Highlights
- •Ocular hypotony after trabeculectomy is treated medically, surgically or with a tamponade.
- •Bandage lenses, symblepharon rings or Simmons shells have been used as a tamponade.
- •A scleral lens can be a successful tamponade for the treatment of ocular hypotony after trabeculectomy.
Abstract
Purpose
Ocular hypotony after trabeculectomy may be treated medically, surgically and with
a tamponade. Three cases are reported in which a scleral lens was applied to treat
ocular hypotony after mitomycin C (MMC) augmented trabeculectomy.
Methods
In this retrospective case series the records of three eyes of three patients who
developed ocular hypotony after they had undergone trabeculectomy augmented with MMC
were evaluated. The patients were between 11 and 69 years of age and the intraocular
pressure (IOP) after surgery ranged between 3 and 6 mmHg. All three patients showed
a negative Seidel test; one had suspected hypotonic maculopathy and one had a collapsed
anterior chamber. After unsuccessful treatment with large bandage lenses all three
patients were subsequently fitted with a scleral lens. The scleral lens was fitted
to fully cover and compress the bleb. Scleral lenses were worn continuously with a
check-up after one night of wear and subsequent check-ups when needed. One patient
continued to wear the scleral lens for a further 6.5 months on a daily wear basis.
Results
In all three eyes the IOP was higher after wearing the scleral lens. Two patients
stopped wearing the scleral lens after the IOP was stable. One patient developed a
cataract; the cataract surgery was combined with a bleb revision and scleral lens
wear was therefore discontinued.
Discussion
The scleral lens might be a useful tool in the treatment of ocular hypotony after
trabeculectomy augmented MMC surgery. The effect of the scleral lens on the ocular
pressure is unpredictable. Caution is advised in vulnerable corneas due to risk factors
such as hypoxia and infection. Further research is warranted to establish the safety
of the procedure, the patient selection and the overall success in a larger patient
group.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Contact Lens and Anterior EyeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Definition of glaucoma: clinical and experimental concepts.Clin Exp Ophthalmol. 2012; 40: 341-349
- The changing conceptual basis of trabeculectomy: a review of past and current surgical techniques.Surv Ophthalmol. 2012; 57: 1-25
- Management of complications in glaucoma surgery.Indian J Ophthalmol. 2011; 59: S131-S140
- Mitomycin C versus 5-Fluorouracil for wound healing in glaucoma surgery (Review).Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858
- Hypotony maculopathy: clinical presentation and therapeutic methods.Ophthalmol Ther. 2015; 4: 79-88
- Efficacy and safety of transconjunctival scleral flap resutering for hypotony after glaucoma filtering surgery.Graefes Arch Clin Exp Opthalmol. 2008; 246: 1751-1756
- Management of hypotony and flat anterior chamber associated with glaucoma filtration surgery.Int J Ophthalmol. 2015; 8: 950-953
- Management of Hypotony after Trabeculectomy with mitomycin C.Korean J Ophthalmol. 2003; 17: 114-121
- Hypotony maculopathy.Acta Ophthalmol Scand. 2007; 85: 586-597
- Compression sutures - A new treatment for leaking or painful filtering blebs.IOVS. 1996; 37: S444
- Use of oversized bandage soft contact lenses in the management of early hypotony following filtration surgery.Ophthalmic Surg Lasers. 1996; 27: 417-421
- Use of the megasoft bandage lens for treatment of complications after trabeculectomy.Am J Ophthalmol. 1990; 110: 264-268
- Use of a symblepharon ring for treatment of over-filtration and leaking blebs after glaucoma filtration surgery.Ophthalmic Surg. 1990; 21: 707-710
- Corneal hazards in use of Simmons shell.Aust N Z J Ophthalmol. 1991; 19: 145-148
- Shell tamponade in filtering surgery for glaucoma.Ophthalmic Surg. 1979; 10: 17-34
- The shell tamponade technique for glaucoma filtration surgery [editorial].Aust N Z J Ophthalmol. 1991; 19: 101-103
Sclerallens.org [internet]. Scleral Lens Education Society; c2009 [cited 2013 June]. Available from: https://www.sclerallens.org/sites/default/files/files/SLS_Nomenclature_LtrHead06_26_2013.pdf.
- Objective and subjective performance of scleral lenses and new advances in scleral lens technologies [dissertation].Universiteit Utrecht, Visser Contactlenzenpraktijk Nijmegen2015
- Large soft contact lenses in the management of leaking blebs.CLAO J. 2000; 26: 37-39
- Soft bandage contact lenses in management of early bleb leak following trabeculectomy.Eye Sci. 2015; 30: 13-17
- Intermediate term outcomes of early post-trabeculectomy bleb leaks managed by large diameter soft bandage contact lens.J Glaucoma. 2017; 26: 816-821
Lim CHL, Stapleton F, Metha JS. Review of contact lens-related complications. Eye Contact Lens 2018 Jan;0(0):1-10. Epub Jan 24.
- Episodes of microbial keratitis with therapeutic silicone hydrogel bandage soft contact lenses.Eye Contact Lens. 2013; 39: 324-328
- The incidence of contact lens-related microbial keratitis in Australia.Ophthalmology. 2008; 115: 1655-1662
- Scleral lenses: a literature review.Eye Contact Lens. 2015; 41: 3-11
- Modern scleral contact lenses: a review.Cont Lens Anterior Eye. 2014; 37: 240-250
- Scleral lenses in the management of ocular surface disease.Ophthalmology. 2014; 121: 1398-1405
- Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty.Eye Contact Lens. 2005; 31: 130-134
Schornack MM. The SCOPE study: An overview. This study evaluated the who, what, why, and how of scleral lens prescribing. Contact Lens Spectrum [Internet]. 2017 Dec [cited 2017 Dec 1];32:[25-28,30,31]. Available from: https://www.clspectrum.com/issues/2017/december-2017/the-scope-study-an-overview.
- Treatment of refractory persistent corneal epithelial defects: a standardized approach using continuous wear PROSE therapy.Ocul Immunol Inflamm. 2015; 23: 219-224
- Modelling corneal oxygen with scleral gas permeable lens wear.Optom Vis Sci. 2016; 93: 1339-1348
- Predicting estimates of oxygen transmissibility for scleral lenses.Cont Lens Anterior Eye. 2012; 35: 266-271
- Hypoxic corneal changes following eight hours of scleral contact lens wear.Optom Vis Sci. 2016; 93: 293-299
Isozaki VL, Chiu GB. Transient corneal epithelial bullae associated with large diameter scleral lens wear: A case series. Cont Lens Anterior Eye 2018 May;0(0):0. Epub 2018 May 25.
- Oxygen tension beneath scleral lenses of different clearances.Optom Vis Sci. 2017; 94: 466-475
Article info
Publication history
Published online: November 12, 2018
Accepted:
October 23,
2018
Received in revised form:
October 7,
2018
Received:
June 30,
2018
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors
Identification
Copyright
© 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
