Retinectomy an alternative for intractable glaucoma

Retinectomy can be a viable option for lowering intraocular pressure in intractable glaucoma, according to a long-term German study. The efficacy and safety of the procedure are dependent on the nature of the underlying disease, the study authors note.

Bernd Kirchhof, MD, and colleagues at the University of Cologne studied 44 eyes of 39 patients that had uncontrolled intraocular pressure despite conventional filtering surgery and drug treatment. The patients’ mean IOP was greater than 35 mm Hg for more than 4 months despite other therapies. Included in the study were patients with neovascular glaucoma, infantile and juvenile glaucoma, secondary glaucoma due to aphakia, severe ocular trauma, uveitis and glaucoma in Ehlers-Danlos syndrome.

Pars plana vitrectomy was performed, and the peripheral retina was surgically excised to various degrees under an intraocular gas tamponade. All patients were followed for 5 years. The mean IOP postoperatively after 4 years was 15.7 mm Hg. In 52.3% of the eyes, long-term IOP regulation was achieved without complications. Patients with neovascular glaucoma had the least successful retinectomy rate due to central retinal vein occlusion. Glaucoma secondary to uveitis resulted in eyes with lower IOP levels and subsequent phthisis bulbi. Visual acuity increased from an initial mean of 1.8 logMAR to 2.3 logMAR at the final follow-up.

Of the 44 cases, 21 developed retinal complications. Phthisis developed in nine eyes, seven of which were enucleated during follow-up.

The study is published in the September issue of British Journal of Ophthalmology.