In this very challenging case, the patient has a nanophthalmic eye with a very short axial length, shallow anterior chamber, thickened sclera, and now malignant glaucoma. Our guest surgeon Prof. Ramesh Ayyala from USF Tampa and his team do a great job of helping this patient. The solution is to perform a partial anterior vitrectomy and via the trabeculectomy site, then to suture the trab flap securely and tightly to avoid choroidal effusion during the post-op period. Then after healing, the sutures are lysed at the slit-lamp to allow flow through the trab site. What is your approach to a challenging case like this? Please comment below.
