Combined Endoscopic Vitrectomy With Pars Plana Tube Shunt Procedure

Abstract

Purpose: : Tube shunt placement in the vitreous cavity may be indicated for intraocular pressure (IOP) control in a number of conditions including corneal disease and anterior segment dysgenesis. In patients with severe media opacity, conventional pars plana vitrectomy using wide angle viewing systems is of limited utility. Endoscopic visualization may be an effective alternative. In this study we report a case series of patients with limited fundus view who underwent combined endoscopic vitrectomy and pars plana tube shunt for IOP control.

Methods: : The records of 13 eyes of 11 patients operated at Cincinnati Eye Institute from 2006 to 2010 who underwent combined endoscopic vitrectomy with pars plana tube shunt placement were retrospectively reviewed. Pre and post operative IOP and visual acuity, and complications were noted. In 4 eyes with keratoprosthesis IOP was determined by tactile estimation.

Results: : Nine eyes had aniridia, 1 had Axenfeld-Rieger syndrome, 2 had chemical injury and 1 had ocular trauma. There were 6 right and 7 left eyes in the series. Mean patient age was 42 years. Mean follow up was 16 months. Indication for pars plana tube shunt was uncontrolled IOP on maximum medical therapy in 12 eyes and malposition of glaucoma tube shunt in 1 eye. Indication for endoscopic vitrectomy surgery was severe media opacity from anterior segment disease in all cases. Median preoperative visual acuity (Snellen chart) was 20/200 and 20/160 postoperatively. Mean preoperative IOP was 23+/-9 mmHg and improved to 12+/-5 mmHg postoperatively (p<0.0003). No complications were noted.

Conclusions: : Endoscopic vitrectomy with pars plana glaucoma tube shunt implantation may be considered in the management of uncontrolled IOP in patients with media opacity. This technique affords excellent and complete visualization of posterior segment anatomy, and allows for a safe and complete vitrectomy surgery prior to pars plana tube placement resulting in excellent IOP control, which can be challenging to measure in these cases. Achieving IOP control prior to attempted anterior segment reconstruction in these severely diseased eyes may increase the success rate and decrease the complexity of subsequent anterior reconstruction procedures.

Keywords: vitreoretinal surgery • vitreous • intraocular pressure