Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kutahya, Turkey.
Rom J Ophthalmol. 2023 Jan-Mar;67(1):92-96. doi: 10.22336/rjo.2023.17.
Trabeculectomy is the gold standard surgery for achieving target intraocular pressure (IOP) in glaucoma. Besides the efficiency of trabeculectomy, intraoperative or postoperative complications such as, suprachoroidal hemorrhage, vitreous loss, malignant glaucoma, flat anterior chamber, hypotony, choroidal detachment, endophthalmitis, are also quite important. We present the management of excessive conjunctival and scleral retraction during trabeculectomy: an unusual intraoperative complication. A 66-year-old woman was referred to our glaucoma unit with progression of primary open angle glaucoma. No known systemic disease was observed in her history except hypertension. The best-corrected visual acuity was 20/ 63 in the right eye and 20/ 20 in the left eye. IOP was 27 mmHg and 19 mmHg (with bimatoprost timolol fixed combination and brimonidine tartrate) in the right and left eyes, respectively. We planned trabeculectomy with mitomycin C for the right eye of the patient. Excessive conjunctival and scleral retraction occurred during surgery. Autograft conjunctival tissue was prepared to cover for bare sclera area. No complications were observed in postoperative period. Seronegative spondyloarthropathy (HLA-B27-negative) was diagnosed postoperatively as a result of consultations. Conjunctival retraction is observed as a postoperative complication after trabeculectomy. Postoperative conjunctival retraction can cause bleb leakage and hypotony, as well as predispose to infection. Nowadays, micro invasive glaucoma surgery (MIGS) is gaining popularity, especially because of its reduced complication rate compared to trabeculectomy. However, considering the IOP reduction rates, MIGS has been indicated in mild and moderate glaucoma. We presented the management of excessive conjunctival and scleral retraction during trabeculectomy, which has not been reported earlier. Conjunctival autograft transplantation is useful to manage this complication.
小梁切除术是治疗青光眼的金标准手术，以达到目标眼压（IOP）。除了小梁切除术的效率外，术中或术后并发症也很重要，如脉络膜上腔出血、玻璃体积血、恶性青光眼、浅前房、低眼压、脉络膜脱离、眼内炎等。我们介绍了小梁切除术中过度结膜和巩膜退缩的处理方法：一种不常见的术中并发症。一位 66 岁女性因原发性开角型青光眼进展被转诊至我们的青光眼专科。除了高血压外，她的病史中没有其他已知的系统性疾病。右眼最佳矫正视力为 20/63，左眼为 20/20。右眼眼压为 27mmHg，左眼眼压为 19mmHg（右眼使用贝美前列素噻吗洛尔固定组合和酒石酸溴莫尼定，左眼使用马来酸噻吗洛尔）。我们计划对患者右眼行小梁切除术联合丝裂霉素 C。手术过程中出现过度的结膜和巩膜退缩。准备自体结膜组织覆盖裸露的巩膜区域。术后无并发症。术后会诊诊断为血清阴性脊柱关节病（HLA-B27 阴性）。小梁切除术后观察到结膜退缩，是一种术后并发症。术后结膜退缩可导致滤泡渗漏和低眼压，并容易感染。如今，微创青光眼手术（MIGS）越来越受欢迎，尤其是因为其与小梁切除术相比，并发症发生率较低。然而，考虑到眼压降低率，MIGS 已被用于轻度和中度青光眼。我们介绍了小梁切除术中过度结膜和巩膜退缩的处理方法，这在以前的报道中尚未提及。结膜自体移植对于处理这种并发症是有用的。
