REFRACTORY GLAUCOMA IN A SINGLE EYE WITH MULTIPLE ASSOCIATED PATHOLOGIES - SURGICAL CHALLENGES

Report of a challenging clinical case from a surgical point of view, in the context of a diagnosis of secondary glaucoma refractory to drug therapy, known patient with antecedents and multiple associated eye pathologies, with a single functional eye

Key words: Secondary refractory glaucoma, artificial drainage systems, single functional eye, retinal detachment sequelae, strong myopia

29-year-old patient known to have a functional single eye, strong myopia OD, retinal detachment sequelae, CP IOL with scleral suture, articulating drainage system placed in 2018 for secondary open-angle glaucoma refractory to medically treatment  all associated with a special emotional state.

Following the evaluations and due to the finding of elevated IOP refractory to drug treatment, it was decided to implant a second Ahmed Valve (artificial drainage system), being an advanced glaucoma in a single eye in a patient with increased life expectancy. The postoperative evolution was favorable with an important release of IOP and its maintenance even one year postoperatively.

It is a challenging case, particularly due to its seriousness and functional and anatomical peculiarities: single functional eye, with sequelae of detachment from the operated retina, implant with scleral suture, strong myopia, very thin sclera which caused serious intraoperative difficulties. Another peculiarity was the surgical intervention by placing the valve in the inferonasal sector, a location difficult to approach even by an experienced surgeon.