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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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SHALLOW ANTERIORCHAMBER
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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SHALLOW ANTERIORCHAMBER
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
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S O O
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SHALLOW ANTERIORCHAMBER
o WITH HIGH IOP
o Aqueous misdirection
o Choroidal hge.
o Pupillary block
o Annular choroidal detachment
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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
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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
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HYPOTONUS
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HYPOTONUSMACULOPATHY
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HYPOTONUS
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HYPOTONUSMACULOPATHY
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
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HYPOTONUS
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HYPOTONUSMACULOPATHY
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
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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
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DEEP SCLERECTOMY
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DEEP SCLERECTOMY
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Deep sc le rec t om y.
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