RETURNYonago Acta medica 1992;35:1–8
The Effects of a Full-Width Tenotomy of the 4 Rectus Muscles Combined with a Transscleral Pars Plana Cyclocryoapplication on Intractable Neovascular Glaucoma
Akihiko Tamai, Isao Okamoto, Hiroshi Nakao, Yuji Sasaki, Kazunori Shimada, Yoshihiro Murata, Hiromi Matsui, Nanae Kunito, Masao Nagata and Keizo Hosogi*
Department of Ophthalmology, Faculty of Medicine, Tottori University, Yonago 683 and *Department of Ophthalmology, Kochi Medical School, Nankoku 783, Japan
We performed a full-width tenotomy of the 4 rectus muscles in 20 eyes of 20 patients with advanced, uncontrollable neovascular glaucoma resulting from various causes. The visual acuity ranged from no light perception to hand motion. As the surgery was intended to sever all the anterior ciliary vessels of the rectus muscles, we added cryoapplication to the site of the incision before resuturing the severed muscles. The patients were followed up for 3 to 32 months, average 9.2 months. At the end of follow-up, the visual acuity had deteriorated in 6 eyes (30.0%) and had remained stationary in the other 14 eyes. The intraocular pressure (IOP) level decreased from the preoperative level of 49.6 ± 9.7 mmHg (mean ± standard deviation) to 11.6 ± 10.9 mmHg without additional medical therapy. The decrease was significant (P < 0.001). The IOP remained below 10 mmHg in 11 eyes, 4 of which became phthisic (20.0% of the 20 eyes). Rubeosis iridis became inconspicuous in 18 eyes (90.0%). All patients felt comfortable. No patients complained of ocular pain, headache or vomiting after surgery. The findings suggest that our surgical procedures are beneficial and effective in the management of intractable neovascular glaucoma with extremely poor vision.
Key words: anterior ciliary vessels; 4 rectus muscles; full-width tenotomy; intractable neovascular glaucoma; transscleral pars plana cyclocryoapplication