque cornea Shandurkov I., Vassileva P.
University Eye Hospital Pashev Sofia, Bulgaria Objective: Malignant glaucoma is a rare complication following intraocular surgery. It is a result of aqueous misdirection towards the vitreous. The only known treatment for break down the vicious circle is vitrectomy.
We present a technique of 23 Ga vitrectomy in patient with malignant glaucoma and opaque cornea.
Methods: 29-year-old female underwent corneoscleral transplantation for corneal perforation as a complication of ophthalmic herpes zoster. Four days after surgery she developed high intraocular pressure resistant to any medications. Malignant glaucoma was diagnosed. We performed two port transconjunctival sutureless 23 Ga pars plana vitrectomy under echographic control. A 2500 cpm vitrectomy probe was used in combination with 10 MHz B-scan probe for core vitrectomy. At the end of surgery prophylactic cryo-retinopexy was made. The patient is on oral antiviral medications and was followed for 8 months.
Results: Core vitrectomy through 23Ga trocars was made without any risk of iatrogenic injury on the retina. The use of 10 Mhz B-scan probe ensured safe movements of vitrector only in the middle of vitreous cavity. The follow-up by regular monthly B-scans showed attached retina, absence of any intraocular inflammation and intraocular pressure within normal range. Blind cryo-retinopexy of peripheral retina was efficiant for prevention of late postvitrectomy retinal detachment. Penetrating keratoplasty will be planned depending on long-term low levels of VZV-antibodies serum titers.
Conclusions: Vitrectomy is well known as the only adequate treatment in malignant glaucoma. When cornea is opaque and there is absence of endoscopic vitreoretinal devices our only option was the chosen technique of B-scan guided pars plana core vitrectomy. This approach assumed further therapeutic possibilities for better visual outcome.
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