Giant filter cushions and glaucoma

Giant pads can grow on the cornea, occupying the central zone and inducing asymmetrical astigmatism with the inability to correct visual acuity. The treatment of giant pads should be progressive, starting from the simplest methods and proceeding to more complex ones.

[1], [2], [3], [4]

Treatment of giant pads

• Technique of separation and extrusion. Using a blunt spatula, the plane of the bundle of the hanging pads is determined, then it is shifted back to the limb.
• The technique of separation and extrusion when compressive sutures are applied. Then use the same technique, apply compression seams in the limb area, which constantly presses on the cushion.
• Removal of the corneal part of the porous filtration pad. This approach is used when the overhanging corneal pads, similar to a sponge. Excessive part of it is excised with scissors of Vance.
• As a rule, the removal of the entire filtration pad is completely unnecessary.

The next clinical study is an exception to the general rule. The patient is 55 years old, African American, with a history of multiple surgical interventions on a single sighted eye. The last operation is a successful trabeculectomy using mitomycin with developed glaucoma. The second eye was lost due to glaucoma.

The patient developed corneal edema, corneal transplantation was performed, visual acuity on a single functioning eye dropped from 20/30 to 20/200. After transplantation of the cornea after 6 months, visual acuity increased to the initial 20/30.

Trabeculectomy remained functioning, maintained a good level of intraocular pressure throughout the postoperative period. After 1 year, the patient developed a giant filtration pad that covered the entire cornea and significantly reduced visual acuity.

The patient underwent treatment with the method described above, but the filtration pad constantly returned to its original state, growing more and more. As a result, visual acuity deteriorated to 20/400, the eye almost did not function. After discussing the risks of the operation with the patient, it was decided to take an unusual step to revise the entire pads.

In this case, the patient had a different problem - an excess of free conjunctiva without scars surrounding the filtration pad. As a result, after removing the filtration pad, it was restored with a double layer of the amniotic membrane of the donor graft. A small filtration pad with minimal vascularization was formed, which maintained good intraocular pressure for more than 4 years.