Unusual sequelae of staphyloma following Ahmed glaucoma valve explantation and its management

2021 ◽  
Vol 14 (3) ◽  
pp. e239585
Author(s):  
Pratinya Gowri Kolipaka ◽  
Rashmi Krishnamurthy ◽  
Bhupesh Bagga
Keyword(s):  
Intraocular Pressure ◽  
Penetrating Trauma ◽  
Secondary Glaucoma ◽  
Ahmed Glaucoma Valve ◽  
Entry Site ◽  
Antiglaucoma Medication ◽  
Patch Graft ◽  
Transscleral Cyclophotocoagulation ◽  
Definitive Management ◽  
Limbal Region

We report a case of a 7-year-old boy, who presented with plate exposure after Ahmed glaucoma valve (AGV) implantation in the eye with secondary glaucoma following penetrating trauma. He underwent AGV explantation with scleral patch graft and conjunctival limbal autograft and started on topical and oral antiglaucoma medication (AGM) for intraocular pressure (IOP) control. Two months later, he presented to us with high intraocular pressure and uveal tissue prolapse at the site of previous tube entry displacing the scleral and conjunctival grafts posteriorly. The defect was closed with corneal patch graft. Patient underwent limited transscleral cyclophotocoagulation and was maintained on topical AGM for IOP control. Our case highlights that explantation is a definitive management in such cases of plate exposure. Tube entry site is a potential weak area and there is risk of uveal prolapse through this area with high IOP. Corneal patch graft helps in successfully managing such defects involving the sclero-limbal region.

Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma

2020 ◽  
pp. 112067212091423 ◽  
Author(s):  
Oya Tekeli ◽  
Helin Ceren Köse
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Secondary Glaucoma ◽  
Open Angle ◽  
Pseudoexfoliation Glaucoma ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean ◽  
Glaucoma Group

Purpose: The aim of this study is to compare the outcomes of micropulse transscleral cyclophotocoagulation between primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. Methods: Outcomes of 96 consecutive patients with refractory, end-stage glaucoma treated with micropulse transscleral cyclophotocoagulation were retrospectively reviewed. Follow-up examinations were performed on a regular basis until 12 months postoperatively. Surgical successes were defined as maintaining intraocular pressure ⩽18 mmHg and ⩾20% reduction in intraocular pressure (criteria A), ⩽15 mmHg intraocular pressure and ⩾25% reduction in intraocular pressure (criteria B), and ⩽12 mmHg intraocular pressure and ⩾30% reduction in intraocular pressure from baseline (criteria C). Results: Ninety-six eyes of 96 patients (50 (52%) females, 46 (48%) males) were included. Among all eyes, 32 were primary open-angle glaucoma, 30 were pseudoexfoliation glaucoma, and 34 were other types of secondary glaucoma. The mean age was 59.37 ± 11.45 (range: 20–91) years. The mean follow-up period was 14.2 ± 3.9 (range: 12–16) months. At 12 months, the success rates of primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma group were 68.75%, 66.6%, and 64.7% (p = 0.185) for criteria A; 56.25%, 53.3%, and 50% (p = 0.153) for criteria B; and 43.75%, 43.3%, and 38.2% (p = 0.146) for criteria C. Four patients (12.5%) in primary open-angle glaucoma group, 5 patients (16.6%) in pseudoexfoliation glaucoma group, and 14 (41.2%) patients in other secondary glaucoma group required reoperation during the follow-up (p < 0.05). Conclusion: Micropulse transscleral cyclophotocoagulation is an equally effective method of lowering intraocular pressure in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. The rate of reoperation was higher in refractory secondary glaucoma patients.

Pars plana Ex-Press mini shunt for management of persistent glaucoma in vitrectomized eyes: A novel technique

2020 ◽  
Vol 30 (5) ◽  
pp. 1179-1184 ◽  
Author(s):  
Abdussalam Abdullatif ◽  
Heba El-Saied
Keyword(s):  
Intraocular Pressure ◽  
Silicone Oil ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Secondary Glaucoma ◽  
Antiglaucoma Medication ◽  
Novel Approach ◽  
Pars Plana ◽  
Secondary Refractory

Purpose: To evaluate the safety and efficacy of a novel approach to implant Ex-Press mini shunt via the pars plana under a scleral flap in pseudophakic or aphakic, vitrectomized patients with secondary refractory glaucoma. Methods: A prospective interventional case series of three patients with secondary glaucoma after pars plana vitrectomy. Intraocular pressure was not controlled by silicone oil removal, if the patient was siliconized, nor the maximum medical treatment. Ex-Press mini shunt via the pars plana was implanted. We evaluated the control of intraocular pressure and the development of intraoperative and postoperative complications. Results: During 1-year follow-up, control of intraocular pressure was achieved; 14, 15, and 15 mmHg at the 3 months, and 15, 15, and 16 mmHg at the 6 months in our three cases without antiglaucoma treatment and 16, 16, and 18 with single antiglaucoma medication at 1 year. Blebs were posterior and diffuse. No complications were encountered intraoperatively or postoperatively. Ultrasound biomicroscopy showed suprachoroidal posterior lake of fluid as an additional filtration route without any choroidal or retinal complication. Conclusion: Implantation of Ex-Press mini shunt via the pars plana in aphakic or pseudophakic, vitrectomized eyes is a promising, safe, and effective technique in patients with secondary glaucoma.

scholarly journals Clinical case of the secondary glaucoma treatment in a dog by transscleral cyclophotocoagulation

2019 ◽  
Vol 135 ◽  
pp. 01071
Author(s):  
Sergey Kartashov ◽  
Maria Oboeva ◽  
Evgenia Kartashova ◽  
Alexandr Butenkov ◽  
Anastasia Rakityanskaya ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Drug Therapy ◽  
Clinical Case ◽  
Secondary Glaucoma ◽  
Common Disease ◽  
Promising Technique ◽  
Steady Decrease ◽  
Transscleral Cyclophotocoagulation ◽  
Glaucoma Treatment ◽  
The Right

Glaucoma is a common disease in animals, often leading to blindness. Nowadays, there are several treatments for glaucoma. One of promising technique is transscleral cyclophotocoagulation. This article presents a clinical case of treating a dog with bilateral secondary glaucoma complicated by optic atrophy and blindness of the right eye. Thanks to the combination of drug therapy and surgical treatment, a steady decrease in intraocular pressure was achieved.

scholarly journals Ahmed Valves vs Trabeculectomy Combined with Pans Plana Vitrectomy for Neovascular Glaucoma with Vitreous Hemorrhage

2017 ◽  
Vol 27 (6) ◽  
pp. 774-780 ◽  
Author(s):  
Menghua H. Wang ◽  
Qiuming M. Li ◽  
Hongtao T. Dong ◽  
Shuqian Q. Dong ◽  
Yang Li ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Vitreous Hemorrhage ◽  
Neovascular Glaucoma ◽  
Ahmed Glaucoma Valve ◽  
Success Rates ◽  
Intravitreal Ranibizumab ◽  
Surgical Success ◽  
Antiglaucoma Medication ◽  
The Mean ◽  
Cumulative Probabilities

Purpose Vitreous hemorrhage is common in advanced neovascular glaucoma (NVG), which has poor visual prognosis. This study aimed to compare the efficacy of 23-G pars planar vitrectomy (PPV) combined with either Ahmed glaucoma valve (AGV) implantation or trabeculectomy after intravitreal ranibizumab (IVR) treatment for NVG with vitreous hemorrhage. Methods This retrospective, nonrandomized study included 33 eyes of 33 patients with NVG with vitreous hemorrhage. After IVR treatment for 3-7 days, 18 eyes underwent PPV + AGV (AGV group) and 15 underwent PPV + trabeculectomy (trabeculectomy group). The success criterion was a postoperative intraocular pressure (IOP) of 6-21 mm Hg, with or without antiglaucoma medication. Results Postoperative IOP decreased significantly in both groups, but the mean IOP after 12 months was significantly lower in the AGV group (16.92 ± 2.75 mm Hg) than the trabeculectomy group (21.50 ± 5.79 mm Hg; p = 0.018). The AGV group required fewer glaucoma medications than the trabeculectomy group. The cumulative probabilities of surgical success rates for the AGV and trabeculectomy groups at 12 months were 71.3% and 46.7%, respectively. No significant differences in postoperative complications were observed between the groups. Conclusions For NVG with vitreous hemorrhage, PPV with AGV implantation may reduce IOP more effectively than PPV with trabeculectomy.

Recurrent scleral patch graft shrinkage and Ahmed valve tube exposure

2019 ◽  
Vol 11 (2) ◽  
pp. 232-236
Author(s):  
Tarannum Mansoori
Keyword(s):  
Silicone Oil ◽  
Ahmed Glaucoma Valve ◽  
Human Donor ◽  
Ahmed Valve ◽  
Patch Graft ◽  
Transscleral Cyclophotocoagulation ◽  
Original Size ◽  
The Right

Aim: To report a case of recurrent Ahmed glaucoma valve (AGV) tube exposure dueto scleral patch graft (SPG) melt Background: AGV is a useful modality in the management of medically refractory glaucoma. Human donor SPG has been employed to cover the external portion of the tube to prevent its exposure. Case Description : A 23 year old male with Anterior chamber intraocular lens (ACIOL)had undergone retinal detachment (RD) surgery with silicone oil insertion (SOI)followed by SO removal (SOR), re- RD and SO re-injection, followed by implantation of Ahmed glaucoma valve (AGV) for uncontrolled glaucoma in the right eye. Three months after the AGV implantation, he presented with exposure of the subconjuctival portion of AGV tube with melted, displaced and shrunk donor sclera graft, which was managed by placing larger sized, full thickness, donor scleral patch graft (SPG) over the exposed tube. Six months later, he presented again with tube exposure and the donor SPG was found to be retracted nasally and shrunk to one fourth of its original size. The AC portion of the tube was blocked by the SO bubble and the emulsified SO could be seen inside the exposed tube. The patient underwent SOR with tube explanation and intraocular pressure was later controlled with transscleral cyclophotocoagulation and medical management. Conclusion : SPG thinning and the overlying conjunctival erosion can occur after the AGV implantation. This can cause AGV tube exposure and hence, long - term patient follow up is essential to ensure timely identification of this possible complication and prompt treatment.

scholarly journals Ahmed Glaucoma Valve Implantation: Graft-Free Short Tunnel Small Flap versus Scleral Patch Graft After 1 Year Follow-Up: A Randomised Clinical Trial

2018 ◽  
Author(s):  
Mohammad Pakravan ◽  
Mohammadmehdi Hatami ◽  
Hamed Esfandiari ◽  
Shahin Yazdani ◽  
Azadeh Doozandeh ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intraocular Pressure ◽  
Success Rate ◽  
Randomised Clinical Trial ◽  
Cumulative Probability ◽  
Ahmed Glaucoma Valve ◽  
Patch Graft ◽  
One Year ◽  
Short Tunnel

Purpose: To compare the efficacy and safety of graft-free short tunnel small flap (STSF) technique with that of scleral patch graft (SPG) in Ahmed glaucoma valve (AGV) implantation. &nbsp;Design: Randomized clinical trial. &nbsp;Participants: Eighty-eyes of eighty patients with medically uncontrolled glaucoma including 41 in STSF and 39 eyes in SPG. Methods: Patients were enrolled and assigned randomly to STSF or SPG. &nbsp;Main Outcome Measures: tube exposure, Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), surgical complications, and success rate ( defined as intraocular pressure (IOP) &gt;5 mmHg, &le;21 mmHg, and IOP reduction &ge;20% from baseline at two consecutive visits after three months, no reoperation for glaucoma). &nbsp;Results: only one case in SPG developed tube exposure at 1-year follow-up. The cumulative probability of success during the first year of follow-up was 70% in the STSF and 65% in SPG (P = 0.36). IOP decreased significantly from 29.6 &plusmn; 8.6 mmHg at baseline to 16.4 &plusmn; 3.6 mmHg at the final follow-up in STSF (p = 0.001). The corresponding numbers for SPG were 30.9 &plusmn; 11.2 and 15.8 &plusmn; 4.7, respectively (p = 0.001). The final IOP was comparable between both groups (p = 0.65). Mean &plusmn; standard deviation of the number of glaucoma medications was 1.8 &plusmn; 0.9 in STSF and 1.6 &plusmn; 0.9 in SPG at final follow-up (P = 0.32). Postoperative complications developed in 8 patients (19%) in STSF and 9 patients (23%) in SPG (P = 0.81). &nbsp;Conclusions: STSF and SPG techniques had comparable complication rate at one-year follow-up. Both techniques were comparable in terms of success rate, postoperative IOP, and glaucoma medications.

scholarly journals Intraocular Endoscopy Resolved Tube Occlusion of an Ahmed Glaucoma Valve

2021 ◽  
Vol 12 (2) ◽  
pp. 706-711
Author(s):  
Rumi Kawashima ◽  
Keita Baba ◽  
Kenji Matsushita ◽  
Takeshi Soma ◽  
Masako Kurashige ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Fibrous Tissue ◽  
Secondary Glaucoma ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Ahmed Glaucoma Valve ◽  
Early Failure ◽  
Implant Surgery

We report a case in which intraocular endoscopy clarified the cause of Ahmed glaucoma valve (AGV) failure with a cloudy cornea. A 42-year-old patient with glaucoma underwent AGV implant surgery to treat secondary glaucoma due to chronic iridocyclitis in his left eye. After AGV, he developed bullous keratopathy (BK) in that eye. After Descemet stripping automated endothelial keratoplasty (DSAEK) was performed to treat BK, the intraocular pressure (IOP) increased and early failure of the DSAEK resulted again in a cloudy cornea. We could not precisely detect any cause of AGV failure with ordinary imaging instrumentation. An intraocular endoscope was used to determine that cause, and we found that the fibrous tissue occluded the tube of the AGV. The IOP decreased soon after the tissue was removed. We conclude that intraocular endoscopy was useful for diagnosing AGV failure with BK.

Outcomes of Ahmed glaucoma valve in paediatric glaucoma following congenital cataract surgery in persistent foetal vasculature

2020 ◽  
pp. 112067212091906 ◽  
Author(s):  
Karina Spiess ◽  
Jesús Peralta Calvo
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Congenital Cataract ◽  
Cox Regression ◽  
Secondary Glaucoma ◽  
Final Visit ◽  
Cumulative Probability ◽  
Ahmed Glaucoma Valve ◽  
Probability Of Success ◽  
Congenital Cataract Surgery

Purpose To evaluate the outcomes of primary Ahmed glaucoma valve in refractory secondary glaucoma following congenital cataract surgery, particularly in persistent foetal vasculature. Method Retrospective review of paediatric patients after Ahmed glaucoma valve implantation for refractory post-lensectomy glaucoma in a tertiary referral centre in Spain. Surgical complications, additional and/or replacements of Ahmed glaucoma valve, intraocular pressure, cup-to-disc ratio, glaucoma medications and final visual acuity were studied. Results A total of 29 eyes, 41% with persistent foetal vasculature and 59% with non–persistent foetal vasculature were included with mean follow-up of 105 ± 67 and 74 ± 45 months, respectively, after first Ahmed glaucoma valve implant. Median survival time for the first Ahmed glaucoma valve was significantly lower in persistent foetal vasculature (7.0 ± 3.2 months) compared to non–persistent foetal vasculature (over 129 months), p = 0.001. The cumulative probability of success in persistent foetal vasculature and non–persistent foetal vasculature eyes with Ahmed glaucoma valve were, respectively, 37.5% and 88.2% at year 1 and 28.1% and 71.9% at year 5. Cox regression model suggested persistent foetal vasculature as predictive risk factor of time to Ahmed glaucoma valve failure (hazard ratio: 5.77, p = 0.004). Four eyes developed phthisis bulbi. Mean intraocular pressure prior glaucoma surgery was 32.66 ± 6.73 mmHg and decreased to 16.54 ± 2.75 mmHg (p < 0.001) at final visit. The most frequent early postoperative complication was severe hypotony (32.6%) which tended to be self-limiting. Vitreous haemorrhage was associated with persistent foetal vasculature (p = 0.024). Ahmed glaucoma valve replacements after complications and additional Ahmed glaucoma valve implantations due to unsatisfactory intraocular pressure were more common in the persistent foetal vasculature group. Conclusion Eyes with persistent foetal vasculature and secondary glaucoma after congenital cataract surgery followed by AGV implantation had a higher number of complications and a decreased probability of success compared to the non-persistent foetal vasculature group. Both groups achieved a significant decrease in intraocular pressure; thus, Ahmed glaucoma valve may be considered as first-line treatment in refractory glaucoma following congenital cataract surgery.

Effect of postural changes on intraocular pressure in patients with acute angle-closure glaucoma in Indian population

2020 ◽  
Vol 3 ◽  
pp. 2
Author(s):  
Sanjay Mishra ◽  
Ashok Kumar
Keyword(s):  
Intraocular Pressure ◽  
Acute Angle ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Sitting Position ◽  
Rebound Tonometer ◽  
Antiglaucoma Medication ◽  
Primary Angle Closure Glaucoma ◽  
Postural Changes ◽  
Healthy Control

Objective: The objective of the study was to compare the posture-induced intraocular pressure (IOP) changes in primary angle-closure glaucoma (PACG) with or without glaucoma medications, and healthy control eyes with normal IOPs in Indian subjects. Materials and Methods: The IOP was measured in the sitting position and the supine position after 10, 20, and 30 min with a rebound tonometer. Results: Twenty-five patients with PACG and 30 controls with normal IOPs were studied. The IOP in the sitting position measured with the rebound tonometer was 13.8 + 3.2 mm Hg in eyes with PAC, and 12.9 + 2.9 mm Hg in eyes with normal IOPs. The IOP increased to 14.4 mm Hg, 16.8 mm Hg, and 18.9 mm Hg at 10 min, 20 min, and 30 min in PACG subjects. In normal age-matched controls, the IOP increased to 13.4 mm Hg, 14.9 mm Hg, and 17.8 mm Hg at 10 min, 20 min, and 30 min, respectively, but none of these differences were significant (P = 0.09; P = 0.08, P = 0.08). The mean postural IOP change from baseline was also not significant between the two groups. Only three patients were on single antiglaucoma medication with well-controlled IOP in the PACG group. Conclusions: Postural IOP changes are comparable among eyes with PACG with and without glaucoma medications, and control eyes.

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