Complication of Glaucoma Surgery

COMMON COMPLICATIONS OF GLAUCOMA SURGERY
ESSAM OSMAN
CONSULTANT OPHTHALMOLOGIST F.R.C.S
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COMPLICATION AVOIDANCE WITH GLAUCOMA SURGERY

Many postoperative complications: Hypotony Shallow AC Leakage A Direct result of poor surgical technique.
GLAUCOMA SURGERY
TRABECULECTOMY DEEPSCLERECTOMY TUBE SURGERY CYCLODESTRUCTIVE PROCEDURES GONIOTOMY TRABECULOTOMY Laser treatment PI LTP LASER SUTURE LYSIS
PREOPERATIVE EVALUATION
History of complications in contra lateral eye : Supra choroidal hge. Shallow AC . Excessive filtration. AMD. Planning of surgery : Tight flap Trab to Deepsclerectomy PPV in AMD
INTRAOPERATIVE COMPLICATIONS
*TYPE OF ANESTHESIA Retrobulbar. Peribulbar. Subtenon- topical. Retro bulbar hgelateral canthotomy *HONAN BALLOON.
INTRAOPERATIVE COMPLICATION
*Laser PI with topical anesthesia is painful. Non preservative lidnocaine *Corneal traction suture. Viscoelastic material- avoid antimetabolite *Conjunctival complications. Cautery Button hole Needle round
Conunctival bleeding :anticoagulanthypertension Scleral flap thin - tear thick -perforation Scleral bleeding :incision and perforators :Avid excessive cautery Pressure and irrigation can stop bleeding
*Intra-operative bleeding: *Inner block removal and PI (irrigation pressure viscoelastic) or fill AC and suture the flap until bleeding stop *Choroidal hge:post-op is common than pre- op. Progressive shallow AC Loss of red reflex Onset of pain LA.
LASER PI
LASER PI
DOES IT PREVENT GLLAUCOMA ATTACK? HOW TO AVOID COMPLICATIONS? Thick iris more than one cession Iris crypt Any site
Spot size Complications Site Bleeding Type color Corneal IOP
LASER TRABECULOPLASTY SPOT SIZE POWER DURATION SITE TYPES
COMPLICATIONS ACUTE RISE OF IOP PAS HGE
TRABECULECTOMY
FORNIX BASE
LIMBAL BASE
Buried suture
Spontaneous leak
Leak on pressure
blanched formed
Su p r rio e n a as l
diffuse
leakage
Cut the suture at the end
intraoperative Improper introduction of the tube Leakage around the tube
Post operative hypotony Tube obstruction

blood-vitreous-fibrin
Tube extraction encapsulation
GONIOTOMY
CLEAR ANGLE VIEW
TRABECULOTOMY
BLEEDING
Cyclodestructive procedures.
1. Cyclocryotherapy. 2. Cyclophotocoagulation. 3. Endoscopic cyclophotocoagulation.
CYCLOCRYOTHERAPY :COMPLICATION
@. 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
YAG CYCLOPHOPTOCOAGULATION complications

1. 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& sympathetic ophthalmia lam.ophth.1992
CPC-Diode laser
CONTROLLED CYCLOPHOTOCOAGULATION COCO
DEEP SCLERECTOMY
advantage multiple drainage mechanism trabeculodescmet membrane give 4 hypothetical mechanism 1-subconjunctival bleb 2-intrascleral bleb 3-subchoroidal space 4-schlemm canal to episcleral veins
Post-operative complications
Shallow AC
SHALLOW ANTERIOR CHAMBER

WITH LOW IOP 1-overfiltration. 2-ciliochoroidal detachment. 3-cyclodialysis cleft. 4-wound leak. WITH HIGH IOP 1-aquos misdirection. 2-choroidal hge 3-pupillary block.

oGrading
o Grade1 peripheral iridocorneal touch o Grade2 iris sphincter cornea touch o Grade3 lenticulo corneal toutch or
vitreous

o Management o G1&G2 usually observation o Treatment of the cause o G3 immediate correction otherwise
endothelial decompansatio,cataract formation&bleb failure,ant.&pos synekia o Some surgeon drain choroid with AC fomation

OVERFILTARION Loose scleral flap sutures. Usually improve and subside by time. Role of external pressure. Surgical interference.
BLEB LEAK
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 of the bleb
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

o WITH HIGH IOP o Aqueous misdirection o Choroidal hge. o Pupillary block o Annular choroidal detachment
SHALLOW ANTERIOR CHAMBER With high IOP

o Aqueous misdirection o Medical ttt o Atropine o Phenyl ephrine o Anti glaucoma med. o Laser ttt o Hyaloidectomy o Posterior capsulotomy,ant.hyaloid. o Surgery vitrectomy
CHOROIDAL EFFUSION
o o o o o o o
A sequel of hypotony Common after surgery Mostly resolving with topical steriod,cycloplgic Indication of drainage Kissing choroidal Low bleb, shallow AC,corneal decomposition Posterior sclerectomy
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
HYPHEMA
o Most of cases resolved spontaneous o Common with cases of NVG o Excessive hyphema with fibrin usually
need TPA
INFECTION
BLEB RELATED ENDOPHTHALMITIS

o o o o o o o
BLEBITIS Injected bleb Eye discharge Photophobia Opalescent bleb Positive seidel test +ttt respond to topical fortified drops with good visual outcome
BLEB RELATED ENDOPHTHAMITIS

o EndophthaLmitis o Worsening pain o Decreased VA o AC reaction o ViTreous involvement o B scan mandatory o Urgent vitrectomy
HYPOTONUS MACULOPATHY
o o o o o o o
Leading causes Overfiltraton Bleb leak Ciliary body detachment Cyclodiaysis cleft Many eyes with hypotony can compromise and no complication Mopia,young patient at great risk----tight suture
o Management o Argon laser application to shrunken bleb o Cryo,cautry o Autologus blood injection o Otherwise bleb revision
DISSECTING BLEB
CYSTIC BLEB
BLEB ENCAPSULATION
DEEP SCLERECTOMY
Descemet detachment Converted to trab High IOP GONIORUPTURE
DEEP SCLERECTOMY
Deep sclerectomy.

Complication of Glaucoma Surgery

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COMMON COMPLICATIONS OF GLAUCOMA SURGERY

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COMPLICATION AVOIDANCE WITH GLAUCOMA SURGERY

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Spot size Complications Site Bleeding Type color 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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Cut the suture at the end

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intraoperative Improper introduction of the tube Leakage around the tube

Post operative hypotony Tube obstruction

Tube extraction encapsulation

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YAG CYCLOPHOPTOCOAGULATION complications

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CONTROLLED CYCLOPHOTOCOAGULATION COCO

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SHALLOW ANTERIOR CHAMBER

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SHALLOW ANTERIOR CHAMBER

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SHALLOW ANTERIOR CHAMBER

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SHALLOW ANTERIOR CHAMBER

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