First Author: F.March de Ribot SPAIN
Co Author(s): P. Lopez Lizarraga A. March de Ribot
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To share the experience and the challenge it represents for a surgeon the treatment of complex diabetic manifestations in the eye involving the anterior and posterior segment.
University hospital, ophthalmology department
Clinical and surgical case: A 57 years old patient with poorly controlled diabetes presented a neovascular glaucoma that was treated with glaucoma surgery. Once the intraocular pressure was stabilized the approach was reevaluated. The patient presented a superior temporal ahmed valve with the tube in the anterior chamber, prominent iris neovessels, bad dilation, retraction of the pupillary margin and a dense cataract. The echography detected vitreous opacities and a tractional retinal detachment. A combined surgery with phacoemulsification and vitrectomy were planned.
Cataract surgery was realized using trypan blue dye to stain the anterior capsule. The capsulorrhexis was difficult because of poor iris dilation. The cataract could be removed using a divide and conquer technique. An intraocular lens was placed in the bag. The posterior vitrectomy identified a vitreous hemorrhage and a tractional retinal detachment. Segmentation and delamination were realized. Endolaser was applied once the retina was flattened.
Neovascular glaucoma and tractional retinal detachment represent an advanced diabetic damage in the eye. Dealing with these cases is a medical and a surgical challenge. Each case has to be evaluated individually to determine the best management. Medical treatment and a close follow up are very important to get the best result.