Trabeculectomy Surgery In Eyes With Implantable Collamer Lens Insitu

Introcuction and Purpose: ICL explanation with or without clear lens extraction/ glaucoma filtering surgery (GFS) is not the solution for all post ICL glaucomas. One can perform GFS with ICL insitu to control the intraocular pressure (IOP) and also maintain good uncorrected visual acuity in these high myopic eyes. We evaluated the outcomes of trabeculectomy in post ICL glaucoma and performed a review of literature.

Materials : We report the managemnet and longterm outcomes of trabeculectomy in 5 eyes of 3 patients with ICL Insitu.

Methods:  The surgeries were conducted between between October 2016 and March 2021. The indications, surgery, postoperative course and management outcomes were evaluated.

Results: All the eyes had medically refractory open angle glaucoma post ICL surgery and underwent trabeculectomy. The pre-ICL mean (± standard deviation) degree of myopia was -19±5.7 D. Post-trabeculectomy, the IOP decreased from 35±2.4 to 12.40±2.6 mmHg (p<0.001) at a mean postoperative follow up of 35.8±20 months. Post trabeculectomy, there was no significant difference in visual acuity (p=0.58) or spherical equivalent (p=0.11), however, there was a significant decrease in the ICL vault from a mean of 352.40±90 to 194.80±71.93 microns (p=0.01). Three eyes had minor early postoperative complications like transient hyphema, dellen formation and peripheral choroidal detachment (all subsided with conservative management within 1-3 weeks).

Conclusion: Trabeculectomy in eyes with post ICL refractory open angle glaucoma is effective in controlling IOP and also maintaining visual acuity.