Medical expert of the article

Ophthalmologist

New publications

Giant filter cushions and glaucoma

Alexey Portnov, medical expert
Last reviewed: 18.10.2021

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.

If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.

Giant pads can grow on the cornea, occupying the central zone and inducing asymmetrical astigmatism with the inability to correct visual acuity. The treatment of giant pads should be progressive, starting from the simplest methods and proceeding to more complex ones.

trusted-source [1], [2], [3], [4]

Treatment of giant pads

Technique of separation and extrusion. Using a blunt spatula, the plane of the bundle of the hanging pads is determined, then it is shifted back to the limb.
The technique of separation and extrusion when compressive sutures are applied. Then use the same technique, apply compression seams in the limb area, which constantly presses on the cushion.
Removal of the corneal part of the porous filtration pad. This approach is used when the overhanging corneal pads, similar to a sponge. Excessive part of it is excised with scissors of Vance.
As a rule, the removal of the entire filtration pad is completely unnecessary.

The next clinical study is an exception to the general rule. The patient is 55 years old, African American, with a history of multiple surgical interventions on a single sighted eye. The last operation is a successful trabeculectomy using mitomycin with developed glaucoma. The second eye was lost due to glaucoma.

The patient developed corneal edema, corneal transplantation was performed, visual acuity on a single functioning eye dropped from 20/30 to 20/200. After transplantation of the cornea after 6 months, visual acuity increased to the initial 20/30.

Trabeculectomy remained functioning, maintained a good level of intraocular pressure throughout the postoperative period. After 1 year, the patient developed a giant filtration pad that covered the entire cornea and significantly reduced visual acuity.

The patient underwent treatment with the method described above, but the filtration pad constantly returned to its original state, growing more and more. As a result, visual acuity deteriorated to 20/400, the eye almost did not function. After discussing the risks of the operation with the patient, it was decided to take an unusual step to revise the entire pads.

In this case, the patient had a different problem - an excess of free conjunctiva without scars surrounding the filtration pad. As a result, after removing the filtration pad, it was restored with a double layer of the amniotic membrane of the donor graft. A small filtration pad with minimal vascularization was formed, which maintained good intraocular pressure for more than 4 years.

Translation Disclaimer: For the convenience of users of the iLive portal this article has been translated into the current language, but has not yet been verified by a native speaker who has the necessary qualifications for this. In this regard, we warn you that the translation of this article may be incorrect, may contain lexical, syntactic and grammatical errors.