Eyeworld

61 EW GLAUCOMA September 2017 Hands free solution control! 4 Reduce the amount of riboflavin used in every case 4 Retain solution on cornea alone 4 Minimize leakage with double walled suction ring 4 Eliminate cross linking effects on limbal and conjuntival cells 4 Supplied sterile and disposable fluid retention ring The Vidaurri solution retained on cornea cross-hairs for centration Developed with Jesus Vidaurri, MD of Monterrey, Mexico ® 973-898-1600 • www.katena.com K20-2135 for PRK & CXL 8.7mm I.D. KI-ADV-072117-REV1 Editors' note: Dr. Hajjar has no finan- cial interests related to her comments. Contact information Hajjar: aida.oftalmo@gmail.com effective in another retrospective re- view in both phakic and pseudopha- kic eyes. 4 One case study found the combination of sclerectomy with phacoemulsification, zonulectomy, hyaloidectomy, and anterior vitrec- tomy to be effective in a nanoph- thalmic eye with white cataract and malignant glaucoma, which reduced pressure from fluctuating between 28 and 45 mm Hg preop to 12 mm Hg postop, deepened the anterior chamber, and restored 20/80 vision. 5 The mechanism of the disorder remains unclear, however a posterior aqueous blockage, vitreous displace- ment, thickening of the anterior hyaloid, and an inability to gener- ate sufficient fluid flow across the vitreous to compensate for aqueous outflow anteriorly under high pres- sure conditions have been suggested. There is evidence that phacoemulsification with IOL implantation in eyes with microph- thalmos/nanophthalmos can cause aqueous misdirection due to the short axial lengths of these eyes, with a higher incidence noted in eyes with smaller axial lengths. Axial lengths less than 20.5 mm were associated with a four-times higher risk of any complication (zonular de- hiscence, uveitis, malignant glauco- ma) and axial length below 20 mm with a 15-times higher risk of any complication. 6 The postop development of malignant glaucoma is more fre- quent in eyes with preexisting angle closure, in which the anatomical positions of the ciliary body and iris seem to be connected with its incidence. Pre- and postop IOP, how- ever, are poor predictors. Despite the known risk factors, Dr. Hajjar urged physicians to keep an eye on all patients undergoing glaucoma filtration surgery. EW References 1. Dada T, et al. Ultrasound biomicroscopy in glaucoma. Surv Ophthalmol. 2011;56:433–50. 2. Dave P, et al. Treatment outcomes in malignant glaucoma. Ophthalmology. 2013;120:984–90. 3. Debrouwere V, et al. Outcomes of different management options for malignant glaucoma: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2012;250:131–41. 4. Harbour JW, et al. Pars plana vitrectomy in the management of phakic and pseudopha- kic malignant glaucoma. Arch Ophthalmol. 1996;114:1073–8. 5. Feng YF, et al. Surgical management of malignant glaucoma with white cataract in nanophthalmos. J Cataract Refract Surg. 2013;39:1774–7. 6. Day AC, et al. Outcomes of phacoemul- sification and intraocular lens implantation in microphthalmos and nanophthalmos. J Cataract Refract Surg. 2013;39:87–96.

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