Transciliary vitreous drainage as a treatment method for hypertensive pain syndrome in terminal glaucoma

OBJECTIVE: To develop a surgical technique based on transciliary vitreous drainage and aimed at pain elimination in refractory glaucoma. MATERIAL AND METHODS: A total of 33 eyes with terminal painful glaucoma were assessed and surgically treated. RESULTS: A drain opening was made under the superficial scleral flap in the site of pars plana projection and was further used for local vitrectomy in the form of a wide well directed to the posterior pole of the eye. In 51.5% of cases normal ocular pressure was achieved without antihypertensive drops. In the rest of cases there was a tendency for ocular hypertension and therapeutic regimen was required. Pain relief after the surgery was achieved in all eyes. CONCLUSION: Vitreous drainage is an effective technique for pain elimination in terminal-stage refractory glaucoma. The presumable mechanism of action involves creating an opportunity for easy evacuation of osmotically active substances (urea in the first place) along with the humour from the vitreous cavity. The operation enables direct draining of the vitreous cavity regardless of organic changes in the anterior chamber that impede the outflow.