VITRECTOMY FOR CILIARY BLOCK (MALIGNANT) GLAUCOMA

Background: Ciliary block(malignant) glaucoma is a rare surgical compl ication occurring in patients with pre-existing glaucoma. Misdirected aqueous fluid causes forward movement of the lens/iris diaphragm, shal lowing the central and peripheral anterior chamber. Although most pati ents with ciliary block respond to medical or laser therapy, those wit h refractory glaucoma often require pars plana vitrectomy to normalize aqueous flow, Methods: The medical records of 21 consecutive patients with refractory ciliary block glaucoma treated by pars plana vitrecto my were reviewed retrospectively to determine the efficacy of this pro cedure in alleviating ciliary block. Data were collected regarding ana tomic characteristics of the eye, history of glaucoma, prior ocular su rgery, and outcome after vitrectomy. Results: Pre-existing glaucoma an d recent intraocular surgery were noted in all patients with ciliary b lock glaucoma. Of 21 eyes, 8 (38%) had undergone multiple prior intrao cular surgeries. The initial pars plana vitrectomy was successful in a lleviating ciliary block in 14 (70%) of 20 eyes. Of those six eyes tha t failed to improve after initial vitrectomy, five (83%) were phakic. Additional vitrectomy surgery to relieve ciliary block was required in three (60%) of five phakic patients who failed initial vitrectomy. Co mplications during the treatment of ciliary block included cataract fo rmation, retinal detachment, bleb failure, and serous choroidal detach ment. Conclusions: Pars plana vitrectomy is a useful adjunct to therap y for ciliary block glaucoma when medical and laser treatment fail to alleviate the process, Surgically removing the anterior hyaloid to re- establish normal aqueous flow constitutes the primary goal of surgery, In some cases, surgery is compromised by poor visualization of the an terior hyaloid, avoiding glaucoma filtration sites, and guarding again st damage to the crystalline lens.