Combined par plana vitrectomy and glaucoma drainage implant placement for refractory glaucoma

PURPOE: To report viual acuity and intraocular preure outcome among patient who have undergone combined par plana vitrectomy and placement of a glaucoma drainage implant. METHOD: The medical record of all patient who underwent combined par plana vitrectomy and placement of a glaucoma drainage implant at the Bacom Palmer Eye Intitute by one of the author between January 1, 1990, and February 28, 1998, were reviewed. Forty patient (40 eye) were identified, including 14 patient with neovacular glaucoma econdary to proliferative diabetic retinopathy or central retinal vein occluion, 15 patient with other poterior egment dieae, even patient with econdary angle-cloure glaucoma, and four patient with aphakia with ruptured anterior hyaloid face. Main outcome meaure included viual acuity and intraocular preure at 1 year potoperatively. REULT: At 1 year potoperatively, 31 (77.5%) of 40 patient had table or improved viual acuity; three eye (7.5%) had a final viual acuity of no light perception and three additional eye (7.5%) were enucleated (becaue of chronic pain in two eye and endophthalmiti in one eye). Mean preoperative intraocular preure wa 34 mm Hg and the median number of preoperative antiglaucoma medication wa two. At 1 year potoperatively, mean intraocular preure wa 13 mm Hg and the median number of antiglaucoma medication wa zero. Twenty-two patient (55.0%) achieved an intraocular preure greater than 5 mm Hg and le than or equal to 21 mm Hg without antiglaucoma medication, and an additional even patient (17.5%) achieved thi level of intraocular preure control with medication. Only one patient (2.5%) underwent further glaucoma urgery for uncontrolled intraocular preure. CONCLUION: Although combined par plana vitrectomy and placement of a glaucoma drainage implant i often a ucceful management option in elected patient with refractory glaucoma, viual outcome may be poor becaue of evere underlying ocular dieae and potoperative complication.