Management of Elevated Intraocular Pressure Associated With Subluxated/Dislocated Lenses by Combining Trabeculectomy With Adjunctive Mitomycin C With Lensectomy, Vitrectomy, and Scleral Fixation of Intraocular Lens

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Abstract

Aim:

To evaluate the short-term outcomes of lensectomy, combined with vitrectomy, scleral-fixated intraocular lens (SFIOL), and trabeculectomy with adjunctive mitomycin C (MMC) in patients with subluxated/dislocated crystalline lenses with associated elevated intraocular pressure (IOP).

Materials and Methods:

This retrospective case series included 51 eyes of 51 patients who underwent lensectomy, vitrectomy, and SFIOL combined with trabeculectomy with MMC between 2003 and 2012. The main outcome measures assessed were IOP, change in visual acuity, IOP-lowering medications, and the complications and reoperation rates.

Results:

The most common etiology observed was blunt trauma in 35 eyes (68.6%). Glaucomatous optic neuropathy was detected in 13 eyes (25.49%) preoperatively. The IOP reduced significantly from a preoperative mean of 26.3±11.5 mm Hg to 13±4.6 mm Hg (P<0.001) at the final visit. The mean preoperative number of IOP-lowering medications of 2.9±0.8 reduced to 0.3±0.7 at last follow-up (P<0.001). The best-corrected visual acuity (Snellens) improved significantly from 20/600 to 20/60 (P<0.001). Complete success defined as IOP≤21 mm Hg without medications was achieved in 93%±5% and 80%±13% at 1 and 2 years, respectively. Major postoperative complications included retinal detachment in one eye and SFIOL dislocation in another.

Conclusions:

The technique of combining SFIOLs with trabeculectomy with adjunctive MMC in the management of subluxated/dislocated lenses resulted in good IOP control and improvement in visual acuity.

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