Tube Shunt Related Complications of the Anterior Chamber

2013 ◽  
Author(s):  
Parag A. Gokhale
Keyword(s):  
Anterior Chamber ◽  
Ciliary Body ◽  
Corneal Edema ◽  
Tube Plate ◽  
Scleral Tunnel ◽  
Flat Anterior Chamber ◽  
Bleb Formation ◽  
Shallow Anterior Chamber ◽  
Incomplete Occlusion ◽  
Tube Shunt

Postoperative complications in the anterior chamber can affect both glaucoma progression and vision. Preoperative considerations and surgical technique are important to reduce and prevent these complications. A flat anterior chamber is one of the most common complications following tube shunt surgery, occurring at a rate of 3.5%– 27%. Although often associated with hypotony and choroidal effusions and usually due to increased outflow after surgery, it may also be related to decreased aqueous production, especially in eyes with previous ciliary body ablation. Increased outflow could result from leakage around the tube or overfiltration either before fibrous capsule formation over the plate or through tube fenestrations. Diagnosis of the cause of hypotony can be made with a careful slit-lamp examination. Leakage around the tube can be viewed internally by gonioscopy, though a flat or shallow anterior chamber can make seeing potential leakage difficult. The location of overfiltration can be determined by looking at areas of conjunctival elevation. Conjunctival bleb formation at the limbus could help identify leakage around the tube at its scleral tunnel insertion. Early elevation of a bleb over the reservoir of a tube shunt is also seen with incomplete occlusion in the nonvalved (or sometimes valved) tube. Elevation near the tube-plate junction could also indicate overflow at a fenestration but is unusual. Intracameral irrigation of fluorescein can help identify the source of leakage. A flat anterior chamber associated with hypotony can have serious sequelae, including corneal edema, cataract, and failure of the procedure. Medical treatment to deepen the anterior chamber with cycloplegics and reduction of wound healing inhibitors should be tried first but is often insufficient, as this treatment will not quickly eliminate the source of leakage. More aggressive intervention will be needed if there is central flattening (Grade 2 or 3 flat chamber). Identifying the source of leakage is important in determining management. If there is leakage at the site of the tube’s entry into the sclera, viscoelastic may be needed to fill the anterior chamber. Air injection is an alternative that allows for continued visualization of the leak if desired.

scholarly journals Clinical management of a rare Peters’ anomaly-induced secondary childhood glaucoma: A case report

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Eva Imelda ◽  
Fany Gunawan
Keyword(s):  
Anterior Chamber ◽  
Light Exposure ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Timolol Maleate ◽  
Post Surgery ◽  
Peters Anomaly ◽  
Shallow Anterior Chamber ◽  
Nasal Region ◽  
The Right

Childhood glaucoma is a rare disorder that occurs from birth until teenage years caused by an abnormality of aqueous humor pathways. About 50–70% of Peters' anomaly is accompanied by secondary childhood glaucoma. The presence of glaucoma will affect the prognosis. We reported the evaluation and treatment of secondary childhood glaucoma due to Peters’ anomaly. A 5 months-old boy was presented with the complaint of a enlarged left eye since 3 months old. The complaint was accompanied by a watering eye and frequently closed upon light exposure. The left eye looked opaquer than contralateral. Examination under anesthesia showed that the intraocular pressure (IOP) was 35 mmHg in the left eye and the corneal diameter was 14 mm. Other findings were keratopathy, diffuse corneal edema, buphthalmos, shallow anterior chamber, anterior synechiae, and linear slit shaped pupils in the nasal region. Patient was treated with ophthalmic timolol maleate which was later followed by trabeculectomy. After 1 week post-surgery, IOP assessment by palpation suggested the right eye within normal range while the IOP of left eye was higger than normal. Blepharospasm, epiphora, photophobia, bleb on superior, subconjunctiva bleeding, buphthalmos, keratopathy, minimal corneal edema, anterior chamber with shallow image, and posterior synechia were found in left eye anterior segment. In conclusion, trabeculotomy and trabeculectomy are recommended if there is no reduction of IOP observed after receiving timolol maleate therapy. The choice of surgical management is dependent on the feasibility of the protocol.

Tube Shunt Related Complications of the Cornea

2013 ◽  
Author(s):  
Nan Wang
Keyword(s):  
Anterior Chamber ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Corneal Edema ◽  
Corneal Graft ◽  
Visual Axis ◽  
Tube Extrusion ◽  
Pars Plana ◽  
Tube Shunt ◽  
Corneal Graft Failure

Tube shunts can be placed in the anterior chamber, the ciliary sulcus, or the pars plana. However, if the eye is phakic, the choice is limited to the anterior chamber; ciliary sulcus placement is likely to result in cataract formation, and pars plana placement will likely complicate removal of the cataract that will likely develop. Most corneal complications of tube shunt surgery result from tubes that are too anterior. Loss of vision may result due to these complications. If the tube is inadvertently inserted too close to the cornea, a loss of endothelial cells will result in edema and require transplantation to restore vision. Reported rates of corneal complications range from 2% to 33% and consist mostly of corneal edema/decompensation and corneal graft failure. In a cohort of patients implanted with the Ahmed™ Glaucoma Valve (New World Medical, Inc., Rancho Cucamonga, California), postoperative corneal abrasions occurred in 5 of 60 (8%) eyes. Another study reported the rate of corneal drying/dellen later in the postoperative course (8 of 59 eyes; 13.6%). Contact between the tube and the cornea has been noted at a rate of up to 5%. As the rate of tube shunt implantation has increased, the incidence of corneal edema in patients with tube shunts has also increased. Some of these cases develop corneal opacification with decreased vision and may require corneal transplantation to clear the visual axis. One large study of patients with Ahmed tube shunts (159 eyes total) reported corneal graft failure resulting in repeat penetrating keratoplasty (PKP) in 11 of 31 (35%) eyes with corneal grafts. Improper anterior chamber tube entry may damage the cornea. If the entry angle is not parallel to the iris and aims anteriorly, the needle used to create the tunnel may tear or detach Descemet’s membrane. Entry through the cornea (rather than the sclera) may also predispose to epithelial downgrowth or tube extrusion. To avoid such a complication, fullthickness entry into the anterior chamber should be as far posterior as possible.

scholarly journals A Case Report of Preoperative, Intraoperative, and Postoperative Anterior Chamber Shallowing Resulting from Different Mechanisms

2016 ◽  
Vol 7 (1) ◽  
pp. 115-118
Author(s):  
Yujiro Mori ◽  
Yoshifumi Ikeda ◽  
Ichiya Sano ◽  
Etsuko Fujihara ◽  
Masaki Tanito
Keyword(s):  
Cataract Surgery ◽  
Anterior Chamber ◽  
Perioperative Period ◽  
Ultrasound Biomicroscopy ◽  
Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Appropriate Treatment ◽  
Flat Anterior Chamber ◽  
Shallow Anterior Chamber ◽  
Underlying Mechanisms

A 54-year-old woman with an epiretinal membrane in her left eye accompanied by a shallow anterior chamber due to primary angle closure glaucoma underwent vitrectomy and cataract surgery. During the cataract surgery, immediately after the ultrasonic tip had been removed from the anterior chamber, anterior chamber flattening occurred. An intraoperative fundus examination showed the development of acute intraoperative choroidal effusion. Postoperatively, the anterior chamber remained shallow even after the choroidal detachment had subsided; capsular bag distension seen by ultrasound biomicroscopy suggested the development of early postoperative capsular block syndrome. After neodymium:yttrium-aluminium-garnet laser capsulotomy, the anterior chamber deepened. Depending on the perioperative period, the mechanism of a flat anterior chamber can change, and understanding the underlying mechanisms is required for appropriate treatment.

Obstruction of the Tube/Valve

2013 ◽  
Author(s):  
Philip P. Chen
Keyword(s):  
Anterior Chamber ◽  
Silicone Oil ◽  
Blood Clot ◽  
Nasolacrimal Duct ◽  
Prednisolone Acetate ◽  
Tube Obstruction ◽  
Flat Anterior Chamber ◽  
Shunt Obstruction ◽  
Tube Shunt ◽  
Distal Tube

Tube shunt obstruction is a relatively common complication, with reported rates up to 15%. Tube obstructions can be divided into 2 basic types: 1) distal tube obstruction in the anterior chamber, ciliary sulcus, or pars plana; and 2) proximal tube obstruction at the tubeplate junction. Occasionally tube obstruction may lead the surgeon and patient to believe that the tube shunt was never successful at controlling intraocular pressure (IOP) postoperatively. This complication generally has a high impact on the patient’s postoperative course. Preoperative planning and careful surgical technique can avoid many cases of obstruction. Distal tube obstruction is typically a serious postoperative complication, with a sudden elevation in IOP resulting in pain, inflammation, and worsened vision. The distal end of the tube may be obstructed by blood, fibrin, iris, vitreous, lens material, silicone oil, and/ or viscoelastic. Treatment is tailored to the immediate cause. No matter what the cause of obstruction, if tube repositioning becomes necessary, the use of tube extenders, available either commercially or created with readily available 22-gauge angiocatheter sleeves and silicone tubing (used for nasolacrimal duct intubation), facilitate this procedure if the tube is too short to reposition (see Chapter 30). If a blood clot or fibrin is present, observation with use of ocular hypotensive agents and frequent (every 1–2 hours) application of topical prednisolone acetate, 1% may be sufficient. Tissue plasminogen activator (tPA) also may be injected into the anterior chamber to rapidly resolve the clot. The usual dose of tPA is 12.5 μg in 0.1 cc (0.1 mL) and is readily available from most hospital pharmacies. Multiple injections may be required, but concerns about cost have lessened with the advent of a recombinant form of tPA. In one series of 36 patients treated with tPA after tube shunt surgery, severe hyphema, flat anterior chamber, and profound hypotony were seen after 11% (6 of 55) tPA injections. Blood in the tube may be flushed out with balanced saline solution, using a 27-gauge cannula inserted into the eye through a paracentesis wound. If the tube is buried in the iris, pilocarpine may pull the iris out of the tube.

The Use of Oculopressor in Shallow Anterior Chamber Cataract Cases

2008 ◽  
Vol 225 (S 1) ◽  
Author(s):  
Z Bíró ◽  
T Kerek ◽  
K Aranyoss ◽  
P Gyaki
Keyword(s):  
Anterior Chamber ◽  
Shallow Anterior Chamber

25-Gauge Catheter as a Surrogate to Anterior Chamber Maintainer in Trabeculectomy

2021 ◽  
pp. 155335062098218
Author(s):  
Alessandra A. Kusabara ◽  
Niro Kasahara
Keyword(s):  
Surgical Technique ◽  
Anterior Chamber ◽  
Distinctive Feature ◽  
Low Cost ◽  
Economic Environment ◽  
Intravenous Catheter ◽  
Flat Anterior Chamber ◽  
Limited Health

A flat anterior chamber (AC) is a distinctive feature in status post vitrectomy eyes during trabeculectomy. The use of AC maintainers is useful to help prevent this peroperative situation. We herein describe the surgical technique using a 25-gauge intravenous catheter as a surrogate to conventional AC maintainers. A potential advantage of this approach is the low cost in the current economic environment with limited health restraints.

scholarly journals Correction to: Retrobulbar tube shunt: anterior chamber to back of the eye (A2B) efficacy in glaucomatous eyes with uncontrolled IOP

2021 ◽  
Vol 259 (3) ◽  
pp. 801-801
Author(s):  
Mario Montelongo ◽  
Francesc March de Ribot ◽  
Earl Randy Craven ◽  
William Eric Sponsel
Keyword(s):  
Anterior Chamber ◽  
Tube Shunt
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