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M. Omran, A.M. Joussen, P. Walter, K. Bartz-Schmidt, B. Kirchhof; Retinectomy for Treatment of Intractable Glaucoma: Long Term Results . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4373.
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Purpose: To report long term efficacy and complications of retinectomy as an intraocular pressure lowering procedure for intractable glaucoma. Design: A consecutive interventional case series. Methods: In 44 consecutive eyes (39 patients, 22 men and 17 women) retinectomy was performed to lower the intraocular pressure in patients with uncontrolled IOP (> 35 mmHg for more than 4 month) despite conventional filtering surgery and drug therapy. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by an intraocular gas tamponade of 20% C3F8. Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (3 eyes), secondary glaucoma due to aphakia (12 eyes), severe ocular trauma (7 eyes), uveitis (7 eyes), and glaucoma in Ehlos Danlos syndrome (2). Results: All patients underwent successful surgical retinectomy. All patients were followed for 5 years. Mean postoperative intraocular pressure after ≥4 years was 15.7±9.4, representing a decrease of IOP by 61 % compared to the preoperative level (41.2±9.4). In 52,3% of eyes long term regulation of IOP could be achieved without complications. Retinectomy was least effective in neovascular glaucome due to central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed a tendency towards low IOP levels with subsequent phthisis bulbi. The initial visual acuity of all patients was lower than 20/50 (mean 1.8 ± 0.8 logMAR) in the treated eye. 47.7% of the patients developed retinal complications after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for proliferative vitreoretinopathy (PVR). Nine eyes developed a phthisis, 7 of which were enucleated during the follow-up. Conclusions: Long term results after retinectomy demonstrate its efficacy in otherwise intractable glaucoma. Efficacy and safety of retinectomy are dependent on the underlying disease. Silicone oil tamponade instead of gas may be helpful for eyes with active neovascularization bearing a high risk of retinal complications.
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