The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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More Needling

Photo by Professor Chua Chung Nen

This 21 year-old with poorly controlled and advanced glaucoma underwent trabeculectomy with MMC. Pre-operatively, the cup disc ratio was 0.8 and the IOP measured 28mmHg despite triple therapy (latanoprost, timolol and trusopt). Post-operatively, the IOP was maintained at around 15mmHg until the third week when the IOP increased to 26mmHg. Despite massage, the IOP failed to drop. Gonioscopy showed the sclerotomy was patent. There was no tenon's cyst. Suture lysis followed by ocular massage did not reduce the IOP. Needling was performed which kept the IOP at 16mmHg. Unfortunately, the IOP increased to 24mmHg 10 days later. The patient declined further needling or further surgery. She was restarted on latanoprost which reduced the IOP to 18mmHg. Addition of timolol eyedrop further reduce the IOP to 15mmHg.

 

Zeiss gonioscopy showed patent sclerotomy.

 

Needling was performed to lift the scleral flap.

 

Raised bleb after needling and gentle massage.

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