Retinectomy lowers intraocular pressure in otherwise intractable glaucoma: preliminary results.

Surgery for glaucomas unresponsive to conventional surgical strategies has always been frustrating and puzzling. I present preliminary results achieved by partial retinectomy in nine eyes that had complete synechial closure of the chamber angle accompanied by very high intraocular pressure (IOP), debilitating pain, and poor vision. The aim of this surgical procedure was to lower IOP by rerouting aqueous humor to the absorbing compartment of the choriocapillaris through a large retinal hole. Since a retinal wound will not heal, this "filtration site" will remain open and functional. Follow up ranged from 2 to 12 months. Preoperative IOPs ranged from 38 to 70 mm Hg; final postoperative IOPs, from 2 to 50 mm Hg. IOP decreased in all of the nine patients. Phthisis developed in two eyes and hypotony in three; the latter three eyes were not phthisical. The procedure was complicated by retinal detachment in one eye. A technique for determining the optimum size of the retinectomy for specific patients remains to be developed.