[What should be done when surgery fails? Intraocular pressure remains too low after filtrating surgery].
The definition of postoperative hypotony should be based on intraocular pressure (<5 mmHg) but should also take into account the associated anatomical risk, risk factors as well as the mechanisms involved, which vary depending on whether the anterior or posterior segment is concerned (presence or absence of the Seidel sign, primary or secondary ciliary body and choroidal detachment, etc.). The course to follow is based on evaluating the urgency of the situation so as to provide an adapted response. The choice and delay of the therapeutic response depends on the degree of inflammation of the bleb, the degree of athalamia (3 stages), and the aspect of the posterior pole. In case one or the other chosen technique fails (simple surveillance, bandage, protective eye shield, contact lens, laser, etc.), surgical revision of the operative site may be necessary. The anterior chamber must be reinflated using viscoelastic in certain situations. Much rarer is the need for intervention on the posterior pole after UBM, B ultrasound, and gonioscopy. Cases of severe and delayed secondary hypotonia with conjunctiva-scleral necrosis require rapid reoperation.
Ubaud
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charlesubaud@yahoo.fr
D018463:Filtering Surgery; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000628:therapy*; D007429:Intraocular Pressure; D011183:Postoperative Complications / Q000628:therapy*; D017211:Treatment Failure