The effectiveness of trabeculectomy with Mitomycin C and releasable suture in Posner‑Schlossman syndrome with secondary glaucoma: A case series

Abstract

The aim of this study is to describe the effectiveness of trabeculectomy with mitomycin C and releasable suture in Posner‑Schlossman syndrome (PSS) with secondary glaucoma. Early treatment is the key to successful   management of PSS with secondary glaucoma. However, unremitting  exposure of high intraocular pressure (IOP) because of the high recurrence rate of PSS may cause further optic nerve damage and visual field defect. It is assumed that trabeculectomy may become the surgical treatment of choice in order to prevent further damage to the optic nerve despite recurring attack of PSS. Trabeculectomy with mitomycin C and releasable suture was  performed in 5 patients (3 females and 2 males) with recurring attacks of PSS and secondary glaucoma after acute attack had subsided. Before surgery, these patients had already suffered more than 3 acute attacks which were alleviated with antiglaucoma and anti‑inflammatory medications; however, optic nerve damage and visual field defect had already developed. After trabeculectomy, 4 patients experienced no recurrent attacks during the follow‑up period. One patient only suffered another episode of acute attack; however, an abrupt increase in IOP of more than 22 mmHg did not occur. In all cases, blebs were well formed, and no further optic nerve damage or visual field defects were observed up until final follow‑up. In PSS with secondary glaucoma, medication may alleviate the IOP increase and inflammation; however, there is still a chance of damage occurring to the optic nerve each time an attack recurs. Trabeculectomy may be considered a safe and effective surgical treatment modality in PSS with secondary glaucoma in order to prevent further optic nerve damage due to the extreme IOP spike in each recurrent attack.

Keywords: Mitomycin C, Posner‑Schlossman syndrome, releasable suture, secondary glaucoma, trabeculectomy