Complex Glaucoma And Anterior Segment Surgeries - A Video Review

Glaucoma can be secondary to trauma and other pathologies. In complex cases that need glaucoma surgery associated with anterior or posterior segment surgery, a multidisciplinary approach with different techniques can be required. We intended to review our surgical complex glaucoma cases in which other advanced anterior or posterior segment surgeries were needed, to identify possible protocols and strategies.

We performed a monocentric study in our tertiary hospital. 

We performed a retrospective study with review of the surgical videos in which there was a glaucoma surgery associated with complex anterior or posterior segment surgery from 2022 to 2025. We performed a literature review regarding complex anterior segment surgery. We compared the techniques to identify strategies that could lead to improved outcomes.

The literature review allowed to identify several articles with different techniques’ adaptations. In our video review, whenever there was intraocular lens (IOL) exchange or repositioning (namely due to uveitis-glaucoma-hyphema syndrome) in glaucoma surgery, with uncontrolled intraocular pressure (IOP), drainage devices and trabeculectomy were used, while micro-invasive glaucoma surgeries (MIGS) were preferred for controlled IOP. Drainage devices were mostly used when vitrectomy was planned, and associated with iris repair techniques. More complex repairs, as iris prostheses were associated with posterior vitrectomy, endo-cautery and MIGS; an adapted technique from Canabrava was used to spare the conjunctiva for future glaucoma surgeries.

A multidisciplinary approach is ideal with complex cases. A systematic but personalized strategy, adapted for each case, is useful to improve the patients outcomes.