[The progression of primary operated glaucoma]. / Progresia glaucoamelor primitive operate.

OBJECTIVE: Study of the causes responsible for glaucoma progression in patients operated for glaucoma. MATERIAL AND METHOD: A series of 185 patients operated for primary open angle glaucoma were followed up for a mean period of 3.2 years. 46 patients had evidence of glaucoma progression: insufficient filtration was recognized as the cause in 23 patients, while blockage of the filtering bleb was responsible for the rest of 23 cases. RESULTS: Progression of glaucoma was detected in 19.32% of patients with functional filtering bleb; 44.1% of patients with intraocular pressure between 16 and 21 mmHg did not show disease progression; 8 out of 23 patients needed a new trabeculectomy; internal obstruction of the bleb was demonstrated in 8 cases; 4 patients needed additional medical therapy; internal revision of the bleb (3 cases) and a new trabeculectomy gave the best results; external obstruction of the bleb was found in 15 patients; 7 had a diffuse fibrovascular proliferation and 8 had an encapsulated bleb. We used a new trabeculectomy for diffuse fibrovascular proliferation and a cystotomy or a cystectomy for encapsulated bleb. The results were good in almost all cases. CONCLUSIONS: Glaucoma progression appears even with postoperative intraocular pressures within statistical normality; identification of the causes responsible for glaucoma progression insures individualized treatment with constant good results.

[Postoperative flat anterior chamber. The therapeutic approach]. / Atalamia postoperatorie. Atitudine terapeutica.

OBJECTIVE: The study of clinical entities followed by postoperative flat anterior chamber and their therapeutical possibilities. Retrospective study of all flat anterior chamber cases in a series of 315 patients operated for glaucoma. There were 16 flat anterior chamber cases with ocular hypotony, 3 cases with pupillary block and 9 cases with ciliary block. Stage I flat anterior chamber cases with ocular hypotony responded well to medical treatment. The most efficient surgical procedures were the application of additional sutures and excision of the over filtering bleb. The most frequent complications are: secondary cataract (75%), filtering failure (25%) and uveitis (18.75%). Flat anterior chamber cases with pupillary block resulted from obstruction and were managed with a new peripheral iridectomy. Flat anterior chamber cases with ciliary block had a severe evolution and didn't show any improvement under medical therapy. All cases were managed successfully by vitreous surgery (especially using pars plana aspiration). The incidence of postoperative flat anterior chamber can be reduced by accurate surgical procedure. Most of flat anterior chamber cases with ocular hypotony had a favorable evolution under medical treatment. Cases associated with intraocular hypertension needed surgical management.