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Prevention of relapse of surgically treated aqueous misdirection by combining primary posterior capsulectomy with irido-zonulo-hyaloido-vitrectomy.
Vanita Pathak-Ray, Gurcharan Singh, Isha Gulati
Purpose: To report the outcomes of Primary Posterior Capsulectomy (PPC) when combined with Irido-Zonulo-Hyaloido-Vitrectomy (IZHV) in the surgical management of Aqueous Misdirection (AM) to prevent relapse.
Methods: Retrospective, non-comparative and interventional case series reporting the outcomes of reformed and sustained deep anterior chamber, intraocular pressure (IOP), Anti-Glaucoma Medications (AGM), complications and Best Corrected Visual Acuity (BCVA) of AM management subsequent upon intervention. A fellowship trained glaucoma specialist managed all cases with IZHV and PPC with an anterior vitrector via various incisional approaches.
Results: Ten eyes of 9 patients with AM were treated with PPC during IZHV. AM occurred in 3 eyes intra-operatively in combined phaco-filtration surgery in Primary Angle Closure Glaucoma (PACG); rest occurred in the post-operative period. Mean age of patients was 56.4 ± 17 years and were followed up for a mean of 31.3 ± 17.9 months (median 32 months, range 12-66 months). All cases achieved reversal of AM; none developed relapse. Each had deepening of Anterior Chamber (AC), control of intraocular pressure (IOP in mmHg) (pre 38.8 mmHg ± 14.6 mmHg, 95%CI [28.3,49.2] vs. post 14.6 mmHg ± 2.5 mmHg, 95%CI [12.8,16.4]; p<0.001) and requirement for anti-glaucoma medication (mean number pre 3.1 ± 0.8, 95% CI [2.5,3.8] vs. post 0.4 ± 0.8, 95%CI [-0.2,1.0]; p<0.001) at last follow-up. No serious long-term complication occurred.
Conclusion: Primary posterior capsulectomy, when combined with IZHV, is an efficient means of ensuring complete hyaloidectomy, essential for preventing recurrence of AM. It can be successfully utilised by the anterior segment surgeon through multiple incisions with an anterior vitrector, thereby reducing burden on the resources and skills required in a vitreo-retinal procedure