Advanced Glaucoma in Angle Closure in a One-Eyed Patient: Can Surgery Be the Last Savior for the Vision?

Advanced glaucoma is defined as glaucomatous optic nerve changes accompanied by visual field loss in both upper and lower hemifields and/or a defect encroaching within 5° of fixation. Most of these patients are on maximally tolerated medical therapy, but when there is evidence of progression, they may require additional surgical intervention. Loss of central vision, also known as a wipeout phenomenon, even in an uncomplicated surgery, has been reported to occur in up to 7.7% of cases as per various studies. There are multiple problems while operating on these patients with advanced glaucoma, especially when done under local anesthesia; the volume of the anesthetic may compromise the perfusion pressure of the optic nerve. This case aims to highlight the management of a one-eyed patient with advanced progressive glaucoma who underwent augmented trabeculectomy planned specifically under topical anesthesia with postoperative preservation of visual fields and central vision.