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Retinectomy for Treatment of Intractable Glaucoma: Long Term Results
1Joussen A. M., 2Walter P., 2Jonescu-Cuypers C., 3Bartz-Schmidt K. U., 2Krieglstein G. K., 1Kirchhof B.,
1Universität zu Köln, Zentrum für Augenheilkunde, Abteilung für Netzhaut- und Glaskörperchirurgie (Köln)
2Universität zu Köln, Zentrum für Augenheilkunde (Köln)
3Eberhard-Karls-Universität Tübingen, Universitäts-Augenklinik, Abt. I (Tübingen)
Purpose: To report long term efficacy and complications of retinectomy as an intraocular pressure lowering procedure for intractable glaucoma. Design: A consecutive interventional case series.
Methods: In 44 consecutive eyes (39 patients, 22 men and 17 women) retinectomy was performed to lower the intraocular pressure in patients with uncontrolled IOP (> 35 mmHg for more than 4 month) despite maximum tolerable therapy and appropriate conventional surgery. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by a short term intraocular tamponade of 20% C3F8-gas. Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (3 eyes), secondary glaucoma due to aphakia (12 eyes), severe ocular trauma (7 eyes), uveitis (7 eyes), and miscellanea (2). The initial visual acuity of all patients was lower than 20/50 (mean 1.8 ± 0.8 logMAR) in the treated eye.
Results: All patients underwent successful surgical retinectomy. All patients were followed for 5 years. Mean postoperative intraocular pressure after *4 years was 15.7±9.4, representing a decrease of IOP by 61 % compared to the preoperative level (41.2±9.4). In 52,3% of eyes long term regulation of IOP could be achieved without complications. 44% of the patients (19 eyes of the total 44 cases) were finally successful after a 5-year follow-up as was determined as cases with no loss of light perception, normal IOP (>7 and <22mmHg), and attached retina over a period of 5 years. Glaucoma was least affectable in conjunction with neovascularization due to central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed tendency towards low IOP levels with subsequent phthisis bulbi. 47.7% of the patients developed retinal complications after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for proliverative vitreoretinopathy (PVR). Nine eyes developed a phthisis, 7 of which were enucleated during the follow-up. In all patients preoperative systemic treatment with CAI was terminated postoperatively.
Conclusions: Long term results after retinectomy demonstrate its efficacy in otherwise irretractable glaucoma. Efficiacy and safety of the treatment are dependent on the underlying disease. Thus retinectomy size should be modified accordingly. Silicone oil tamponade instead of gas may be helpful for eyes with active neovascularization bearing a high risk of retinal complications.