title: Surgical management of malignant glaucoma: a retrospective analysis of fifty eight eyes.
abstract: PurposeTo assess outcomes of surgical management of malignant glaucoma in terms of re-formation of anterior chamberMethodsThis was a retrospective analysis of consecutive patients who underwent surgical treatment for malignant glaucoma between January 1995 and December 2013 at a tertiary care ophthalmic institute, with a minimum follow up of 2 months.ResultsFifty eight eyes of 58 patients were included. Fifty two (89.7%) patients had primary angle closure glaucoma. The majority had undergone glaucoma filtration surgery earlier (n=53, 91.4%). Lensectomy and anterior vitrectomy was performed in 15 (25.9%) eyes (Group 1). Vitrectomy and anterior chamber re-formation was performed in 27 (46.6%) eyes (Group 2). Vitrectomy-phacoemulsification-vitrectomy was performed in 16 (27.6%) eyes (Group 3). Communication between the two segments of eye through anterior hyaloid, lens capsule complex and/or iris was achieved in all groups. The median follow-up (Inter-quartile range) was 30 (71.5) months. Anterior chamber re-formation was achieved in 56 (96.5%) eyes at final visit. The improvement in mean±SD LogMAR visual acuity (1.1±1 to 0.7±0.8) and reduction in number ±SD of anti-glaucoma medications (2.1±1.1 to 1±1.6) between onset and final visit were significant (P=0.02 and <0.01, respectively). The intraocular pressure (mm Hg) at onset and at final visit was 30.7±17.4 and 14±6.2, 32.8±12.6 and 15.3±7.4, and 27.2±14 and 10.9±3 in groups 1-3, respectively (all P<0.01).ConclusionOur anatomical success rate was high. The key element in achieving this outcome was the establishment of a patent communication between the vitreous cavity and the anterior chamber.
authors.affiliation: Jadhavbhai Nathamal Singhvi Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: S
authors.initials: S
authors.lastname: Balekudaru
authors.affiliation: VST Glaucoma Center, L. V. Prasad eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
authors.forename: N S
authors.initials: NS
authors.lastname: Choudhari
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: P
authors.initials: P
authors.lastname: Rewri
authors.affiliation: Jadhavbhai Nathamal Singhvi Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: R
authors.initials: R
authors.lastname: George
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Bhende
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: M
authors.initials: M
authors.lastname: Bhende
authors.affiliation: Jadhavbhai Nathamal Singhvi Department of Glaucoma, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: V
authors.initials: V
authors.lastname: Lingam
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: G
authors.initials: G
authors.lastname: Lingam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000000981:diagnostic imaging*; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D018918:Phacoemulsification / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D055815:Young Adult