Predictors of Successful Outcome for Malignant Glaucoma
American Journal of Ophthalmology, January 2020
Thompson et al. set out to identify factors linked to favorable outcomes of malignant glaucoma. They found that earlier vitrectomy may shorten recovery time and that Nd:YAG laser hyaloidotomy and oral carbonic anhydrase inhibitors may be the most ideal methods to reduce intraocular pressure (IOP). Maximum improvement in IOP and best visual acuity (BVA) may lag behind anatomic resolution.
This retrospective study included 64 eyes (55 patients) with malignant glaucoma treated at the same facility. Data from medical records were collected, including anatomic details, IOP, and BVA. Of the 64 eyes, 56 (87.5%) required surgery. Data analysis indicated that vitrectomy was more likely to be successful in eyes that had previously undergone fewer than three incisional surgeries, were treated with fewer than three topical glaucoma medications, or had IOP ≤30 mm Hg (all p < .05). If vitrectomy was performed within 30 days of the malignant glaucoma diagnosis, the time to recovery of anatomy, BVA, and IOP was faster (all p < .05). IOP reductions were greater for patients who received oral carbonic anhydrase inhibitors (p = .016, underwent Nd:YAG laser hyaloidotomy (p = .007), or had no history of malignant glaucoma (p = .007).
Resolution of anatomy occurred much faster than maximal improvement in IOP or BVA (both p < .001); and treatment with an oral carbonic anhydrase inhibitor hastened anatomic recovery (p = .01). Improvement in BVA was significantly faster for men and African Americans (both p < .05). Eyes that had chamber reformation in the clinic achieved maximum IOP reduction more quickly (p < .002). Trabeculectomy before diagnosis of the malignancy predicted prolonged recovery of anatomy, BVA, and IOP (all p < .05). Surgical reconstruction of the anterior chamber at the time of pars plana and/or anterior vitrectomy had no significant effect on recovery. Vitrectomy (either type) was more likely to be successful in eyes with better glaucoma control before the malignancy. The degree of improvement in IOP, BVA, or the number of glaucoma medications did not differ according to whether the condition was managed medically or surgically.
Trabeculectomy may slow recovery from malignant glaucoma, but anatomic resolution may be swifter with oral carbonic anhydrase inhibitors, and IOP may be optimized by clinic-based reformation of the anterior chamber. The authors recommend pooling data from multiple institutions to better gauge the effectiveness of methods to manage malignant glaucoma.
The original article can be found here.