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Trabeculectomy or tube shunt surgery as management option for refractory glaucoma in a monocular patient?

Poster Details

First Author: P.Kalouda GREECE

Co Author(s):    E. Kanonidou   I. Zampros   T. Lalias   F. Sakkias   G. Sakkias        

Abstract Details

Purpose:

To present an interesting case of a monocular glaucoma patient, requiring surgical intervention for refractory glaucoma and the dilemma between trabeculectomy or an aqueous drainage device (tube shunt).

Setting:

Department of Ophthalmology, ‘’Hippokrateion’’ General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

A 47-year-old female was referred to the glaucoma outpatients department of Ophthalmology due to refractory glaucoma to standard topical and systemic antiglaucoma medication. The patient was treated with antiglaucoma eye drops (4 medications) and acetazolamide tablets per os which caused a significant renal impairment.

Results:

The ophthalmological findings included visual acuity: RE=8/10, LE=LP, tonometry RE=24mmHg, LE=13mmHg.She had undergone cataract surgery in the RE in the past, whereas she refused cataract surgery at her LE, which had mature white cataract. She also had bilateral iris colobomas. Fundus examination revealed RE c/d ratio=0.9. LE fundoscopy was impossible due to dense cataract. RE visual field testing demonstrated the remaining central vision. The initial surgical approach to lowering RE’s intraocular pressure was decided to be a trabeculectomy, with good results throughout the nine-month follow up.

Conclusions:

When confronted with the monocular glaucoma patient requiring initial surgical intervention for filtration, the decision between trabeculectomy or aqueous drainage device (ADD) surgery is controversial. Considering factors such as more reported serious complications (endophthalmitis, retinal detachment) after ADD surgery, unresolved concerns about the long-term effect of ADD tubes upon the cornea, the use of suture release techniques and post-operative use of antifibrosis agents in trabeculectomy, our initial choice was a trabeculectomy.

Financial Disclosure:

NONE

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