J Korean Ophthalmol Soc.  2014 Oct;55(10):1511-1519. 10.3341/jkos.2014.55.10.1511.

Glaucoma Surgery in Patients with Painful Blind Glaucomatous Eyes

• Kang EM
• Lee YH
• Seo SJ
• Kim CY
• Seong GJ
• Hong S

• KMID: 2216871
• DOI: http://doi.org/10.3341/jkos.2014.55.10.1511

Abstract

PURPOSE
To investigate the clinical outcome of glaucoma surgery performed in patients with painful blind glaucomatous eyes.
METHODS
A single-center, retrospective, interventional case series was performed by reviewing the medical records of 74 glaucoma patients (74 eyes) who underwent Ahmed glaucoma valve (AGV) implantation or trabeculectomy for painful blind eyes from October 2004 to January 2014. Blindness was defined as visual acuity less than hand motion at the time of surgery. Preoperative and postoperative intraocular pressure (IOP), number of anti-glaucoma medications, and presence of pain were compared in the patients grouped according to the type of glaucoma surgery. The glaucoma type, history of previous glaucoma surgery and postoperative failure/complications were also evaluated.
RESULTS
AGV implantation was performed in 42 eyes (56.8%) of 42 patients, and trabeculectomy was performed in 32 eyes (43.2%) of 32 patients. The average IOP decreased from 41.73 +/- 11.77 mm Hg before surgery to 14.29 +/- 9.34 mm Hg at five years after the surgery (p < 0.001, paired t-test). The IOP was not significantly different between the groups at any follow-up time point (p = 0.949, linear mixed model). Overall, three patients (4.1%) still experienced eye pain after surgery, IOP greater than 30 mm Hg was observed in eight eyes (10.8%), and additional surgery was required in 11 eyes (14.9%). Evisceration was required in only two eyes (2.7%). Sympathetic ophthalmia was not found in any patient during the follow-up period.
CONCLUSIONS
Glaucoma surgery including AGV implantation/trabeculectomy was effective and safe even for painful blind eyes. The procedure may be considered as an alternative to enucleation as an initial surgical option for painful blind glaucomatous eyes.

Keyword

Ahmed glaucoma valve; Glaucoma; Painful blind eye; Sympathetic ophthalmia; Trabeculectomy

MeSH Terms

Blindness
Eye Pain
Follow-Up Studies
Glaucoma*
Hand
Humans
Intraocular Pressure
Medical Records
Ophthalmia, Sympathetic
Retrospective Studies
Trabeculectomy
Visual Acuity

Figure

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  Figure 1. Intraocular pressure (IOP) change after Ahmed glaucom a valve (AGV) implantation and trabeculectomy in painful blind eyes. Each bar represents the 95% confidence interval of each group at each time point. TRAB = trabeculectomy.

Reference

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