Clinical case of surgical treatment of refractory secondary glaucoma against the background of chronic sluggish uveitis

Objective. To present a clinical case of surgical treatment of refractory secondary glaucoma against the background of chronic sluggish uveitis. Methods. Patient K., 20 years old, came to the Scientific and Technical Complex of the S.N. Fedorov Moscow State Medical University (Novosibirsk) with complaints of decreased visual acuity. It is known from the anamnesis that the patient underwent cataract phacoemulsification with intraocular lens implantation in both eyes and vitrectomy in the right eye due to retinal detachment. Of the concomitant pathology, the patient has autoimmune thyroiditis, diffuse-nodular toxic goiter, increased titer of antibodies to toxoplasmosis and HLA-B27. Visual acuity at the time of examination was 0.1 in both eyes, tonometry according to Maklakov - 15/28 mm Hg. During the examination, the patient was diagnosed with chronic sluggish uveitis in both eyes, operated retinal detachment, condition after vitrectomy without silicone oil tamponade in both eyes, pseudophakia, posterior chamber lens in both eyes, macular edema in the right eye, secondary glaucoma in the left eye, band-like degeneration with calcification of the cornea in the left eye, intralamellar macular rupture in the left eye. Recommendations were given on the need for intravitreal administration of Ozurdex in the right eye and implantation of the Ahmed valve in the left eye. The patient successfully underwent both procedures without any complications. Nine months after the surgery, the patient suffers a contusion of the left eye. Biomicroscopy of the left eye does not reveal the Ahmed valve tube in the anterior chamber of the eye, and the intraocular pressure is 35 mm Hg. The filtration zone was revised, and due to the pronounced adhesion process, it was not possible to access the Ahmed valve. A decision was made to implant the GlaucoDrain drainage device, the operation was successful, without any complications. In the postoperative period, after 1.5 months, the patient developed exophthalmos, limited lifting of the eyeball when looking up, and vertical diplopia. Several revisions of the drainage filtration were performed, drainage elements in contact with the muscles were cut off. Subsequently, the patient developed restrictive strabismus with a vertical component. Intraocular pressure is compensated and is 20 mm Hg. Conclusions. Refractory secondary glaucoma refers to severe forms of glaucoma, the treatment of which is not always accompanied by the desired hypotensive success. When managing and treating patients in this category, it is necessary to consider not only the ocular causes of glaucoma, but also concomitant diseases, taking into account the immunological aspects of this nosology. Keywords: glaucoma, uveitis, Ahmed valve, GlaucoDrain drainage, strabismus