Journal of American Association for Pediatric Ophthalmology and Strabismus
Short ReportPediatric intraoperative ciliary block
Pediatric patients who undergo intraocular surgery are at risk for many of the same perioperative complications as adults. The same methodical approach to assessing perioperative shallowing of the anterior chamber that presents in the adult population should be followed for children. We present a rare case of intraoperative ciliary block in a 3-year-old boy undergoing a second glaucoma drainage device implantation that was successfully treated with pars plana vitrectomy and hyaloid-zonulo-iridectomy.
Section snippets
Case Report
A 3-year-old boy with primary congenital glaucoma in both eyes with a history of prior bilateral temporal rigid probe trabeculotomies, bilateral inferonasal glaucoma drainage devices, and bilateral cataract extraction with posterior capsulotomy, anterior vitrectomy, and intraocular lens (IOL) placement underwent routine examination under anesthesia at Bascom Palmer Eye Institute. His assessment was notable for median intraocular pressure (IOP) of 37 mm Hg in the right eye and 18 mm Hg in the
Discussion
Although glaucoma drainage device implantation is reasonably successful at controlling IOP, surgery in children can have similar complications as in adults, including tube exposure, malposition, and obstruction as well as endophthalmitis, retinal detachment, and phthisis.1 When confronted with perioperative shallowing of the anterior chamber, the differential diagnosis should first assess whether the IOP is reduced or elevated. If reduced, the surgeon should evaluate for a wound leak, and if
References (10)
- et al.
Baerveldt glaucoma implant in the management of refractory childhood glaucomas
Ophthalmology
(2004) - et al.
Current concepts in the treatment of vitreous block, also known as aqueous misdirection
Surv Ophthalmol
(2015) - et al.
Neodymium-YAG laser therapy to the anterior hyaloid in aphakic malignant (cilovitreal block) glaucoma
Ophthalmology
(1984) - et al.
Surgical vitrectomy for pseudophakic malignant glaucoma
Am J Ophthalmol
(1986) - et al.
Factors impacting outcomes and the time to recovery from malignant glaucoma
Am J Ophthalmol
(2020)
Cited by (0)
Financial support: Supported in part by NIH Center Core Grant P30EY014801, an unrestricted grant from Research to Prevent Blindness (GR004596), the Heed Ophthalmic Foundation (ALR), the 2019 University of Miami Institute for Advanced Study of the Americas Pilot Grant (TCC), and Grant Number UL1TR002736, Miami Clinical and Translational Science Institute (TCC).