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Surgical approach to retinal detachment with primary congenital glaucoma

Ali Olgun; Dilek Guven; Eyup Duzgun; Selam Yekta Sendul; Hakan Kacar.

Abstract
We present the clinical features and treatment approach of a case with congenital glaucoma, trabeculectomy and rhegmatogenous RD, and other ophthalmic complications. A 41-year-old male patient with trabeculectomy due to congenital glaucoma in both eyes was admitted to our clinic due to decreased visual acuity for the past three days. Visual acuity was at the level of hand movement in the right eye, and his left eye was phthisic. The bleb on the upper nasal side of the right eye was well formed but cystic and avascular. Fundus examination revealed a patchy RD in the upper half including the macula. Phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy-liquid-perfluorocarbon-air-silicone oil change and endolaser application was performed under general anesthesia. Silicone oil tamponade was removed 2 months later, and IOL was implanted with optic capture in the same session. The final visual acuity was 1/10. There was non-functional, avascular and flat bleb due to bleb sclerosis. From the beginning to the last follow-ups, progressive shallowing of the bleb was observed in anterior OCT sections.In a patient with monocular buphthalmos, cataract surgery combined with RD surgery involves multiple risks. In this case, we achieved good visual and anatomic outcome of the retina, but we had bleb functional loss because of bleb sclerosis. We recommend periodic fundus examinations in patients with congenital glaucoma. Rhegmatogenous RD in patients with congenital glaucoma can be reattached, but full recovery may not be achieved.

Key words: congenital glaucoma;retinal detachment;trabeculectomy


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