Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma
J. W. Harbour, P. E. Rubsamen and P. Palmberg
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Fla.
OBJECTIVE: To determine the indications for and outcome of pars plana
vitrectomy in the management of phakic and pseudophakic malignant glaucoma.
DESIGN: Retrospective review. SETTING: Tertiary referral ophthalmic
hospital. PATIENTS: Twenty-two patients (24 eyes) who underwent pars plana
vitrectomy in the management of malignant glaucoma. RESULTS: Fourteen eyes
were phakic and 10 were pseudophakic at the initial vitrectomy. The primary
indication for vitrectomy was failure of other therapies. In phakic eyes,
the initial vitrectomy was successful in terminating malignant glaucoma
without further surgery in 7 (100%) of 7 eyes that underwent lensectomy and
in 5 (71%) of 7 eyes that not did not undergo lensectomy. The primary
indication for lensectomy was corneal edema caused by lens-corneal touch.
In pseudophakic eyes, the initial vitrectomy was successful in 9 (90%) of
10 eyes. Removal of the intraocular lens was performed in 1 eye.
Perioperative complications included transient serous choroidal detachment
in 2 eyes, transient exudative retinal detachment in 1 eye, and
suprachoroidal hemorrhage in 1 eye. CONCLUSIONS: Pars plana vitrectomy is
effective in treating phakic and pseudophakic malignant glaucoma. Success
is contingent on establishing a pathway for aqueous flow into the anterior
chamber, which usually is accompanied by intraoperative deepening of the
anterior chamber. In phakic eyes, lensectomy may be considered for marked
corneal edema, for dense cataract, or when the anterior chamber will not
deepen during vitrectomy.
