Complication of Glaucoma Surgery

7/29/2019 Complication of Glaucoma Surgery

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COMMONCOMPLICATIONS OFGLAUCOMA SURGERY

ESSAM OSMANF.R.C.SCONSULTANTOPHTHALMOLOGIST

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COMPLICATION AVOIDANCE

WITH GLAUCOMA SURGERYMany postoperative

complications:

Hypotony

Shallow AC

Leakage

A Direct result of poor

surgical technique.



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GLAUCOMA SURGERY

TRABECULECTOMYDEEPSCLERECTOMYTUBE SURGERY

CYCLODESTRUCTIVE PROCEDURESGONIOTOMYTRABECULOTOMYLaser treatment

PILTPLASER SUTURE LYSIS



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PREOPERATIVE

EVALUATIONHistory of complications in contra lateral eye :

Supra choroidal hge.

.Shallow AC

Excessive filtration.

AMD.

Planning of surgery :

Tight flap

Trab to DeepsclerectomyPPV in AMD



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INTRAOPERATIVE

COMPLICATIONS*TYPE OF

ANESTHESIA

Retrobulbar.

Peribulbar.

Subtenon- topical.

Retro bulbar hge-

lateral canthotomy

*HONAN BALLOON.



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INTRAOPERATIVE

COMPLICATION*Laser PI with topical anesthesia is painful.

Non preservative lidnocaine

*Corneal traction suture.Viscoelastic material- avoid antimetabolite

*Conjunctival complications.

Cautery

Button holeNeedle round



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Conunctival bleeding :anticoagulant-

hypertension

Scleral flap thin - tear

thick -perforation

Scleral bleeding :incision and perforators

:Avid excessive cauteryPressure and irrigation can stop bleeding

INTRAOPERATIVE

COMPLICATIONS



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*Intra-operative bleeding:

*Inner block removal and PI (irrigation

pressure viscoelastic) orfill AC and

suture the flap until bleeding stop

*Choroidal hge:post-op is common than pre- op.

Progressive shallow AC

Loss of red reflexOnset of pain LA.

INTRAOPERATIVE

COMPLICATIONS



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LASER PI



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LASER PI

DOES IT PREVENT GLLAUCOMA

ATTACK?

HOW TO AVOID COMPLICATIONS?

Thick iris more than one cession

Iris crypt

Any site



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Spot size

Site

Typecolor

Complications

Bleeding

Corneal

IOP



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LASER TRABECULOPLASTY

SPOT SIZE

POWER

DURATION

SITE

TYPES

COMPLICATIONS

ACUTE RISE OF IOP

PAS

HGE



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TRABECULECTOMY

FORNIX BASE



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LIMBAL BASE



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Buried suture



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Spontaneous leak

Leak on pressure



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Supe

riorn

asal

blanched

formed

diffuse

leakage



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Cut the suture at the end



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hypotonyTube obstruction

blood-vitreous-fibrin

Tube extraction

Improper introduction of the tube

Leakage around the tube

intraoperativePost operative

encapsulation



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GONIOTOMYCLEAR ANGLE VIEW



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TRABECULOTOMY

BLEEDING



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Cy c lodes t r uc t iv e

.pr ocedur es

1. Cyclocryotherapy.

2. Cyclophotocoagulation.

3. Endoscopic

cyclophotocoagulation.



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CYCLOCRYOTH ER AP Y :COMP LICATION

@. Pain.@. Uveitis.@. Hyphema.

@. vitreous hge rare

@. Cataract.

@. choroidal detachment.

@. visual loss-vitritis&CME

@. high spike of IOP.

@. Hypotony. (( more than one third of cases.))

@. Phthisis bulbi. (( more than one third of cases.))

@. Sympathetic ophthalmia



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YAG CYCLOPHOPTOCOAGULATION

complications1. Mild to severe pain.2. Moderate to severe uveitis.

3. Conj. edema.

4. Loss of more than one line of V.A.

5. Flat AC & hypotony & choroidal.6. Malignant glaucoma Hardten.Am J ophth1991

7. Scleral thinning.

8. Corneal epithelial defect.

9. Hyphema & vit.hge.

10. Persistent hypotony & phthisis& sympatheticophthalmia lam.ophth.1992



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CPC-Diode laser



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CONTROLLEDCYCLOPHOTOCOAGULATION

COCO



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DEEP SCLERECTOMY

advantage

multiple drainage mechanism

trabeculodescmet membrane give 4

hypothetical mechanism

1-subconjunctival bleb2-intrascleral bleb

3-subchoroidal space

4-schlemm canal to episcleral veins



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Post-operative complications

Shallow AC



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SHALLOW ANTERIOR

CHAMBERWITH LOW IOP

1-overfiltration.

2-ciliochoroidal detachment.

3-cyclodialysis cleft.

4-wound leak.

WITH HIGH IOP

1-aquos misdirection.

2-choroidal hge3-pupillary block.



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SHALLOW ANTERIORCHAMBER

o Gradingo Grade1 peripheral iridocorneal touch

o Grade2 iris sphincter cornea touch

o Grade3 lenticulo corneal toutch orvitreous



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o Management

o G1&G2 usually observation

o Treatment of the cause

o G3 immediate correction otherwiseendothelial decompansatio,cataractformation&bleb failure,ant.&pos synekia

o Some surgeon drain choroid with ACfomation



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OVERFILTARION

Loose scleral flap

sutures.

Usually improve andsubside by time.

Role of external

pressure.

Surgical interference.



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BLEB LEAK



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BLEB LEAK

o Leads to

hypotony&its

complication

o Failure of surgery

o Either profuse or

micro leak or

buttonhole

o Interference depend

on the appearance ofthe bleb



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BLEB LEAK

o Management

o Light patch

o Hold steroid

o Appropriate size of contact lens

o Nurses cleaning

o Patient advice

o

Adhesive glue


S O O


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o WITH HIGH IOP

o Aqueous misdirection

o Choroidal hge.

o Pupillary block

o Annular choroidal detachment


SHALLOW ANTERIOR


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SHALLOW ANTERIORCHAMBER With high IOP

o Aqueous misdirectiono Medical ttto Atropineo Phenyl ephrineo Anti glaucoma med.o Laser ttto Hyaloidectomyo Posterior capsulotomy,ant.hyaloid.o Surgery vitrectomy



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CHOROIDAL EFFUSION

o A sequel of hypotony

o Common after surgery

o Mostly resolving with topical steriod,cycloplgic

o

Indication of drainageo Kissing choroidal

o Low bleb, shallow AC,cornealdecomposition

o Posterior sclerectomy



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DEEP AC WITH HIGH IOP

BLEB looking: almost not forming

Tight flap suture

Massage------- suture lysis

SCLEROTOMY SITE obstruction

Blood

Fibrin } steroid, TPA

Vitreous } YAG LASER

iris



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HYPHEMA

o Most of cases resolved spontaneous

o Common with cases of NVG

o Excessive hyphema with fibrin usually

need TPA



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INFECTION


BLEB RELATED


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BLEB RELATEDENDOPHTHALMITIS

o BLEBITIS

o Injected bleb

o Eye discharge

o

Photophobiao Opalescent bleb

o Positive seidel test +-

o ttt respond to topical fortified drops with good

visual outcome



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BLEB RELATED


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BLEB RELATEDENDOPHTHAMITIS

o EndophthaLmitis

o Worsening pain

o Decreased VA

o AC reaction

o ViTreous involvement

o B scan mandatory

o Urgentvitrectomy


HYPOTONUS


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HYPOTONUSMACULOPATHY


HYPOTONUS


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o Leading causes

o Overfiltraton

o Bleb leak

o Ciliary body detachment

o Cyclodiaysis cleft

o Many eyes with hypotony can compromise and

no complication

o Mopia,young patient at great risk----tight suture


HYPOTONUS


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o Management

o Argon laser application to shrunken bleb

o Cryo,cautry

o Autologus blood injection

o Otherwisebleb revision



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DISSECTING BLEB



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CYSTIC BLEB


BLEB ENCAPSULATION


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BLEB ENCAPSULATION



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DEEP SCLERECTOMY


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DEEP SCLERECTOMY

Descemet detachment

Converted to trab

High IOP GONIORUPTURE


DEEP SCLERECTOMY


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DEEP SCLERECTOMY



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Deep sc le rec t om y.


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Complication of Glaucoma Surgery

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