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.
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Zeiss gonioscopy showed patent
sclerotomy.
Needling was performed to lift the
scleral flap.
Raised bleb after needling and
gentle massage.
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