Reevaluation of Full-Width Tenotomy of Four Rectus Muscles Combined with Transscleral Pars Plana Cyclocryoapplication for Intractable Neo- vascular Glaucoma

We reevaluated full-width tenotomy of 4 rectus muscles combined with transcleral pars plana cyclocryoapplication for intractable neovascular glaucoma. Fifteen patients (15 eyes) with advanced, uncontrollable neovascular glaucoma resulting from various causes were treated with the new surgical procedures. The visual acuity ranged from no light perception to hand motion. As the surgery was intended to disrupt all the anterior ciliary arteries in the rectus muscles, we added the cyclocryoapplication to the site of insertion before resuturing of the severed muscles, with the aim of interrupting the recanalization of the fully cut ciliary vessels. The patients were followed up for 6 to 78 months, average 55.7 months. At the end of follow-up, all 15 eyes had no light perception. The intraocular pressure level decreased from the preoperative level of 53.7 ± 13.4 mmHg (mean ± SD) to 13.0 ± 5.3 mmHg without additional medical therapy. The decrease was significant (P < 0.0001). The intraocular pressure remained below 10 mmHg in 5 eyes, one of which became phthisic. Prominent rubeosis iridis regressed or appeared to regress in the 15 eyes. All patients felt comfortable. No patients complained of ocular pain, headache or vomiting after surgery. The findings reconfirm that the current surgical procedure is beneficial and effective in the management of uncontrollable neovascular glaucoma with extremely poor vision.