How are complications of Sturge-Weber syndrome (SWS) glaucoma surgery prevented?

Updated: Dec 26, 2018
  • Author: Masanori Takeoka, MD; Chief Editor: George I Jallo, MD  more...
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Answer

Various preoperative and perioperative prophylactic measures to counteract or prevent the above complications have been suggested, including the use of hyperosmotics, maximum preoperative antiglaucoma therapy, prophylactic posterior sclerotomy, prophylactic radiotherapy or laser photocoagulation of the choroidal hemangioma, and electrocautery of the anterior episcleral vascular anomaly.

Eibschitz-Tsimhoni and colleagues demonstrated minimal risk of subchoroidal hemorrhage or effusion in a large case series of patients with SWS undergoing filtration surgery using modern surgical techniques. [112] The authors questioned the need for prophylactic posterior sclerotomy in patients with SWS.

Suggested steps to minimize the intraoperative and postoperative hypotony include the following:

  • Preplacement of scleral flap sutures

  • Injection of a viscoelastic prior to excision of the trabecular meshwork

  • Tight suturing of the scleral flap with releasable sutures that can be lysed after surgery with argon laser, removed at the slit lamp or at the time of examination under anesthesia

Any recent intraocular surgery predisposes the eye to the risk of bacterial endophthalmitis. Patients with filtering blebs, especially the thin, avascular blebs seen with the use of mitomycin-C, are at increased risk for developing bacterial endophthalmitis months, or even years, after surgery. Because this risk is increased further by contact lens wear, the use of any type of contact lens in these patients is discouraged. Other potential sources of infection include normal conjunctival flora, episodes of bacterial conjunctivitis, and contaminated medicine dropper bottle tips.


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