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Pars plana vitrectomy combined with hyaloido‐zonula‐iridectomy in treatment of patients with chronic aqueous misdirection: A systematic literature review and case series
Author(s) -
Schmidt Diana Chabané,
Kessel Line,
Pedersen Karen Bjerg,
Villumsen Jørgen Ebbe,
BachHolm Daniella
Publication year - 2021
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14580
Subject(s) - vitrectomy , pars plana , iridectomy , medicine , ophthalmology , glaucoma , surgery , visual acuity
Purpose To evaluate the efficacy of vitrectomy combined with hyaloido‐zonula‐iridectomy from an anterior or a posterior approach in patients with treatment‐resistant aqueous misdirection (chronic aqueous misdirection) by systematically reviewing existing literature in combination with presentation of a case series. Methods A systematic literature review was performed in PubMed, EMBASE and Cochrane Library databases using search terms: malignant glaucoma, ciliary block, ciliolenticular block and aqueous misdirection. A consecutive series of three pseudophakic patients (5 eyes) diagnosed with chronic aqueous misdirection after cataract surgery is presented. Results A literature search identified 31 articles describing treatment of chronic aqueous misdirection with vitrectomy and a hyaloido‐zonula‐iridectomy. Studies, where patients were treated with a complete vitrectomy from pars plana in combination with a hyaloido‐zonula‐iridectomy, reported low relapse rates. Studies describing a surgical approach with vitrectomy performed from the anterior chamber, followed by a hyaloido‐zonula‐iridectomy, also reported low relapse rates except for one reporting relapse in nearly half of the patients. In our case series, a complete vitrectomy combined with a hyaloido‐zonula‐iridectomy resolved the chronic aqueous misdirection in all five eyes after one procedure except one eye where the hyaloido‐zonula‐iridectomy was repeated due to an insufficient opening. Some of the eyes still needed antiglaucomatous treatment due to chronic angle closure. Conclusion In treatment‐resistant malignant glaucoma, vitrectomy combined with a hyaloido‐zonula‐iridectomy should be considered performed to ensure communication between the anterior chamber and the vitreous cavity. If the condition has been unresolved for a long time, extensive synechiae of the angle may decrease the success rate due to chronic angle closure.