Vitreous cavity drainage in absolute painful glaucoma (clinical case)

A case of transciliary vitreous drainage with simultaneous local vitrectomy as surgical treatment for hypertensive pain syndrome (HPS) in absolute glaucoma is described and analyzed. The patient presented with severe eye pain, high intraocular pressure, corneal edema, and hyphema. During surgery a drain opening was made under the superficial scleral flap in the site of pars plana projection. This opening was further used for local vitrectomy with removal of a truncated cone-shaped fragment of the vitreous. The apex of the cone was located at the drain opening and its base (10 mm in diameter) was directed at the posterior pole of the eye. The authors consider the retrohyaloid space, which is always present in eyes with absolute glaucoma, as an enabling factor for such drainage. A surgical revision of the drain opening was performed due to its obstruction in the postoperative period. After the revision a durable pain relief was achieved. Vitreous drainage, in authors' opinion, is of good potential in refractory glaucoma treatment.