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D. A. Reichstein, J. Kammer, F. M. Recchia; Combined 25-gauge Pars Plana Vitrectomy and Posterior Tube Shunt for Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2067.
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Glaucoma drainage implants are often used for refractory glaucoma. Posterior tube placement may be required in cases anterior segment abnormalities. Advantages of combined 25-gauge vitrectomy include vitreous removal with reduced inflammation, flow of intraocular fluid, and conjunctival dissection, as well as tube placement through one of the 25-gauge sclerotomies. We describe a modified technique of combined 25-gauge PPV and posterior placement of glaucoma drainage implants and report preliminary clinical results in patients with advanced glaucoma.
Technique Following suturing of the episcleral plate approx 8mm from the limbus, 3 25-gauge cannulas are placed. 2 are placed through conjunctiva. 1 is placed directly in line with the implant and serves as the insertion point. Following complete vitrectomy, the vitrector cleans the tube's path prior to insertion. The tube is covered by pericardium, conjunctiva is reapproximated, and the infusion line and transconjunctival cannula are removed. Postop, the number of antihypertensive drops was not changed if desired intraocular pressure (IOP) was attained.Data Collection Records of consecutive patients who underwent the procedure were reviewed. Primary outcome measures were IOP, BCVA, and # of antihypertensive drops required at 1, 2, 6, and 12 months postop. Secondary outcome measures were rate of retinal detachment (RD) and need for additional surgery.
13 patients (9 Caucasians; 10 females) were treated. Mean age was 61 yrs (range 37 - 86 yrs). Mechanism of glaucoma included CACG (4), mixed mechanism (6), NVG (1), POAG (1), and uveitic (1). 6 patients had undergone prior IOP-lowering procedures. Mean number of antihypertensive drops was 2.8 (range 0 - 5). Table 1 outlines primary outcome measures. Mean IOP at preop and post op visits are listed in table 2. Mean IOP was significantly decreased from preop at all post visits (see table 2). No patient developed RD at 1 year. 2 patients required another surgery to control IOP. 1 patient developed bullous keratopathy requiring PKP.
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