Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions.Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement.Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from39±14 mmHg to15±2 mmHg and the number of glaucoma medications was reduced from4±1to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively.Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

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Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

BMC Ophthalmology ◽

10.1186/s12886-021-01872-z ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Pars Plana ◽

Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

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Combined Pars Plana Glaucoma Drainage Device Placement and Vitrectomy Using a Vitrectomy Sclerotomy Site for Tube Placement: A Case Series

10.21203/rs.3.rs-92136/v1 ◽

2020 ◽

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Statistical Tests ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Retrospective Case ◽

Tube Obstruction ◽

Pars Plana ◽

Sclerotomy Site

Abstract Background: The purpose of this study is to report the safety and efficacy of pars plana (PP) glaucoma drainage devices (GDDs) with pars plana vitrectomy (PPV) using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma.Methods: Retrospective case series of 28 eyes of 28 patients who underwent combined PP GDD and PPV between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity (BCVA), and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests.Results: Mean IOP decreased from 22.8 mmHg to 11.4 mmHg at 1.5 years (p = 0.009), and mean medication burden decreased from 4.3 to 1.7 at 1.5 years (p = 0.009). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 ≤ IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 77.7% at 1 year and 45.8% at 1.5 years. At their last visit, four eyes (14.3%) achieved complete success with IOP reduction as above without medications, and 13 eyes (46.2%) achieved qualified success with medications. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of >2 lines. Two eyes required subsequent PPV for tube obstruction, and one eye had transient hypotony.Conclusions: The results of pars plana GDD and vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting GDDs into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

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Iris from Iridectomy Used as Spacer underneath the Scleral Flap: The Iridenflip Trabeculectomy Technique

Journal of Ophthalmology ◽

10.1155/2015/359450 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Veva De Groot ◽

Liselotte Aerts ◽

Stefan Kiekens ◽

Tanja Coeckelbergh ◽

Marie-José Tassignon

Keyword(s):

Open Angle Glaucoma ◽

Corneal Transplantation ◽

Case Series ◽

Postoperative Management ◽

Open Angle ◽

Scleral Flap ◽

Retrospective Case ◽

Corneal Incision ◽

Pressure Lowering

Purpose. We describe a modified trabeculectomy technique in which the iris is used to prevent fibrosis of the scleral flap.Material and Methods. A retrospective case series of patients with medically uncontrolled open angle glaucoma underwent trabeculectomy. Instead of performing a classical iridectomy, the iris was used as spacer underneath the scleral flap. Postoperative management was identical to classical trabeculectomy, with suture removal and needling if necessary. Five of the patients underwent simultaneous phacoemulsification through a separate temporal corneal incision. Patients should have two-year follow-up.Results. Data of ten patients were analysed, two had a previous failed trabeculectomy, two had LTP, and one had a corneal transplantation. In 3 patients MMC 0,1 mg/mL was used. After one and two years mean IOP was, respectively, 13,1 and 12,1 mmHg. IOP ≤ 16 mmHg was reached in 90% of patients without pressure lowering medication. No major complications were seen; no abnormal inflammatory reaction and no deformation or dislocation of the pupil occurred.Conclusion. By using the iris from the iridectomy as spacer under the scleral flap, fibrosis of the scleral flap is no longer possible. This iridenflip trabeculectomy technique gives an excellent complete success rate (IOP ≤ 16 mmHg) of 90%. A larger study is currently being done.

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Short-Term Outcomes of KeraSys Patch Graft for Glaucoma Drainage Devices: A Case Series

Journal of Ophthalmology ◽

10.1155/2013/784709 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Kundandeep S. Nagi ◽

Ricardo J. Cumba ◽

Nicholas P. Bell ◽

Lauren S. Blieden ◽

Alice Z. Chuang ◽

...

Keyword(s):

Case Series ◽

Wound Dehiscence ◽

Glaucoma Drainage Device ◽

Exposure Rate ◽

Early Exposure ◽

Consecutive Case ◽

Short Term ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Patch Graft

Purpose. Tube-related exposure is a known complication of glaucoma drainage device (GDD) surgery. Our objective is to report the early (approximately 1 year) tube exposure rate of implants covered with a keraSys (IOP Inc., Costa Mesa, CA, USA) tissue reinforcement graft.Patients and Methods. A retrospective, noncomparative, consecutive case series of 42 eyes with GDD implantation with keraSys patch grafts was performed. Main outcome measurements included patch-related complications: patch exposure, tube exposure, wound dehiscence, and patch migration.Results. Forty-two eyes were followed for an average of15.24±10.44months (range 1.0–32.3 months). Four (10%) eyes experienced patch-related complications: two with exposure 8 months postoperatively, one with exposure 13 months postoperatively, and one with exposure 4 weeks postoperatively.Conclusion. The effectiveness of the keraSys patch graft is limited by the higher than expected early exposure rate found in this case series. These results should be confirmed in other studies.

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Baerveldt Scleral Patch Graft Abscess Secondary to Coagulase-Negative Staphylococcus

Case Reports in Ophthalmology ◽

10.1159/000484918 ◽

2017 ◽

Vol 8 (3) ◽

pp. 521-526

Author(s):

Van Nguyen ◽

Mason Schmutz ◽

Sarah Farukhi ◽

Sameh Mosaed

Keyword(s):

Open Angle Glaucoma ◽

Staphylococcal Infection ◽

Glaucoma Drainage Device ◽

Coagulase Negative Staphylococcus ◽

Drainage Device ◽

Implant Placement ◽

First Case ◽

Severe Stage ◽

Device Placement ◽

Patch Graft

We report the case of a 69-year-old female who underwent a Baerveldt implant placement for severe-stage primary open-angle glaucoma and developed a bacterial infection of the conjunctiva and abscess of the scleral patch graft with subsequent tube exposure. The infection was identified 3 weeks postoperatively and a topical antibiotic was immediately initiated. A concurrent systemic staphylococcal infection was discovered by an outside physician and oral cephalexin was initiated. Despite antibiotic treatment, the conjunctival erosion progressed, and tube revision was required. Culture of the abscess revealed coagulase-negative Staphylococcus. As alluded to above, the patient also had multiple abscesses on the skin that cultured positive for Staphylococcus aureus. To our knowledge, this is the first case in the literature of coagulase-negative Staphylococcus causing an early postoperative abscess of the scleral patch graft following glaucoma drainage device placement.

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Allogenic dehydrated human pericardium patch graft (Tutoplast): A novel use for reconstruction in orbital implant exposure

European Journal of Ophthalmology ◽

10.1177/11206721211004398 ◽

2021 ◽

pp. 112067212110043

Author(s):

Hetvi Bhatt ◽

Linda Okafor ◽

Rina Bhatt

Keyword(s):

Case Series ◽

Glaucoma Drainage Device ◽

Fat Graft ◽

Silicone Implants ◽

Orbital Implant ◽

Presenting Symptoms ◽

Implant Exposure ◽

Patch Graft ◽

Human Pericardium

Purpose: Exposure of orbital implant post enucleation or evisceration remains one of the common complications irrespective of the type of implant used. Dermis fat graft and temporalis fascia have been used to repair the implant exposure in anophthalmic sockets. Tutoplast® pericardium, gamma sterilised dehydrated human pericardium, has been used as a scleral patch graft for glaucoma drainage device exposure and scleral thinning post squint surgery. We report the novel use of Tutoplast® patch graft to repair orbital implant exposure in this case series. Methods: The case notes of three patients who received Tutoplast® pericardium patch graft to repair implant exposure were reviewed. Data regarding presenting symptoms, implant type, time to exposure from primary surgery, post-operative complications and length of follow up post Tutoplast® pericardium patch graft were collected. Results: Three patients presented with implant exposure following evisceration. The presenting symptoms were recurrent infection, discharging socket and discomfort in all three patients. One patient had a Medpore implant, two had silicone implants. Total follow-up ranged from 9 to 22 months. In all three cases, there was relief from symptoms and the graft had incorporated fully into the surrounding orbital tissue with no recurrent exposure noted during the follow-up period. Conclusion: Tutoplast® pericardium has demonstrated a good safety profile and is a suitable material to use as a patch graft for orbital implant exposure.

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Corynebacterium ocular infection after Baerveldt glaucoma implant surgery: treatment involving immediate tube withdrawal and temporary subconjunctival tube placement: a case report

BMC Ophthalmology ◽

10.1186/s12886-021-02136-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Naruka Mitsui ◽

Kae Sugihara ◽

Jiro Seguchi ◽

Etsuo Chihara ◽

Yuki Morizane ◽

...

Keyword(s):

Anterior Chamber ◽

Vitreous Body ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Ocular Infection ◽

Implant Surgery ◽

Drainage Device ◽

Old Japanese ◽

Patch Graft ◽

Baerveldt Glaucoma Implant

Abstract Background We report a case of Corynebacterium endophthalmitis secondary to tube exposure following Baerveldt glaucoma implant surgery that was successfully treated with prompt tube withdrawal and temporary subconjunctival tube placement without removing the glaucoma drainage device. Case presentation A 65-year-old Japanese man with secondary glaucoma underwent glaucoma drainage device surgery with a donor scleral patch graft in the inferonasal quadrant of his right eye. Ten months after surgery, he presented with tube exposure due to dehiscence of the overlying conjunctiva and erosion of the scleral patch graft. Eleven days later, mild inflammation was found in the anterior chamber and anterior vitreous body, with the root of the tube surrounded by a plaque at the site of insertion in the anterior chamber. He was diagnosed with infectious endophthalmitis secondary to tube exposure. Two days later, since medical therapy was ineffective, the tube was withdrawn from the anterior chamber and irrigated with a polyvinyl alcohol-iodine solution, and the tube was tucked into the subconjunctival space. Complete resolution of the infection was achieved 1.5 months later. The tube was reinserted nasally into the anterior chamber and covered with a scleral patch graft and a free limbal conjunctival autograft. Thereafter, there has been no recurrence of infection or tube exposure. Twenty eight months after tube reinsertion, his right best-corrected visual acuity was 20/50 and intraocular pressure was 12 mmHg. Conclusion Prompt tube withdrawal and temporary subconjunctival tube placement followed by tube reinsertion may be effective for endophthalmitis associated with tube exposure after glaucoma drainage device surgery.

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Continuous Etomidate Infusion for the Management of Severe Cushing Syndrome: Validation of a Standard Protocol

Journal of the Endocrine Society ◽

10.1210/js.2018-00269 ◽

2018 ◽

Vol 3 (1) ◽

pp. 1-12 ◽

Cited By ~ 8

Author(s):

Ty B Carroll ◽

William J Peppard ◽

David J Herrmann ◽

Bradley R Javorsky ◽

Tracy S Wang ◽

...

Keyword(s):

Cortisol Level ◽

Cushing Syndrome ◽

Effective Means ◽

Case Series ◽

Serum Cortisol ◽

Serum Cortisol Level ◽

Retrospective Case ◽

Life Threatening ◽

Cortisol Levels ◽

Infusion Protocol

Abstract Objective Demonstrate the safety and efficacy of a standardized intravenous etomidate infusion protocol in normalizing cortisol levels in patients with severe and life-threatening hypercortisolism. Methods A retrospective case series of seven patients representing nine episodes of severe hypercortisolism at two large academic medical centers was conducted. Patients were included in this series if they received an etomidate infusion for the treatment of severe and life-threatening hypercortisolism. The etomidate infusion was administered via a newly developed protocol designed to safely reduce cortisol levels until more long-term medical or definitive surgical therapy could be instituted. Results Seven patients representing nine episodes received etomidate treatment. In eight of nine episodes of therapy, rapid control of hypercortisolemia was achieved, generally defined as a serum cortisol level of 10 to 20 µg/dL. Patients with a median baseline cortisol of 105 µg/dL (range, 32 to 245 µg/dL) achieved a median nadir serum cortisol of 15.8 µg/dL (range, 6.9 to 27 µg/dL) after a median of 38 hours (range, 26 to 134 hours). Conclusions A standardized continuous intravenous etomidate infusion protocol is a safe and effective means of achieving a serum cortisol level of 10 to 20 µg/dL in patients with severe hypercortisolemia.

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Hemilaminectomy and vertebral stabilization for thoracolumbar intervertebral disc associated dynamic compression in 11 dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-12-12-0150 ◽

2013 ◽

Vol 26 (06) ◽

pp. 498-504 ◽

Cited By ~ 4

Author(s):

M. Shibata ◽

S. Sadahiro ◽

T. Aikawa

Keyword(s):

Spinal Cord ◽

Intervertebral Disc ◽

Dynamic Compression ◽

Effective Means ◽

Surgical Techniques ◽

Case Series ◽

Retrospective Case ◽

Cord Injury ◽

Vertebral Stabilization

Summary Objective: To describe the diagnostic findings, surgical technique and outcome in dogs with thoracolumbar intervertebral disc-associated dynamic compression. Study design: Retrospective case series. Animals: Client owned dogs (n = 11). Methods: Medical records (2005–2010) of dogs with a stress myelographic diagnosis of spinal cord injury due to thoracolumbar intervertebral disc-associated dynamic compression with inconclusive compression in the neutral myelographic views that had hemilaminectomy and vertebral stabilization were reviewed. Data on pre- and postoperative neurologic status, diagnostic findings, surgical techniques and outcomes were retrieved. Follow-up clinical and radiographic evaluations were performed immediately, and at approximately one, two, and six months postoperatively as well as at annual followup examinations. Results: The stress myelography demonstrated distinct ventral dynamic compression due to bulging of the disc and additional dorsal compression due to infolding of the ligamentum flavum in some cases. The median percentage of post-stress reduction in spinal cord height on the lateral view was 18.0% (9.8-27.2%). All dogs recovered after surgery and at follow-up examinations were still ambulatory (median: 45 months, range: 7 to 94 months). Conclusions and clinical relevance: Thoracolumbar intervertebral disc degeneration may result in disc-associated dynamic compression. Stress myelography was an effective means of diagnosing this condition and hemilaminectomy with vertebral stabilization was an effective treatment resulting in longterm neurological improvement in all dogs.

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Comparison of Using One Trabecular Microbypass Stent versus Two during Cataract Surgery at Two Sites: One-Year Follow-Up

BioMed Research International ◽

10.1155/2020/1920352 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Shuo Yang ◽

Mantapond Ittarat ◽

Elaine Tran ◽

Patricia Ferrell ◽

Gloria Wang ◽

...

Keyword(s):

Cataract Surgery ◽

Open Angle Glaucoma ◽

Case Series ◽

Palo Alto ◽

Stent Group ◽

Retrospective Case ◽

Significant Difference ◽

Stanford Versus ◽

One Year

Purpose. To compare IOP and ocular hypotensive medication reduction of using one trabecular microbypass stent versus two in patients with open-angle glaucoma. Setting. Palo Alto Veterans Affairs (VA) Hospital and the Byers Eye Institute at Stanford University, Palo Alto, California, USA. Design. Retrospective case series. Methods. A chart review included patients who underwent trabecular microbypass implantation with cataract surgery in 2015-2017, with at least one-year follow-up. Subjects were divided into two groups by location (always one stent at Stanford versus two stents at the VA). Primary outcome measures included IOP and medication reduction at baseline and 12-month follow-up. Results. 132 subjects (166 eyes) were included. The preoperative IOP was 16.3±3.4 mmHg on 2.6±1.1 medications in the one-stent group (N=85) and 17.5±3.1 mmHg on 2.7±0.6 medications in the two-stent group (N=81). There was no significant difference between the two groups (p=0.06). At the 12-month visit, there was a 13.37%±2.93 reduction in IOP in the 1-stent group (p≤0.001) and 13.49%±2.69 in the 2-stent group (p≤0.001); both were not significantly different from each other (p=0.074). At 12 months, there was also a 14.5% reduction in medication use for the 1-stent group and 15.3% reduction in the 2-stent group, both statistically significant from baseline, (p=0.022 and p=0.037, respectively). Conclusions. Implantation with either one or two stents during cataract surgery in patients with glaucoma demonstrated similar IOP and med reduction in both groups between the two sites.

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