Tenon Capsule Grafting versus Autologous Scleral Graft in Ahmed Glaucoma Valve Surgery

Objective. To compare between the surgical outcomes of Tenon capsule grafting and autologous scleral graft in Ahmed glaucoma valve (AGV) surgery in the management of refractory glaucoma and prevention of tube exposure. Patients and Methods. This prospective randomised study included 30 eyes of 30 patients with refractory glaucoma, who were aged between 46 and 58 years and diagnosed with refractory glaucoma. This study was conducted in Menofia University Hospital between July 2018 and December 2019. Informed patient consent was obtained. The studied eyes were divided into two groups: the first group included 15 eyes for which AGV with Tenon capsule grafting was performed, while the second group included 15 eyes for which AGV with autologous scleral graft was performed. All patients were followed up for one year after the surgery. The outcomes were evaluated according to intraocular pressure (IOP) and the number of postoperative glaucoma medications. Visual acuity, visual field, number of postoperative glaucoma medications, and postoperative complications were followed throughout the 1-year follow-up period. Results. There was a significant reduction in IOP in both groups, with more reduction in the Tenon graft group where the mean IOP after one year was 11.66 ± 0.89 mmHg, whereas in the scleral graft group, the mean IOP was 14.20 ± 4.0 mmHg (p value < 0.001). However, the difference between the 2 groups in lowering IOP was insignificant. Regarding postoperative complications, tube exposure was observed in one case in the scleral graft group with associated scleral melting and hypotony, postoperative hypotony was more in the scleral graft group with 3 cases (20%), and in the Tenon graft group, hypotony occurred only in 1 case (6.67%). In addition, less vascular blebs were seen in most cases in the Tenon graft group, while most blebs seen in the scleral graft group were vascular blebs. In addition, both groups showed stability in terms of visual acuity and visual field. Conclusion. Tenon capsule grafting and autologous scleral grafting might be effective and safe techniques when applied with AGV in the management of refractory glaucoma. Tenon capsule resection with grafting showed relatively low incidence of tube exposure and hypertensive phase.

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Surgical Outcomes of a Second Ahmed Glaucoma Valve Implantation in Asian Eyes with Refractory Glaucoma

Journal of Ophthalmology ◽

10.1155/2020/8741301 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Sze Chuan Ong ◽

Maria Cecilia Aquino ◽

Paul Chew ◽

Victor Koh

Keyword(s):

Postoperative Complications ◽

Outcome Measurement ◽

Ahmed Glaucoma Valve ◽

Success Rates ◽

Refractory Glaucoma ◽

Glaucoma Tube Shunt ◽

One Year ◽

Valve Implantation ◽

Tube Shunt

Introduction. When the initial glaucoma tube shunt fails in eyes with refractory glaucoma, one option is implantation of an additional Ahmed glaucoma valve (AGV) to control intraocular pressure (IOP). We aim to evaluate the outcomes of a second AGV in Asian glaucoma. Material and Methods. This is a retrospective interventional study, consisting of 21 eyes belonging to 20 patients which underwent a second FP7 AGV. Data collected included demographic characteristics, best corrected visual acuity, IOP, and number of medications. Both intraoperative and postoperative complications or interventions were recorded. The primary outcome measurement was success rate: complete success (IOP ≥5 mmHg and ≤21 mmHg without IOP-lowering medications) and qualified success (IOP ≥5 mmHg and ≤21 mmHg with IOP-lowering medications). Failure was defined as IOP ≥5 mmHg and ≤21 mmHg, reoperations for IOP-related indications, removal of second AGV implant, or loss of light perception. Postoperative complications were included as secondary outcomes. Results. The cumulative failure rates were 9.5%, 20.0%, 32.5%, and 46.0% at six months, one year, two years, and three years of follow-up. At final follow-up, complete success and qualified success rates were 23.8% and 33.3%, respectively; mean IOP and number of medications decreased by 5.6 mmHg (23.9%) and 1.7 mmHg (54.8%), respectively, from preoperative baseline (P<0.01). More common postoperative complications included hypertensive phase (38.1%), corneal decompensation (23.8%), and tube exposure (14.3%). Conclusion. An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed.

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Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus

European Journal of Ophthalmology ◽

10.1177/11206721211018362 ◽

2021 ◽

pp. 112067212110183

Author(s):

Yasin Cinar ◽

Cagla Cilem Han ◽

Alparslan Sahin ◽

Zeba A Syed

Keyword(s):

Visual Acuity ◽

Corneal Thickness ◽

University Hospital ◽

Long Term Results ◽

Cross Linking ◽

Distance Visual Acuity ◽

The Mean ◽

Collagen Cross Linking ◽

Corneal Collagen

Purpose: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). Methods: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. Results: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5–17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0–8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively ( p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively ( p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively ( p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different ( p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL ( p = 0.012). Although central corneal thicknesses decreased significantly ( p = 0.029), the decrease in thinnest corneal thickness was not statistically significant ( p = 0.205). Conclusion: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.

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Effect of phacoemulsification with intraocular lens implantation in eyes with cataract and functioning filtering blebs

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v13i2.44 ◽

2013 ◽

Vol 13 (2) ◽

pp. 33-41

Author(s):

Devendra Maheshwari ◽

Rengappa Ramakrishanan ◽

Mohideen Abdul Kader ◽

Neelam Pawar ◽

Ankit Gupta

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Intraocular Lens ◽

Intraocular Lens Implantation ◽

Corrected Visual Acuity ◽

Lens Implantation ◽

The Mean ◽

One Year ◽

Best Corrected Visual Acuity

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.

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Association of foveal avascular zone with the metamorphopsia in epiretinal membrane

Scientific Reports ◽

10.1038/s41598-020-74190-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hideki Shiihara ◽

Hiroto Terasaki ◽

Shozo Sonoda ◽

Naoko Kakiuchi ◽

Hidetaka Yamaji ◽

...

Keyword(s):

Visual Acuity ◽

Superficial Layer ◽

University Hospital ◽

Foveal Avascular Zone ◽

Service Unit ◽

Corrected Visual Acuity ◽

Avascular Zone ◽

The Mean ◽

The Relationship ◽

Best Corrected Visual Acuity

Abstract This study was to investigate the relationship between the metamorphopsia and foveal avascular zone (FAZ) parameter in eyes with epiratinal membrane (ERM). We studied patients with an ERM visited retinal service unit at the Kagoshima University Hospital or Shirai Hospital. The best-corrected visual acuity (BCVA), and the degree of metamorphopsia by M -CHARTS™ were evaluated. The 3 × 3 mm optical coherence tomography angiography (OCTA) images of the superficial layer were obtained. Area (mm2), the circularity, eigen value were calculated using ImageJ software. The relationship between visual function, such as best corrected visual acuity (BCVA) and metamorphopsia, and FAZ parameters were studied by Pearson’s correlational coefficient. Fifty-four eyes of 51 patients (24 men and 27 women) with an ERM were studied. The mean age of the patients was 69.6 ± 8.20 years. The mean BCVA and metamorphopsia score was 0.31 ± 0.29 logMAR units and 0.49 ± 0.42. There was no significant relationship between BCVA and FAZ parameters. While, metamorphopsia score was significantly and negatively correlated with all of FAZ parameters (area R = − 0.491, P < 0.001; circularity R = − 0.385, P = 0.004; eigenvalue ratio R = − 0.341; P = 0.012). Multiple regression analysis showed the FAZ area was solely and significantly correlated with metamorphopsia score (β − 0.479, P < 0.001). The size but not the shape of the FAZ was significantly correlated with the degree of metamorphopsia suggesting that it could be an objective parameter of metamorphopsia in ERM patients.

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Contrast Sensitivity and Visual-Field Thresholds in Patients with Thyroid Optic Neuropathy

Perception ◽

10.1068/v970237 ◽

1997 ◽

Vol 26 (1_suppl) ◽

pp. 194-194

Author(s):

J Jankauskiene ◽

R Lukauskiene ◽

B Mickiene

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Contrast Sensitivity ◽

Optic Neuropathy ◽

Control Group ◽

Ophthalmological Examination ◽

Threshold Test ◽

Spatial Frequencies ◽

Snellen Visual Acuity ◽

The Mean

Thyroid optic neuropathy is one of the most troubling complications of endocrine ophthalmopathies. It is related to the degree of extraocular muscle swelling in the apex of the orbit. The purpose of this study was to investigate contrast sensitivity and visual-field thresholds in patients with thyroid optic neuropathy. We examined twenty-two patients aged 29 – 63 years (mean 45.3 years). The control group consisted of fifteen healthy persons of similar age. Contrast sensitivity was measured by means of Volkov's charts (sinusoidal gratings) at eight spatial frequencies from 17.5 to 0.46 cycles deg−1. The visual field was investigated with a static automatic perimeter (Allgan Humphrey Field Analyzer) by means of the central 30-2 threshold test. All patients underwent a complete ophthalmological examination including best corrected Snellen visual acuity, fundus copy, and proptosis measurement with the Hertel exophthalmometer. The mean proptosis of patients was 19.4 mm. Fifteen of the patients had decreased visual acuity. Contrast sensitivity at low spatial frequencies was significantly reduced in the patients. It was established that a reduction of visual-field threshold accompanies the decrease of visual acuity. Our results show that contrast sensitivity and visual-field threshold testing are very sensitive at detecting early optic neuropathy and may be a useful means of following patients after treatment.

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An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.03.08 ◽

2021 ◽

Vol 14 (3) ◽

pp. 383-387

Author(s):

Faried Wagdy ◽

◽

Hisham Elsorogy ◽

Ahmed Alnagdy ◽

Dina Abd Elfattah ◽

...

Keyword(s):

Postoperative Complications ◽

Open Angle Glaucoma ◽

Implant Surgery ◽

Late Failure ◽

Group I ◽

The Mean ◽

The Difference ◽

One Year ◽

Age Range

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

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PHACOEMULSIFICATION

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.11.1774 ◽

2016 ◽

Vol 23 (11) ◽

pp. 1422-1428

Author(s):

Faheem Ahmad ◽

Syeda Iqra Iqbal

Keyword(s):

Visual Acuity ◽

Case Series ◽

Visual Outcome ◽

University Hospital ◽

Complication Rates ◽

Basic Training ◽

Ophthalmic Surgery ◽

Counting Finger ◽

Good Visual Outcome ◽

One Year

Introduction: Any opacity in crystalline clear lens that may or maynot impaired vision is called cataract. According to maturity of cataract it may beimmature, mature or hypermature. When a patient develop cataract than there isno significant medical treatment for cataract. Surgery is the treatment of choice forcataract. Phacoemulsification (phaco), a modification of ECCE, has found worldwidepopularity in last two decades. Objectives: To find out visual acuity and complicationsof phacoemulsification in patients operated by senior surgeon during learning curve.Study Design: Descriptive case series. Settings: Department of OphthalmologyIndependent University Hospital, Faisalabad. Period: One year from 01-04-2014to 31-03-2015. Data Collection Methods: Patients coming through the OPD ofthe eye department who fulfilled the inclusion criteria were enrolled and informedconsent was taken from all patients. Results: In this study 100 eyes had undergonePhacoemulsification with IOL under Local anesthesia during study period. The meanage of patients was 57.50 years (range 30-85 years). Regarding the visual acuity inoperated eyes, 80 eyes ( 80 %) had a BCVA of 6/6-6/12, 12 eyes (12 %) had a BCVA of6/18 to 6/36 and 6 eyes (6 %) had a BCVA of 6/60 to CF. While only 2 percent Patienthad visual acuity less than Counting finger(CF). Discussion: During phaco training,the author was taught in stepwise about various stages of phaco and then authorpractice single part every stage of phaco multiple times to be master in every step ofphaco under supervision of an experienced ophthalmologist. Due to learning of phacostep-by-step leads to good surgical outcomes and least complication rates. Afterlearning the phaco basic training, the author started to perform phacoemulsification inIndependent University Hospital Faisal Abad under the supervision of an experiencedophthalmologist followed by independently performing phacoemulsification.Conclusion: Surgeon experienced in ophthalmic surgery along with adequatephacoemulsification training leads to a good visual outcome with minimum peroperativeand post-operative complications.

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Safety and effectiveness of intrastromal corneal ring segment implantation at Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia

International Surgery Journal ◽

10.18203/2349-2902.isj20191265 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1295

Author(s):

Abdulaziz Alaqsam ◽

Mohanna AL-Jindan ◽

Ammar Almahmod ◽

Ibrahim Gosadi

Keyword(s):

Visual Acuity ◽

Saudi Arabia ◽

Case Series ◽

Applanation Tonometry ◽

Retrospective Case ◽

Intrastromal Corneal Ring ◽

Case Series Study ◽

Ring Segment ◽

The Mean ◽

One Year

Background: Intrastromal corneal ring segment (ICRS) implantation is one of the treatment options of keratoconus. This study is aiming to evaluate safety and effectivness of ICRS implantation at Al-Dharan Eye Specialist Hospital.Methods: This study is a descriptive retrospective case series study. The target population of this study is patients diagnosed with corneal ectasia who underwent ICRS implantation in Al-Dharan Eye Specialist Hospital, Al-Dharan, Saudi Arabia. Preoperative and postoperative data about uncorrected visual acuity (UCVA), best spectacle–corrected visual acuity (BSCVA), manifest refraction, keratometry, applanation tonometry, corneal topography, and slit-lamp biomicroscopy and indirect ophthalmoscopy were retrieved from medical records of department of Medical Archive. Paired students t-test was used to compare preoperative and postoperative means of study variables.Results: The total number of recruited patients in this study was 57 patients where 62% of them were males. Sixty-six treated eyes were included in this study where no intra-operative complications were recorded. Upon comparing the mean preoperative data to the mean postoperative data at three months, six months and one year intervals, an overall improvement in the measured outcomes was witnessed. UCVA, BSCVA, and keratometric readings exhibited a statistically significant improvement when comparing preoperative with one-year postoperative findings (p<0.001).Conclusions: The findings of this study indicate that ICRS implantation is a safe and effective treatment for keratoconus.

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Aflibercept for Vascularised Serous Pigment Epithelial Detachment: One-Year Anatomical and Functional Results

Czech and Slovak Ophthalmology ◽

10.31348/2020/16 ◽

2020 ◽

Vol 76 (2) ◽

pp. 88-93

Author(s):

Jaroslav Románek ◽

Hana Palyzová ◽

Jan Grygar ◽

Jan Ernest

Keyword(s):

Visual Acuity ◽

Functional Results ◽

University Hospital ◽

Pigment Epithelial Detachment ◽

Intravitreal Therapy ◽

Pigment Epithelial ◽

Department Of Ophthalmology ◽

Treatment Naïve ◽

One Year ◽

The Military

Purpose: To assess the effect of intravitreal aflibercept on pigment epithelial detachment (PED) secondary to occult choroidal neovascularization (CNV) in treatment-naive patients. Patients and methods: Retrospective analysis of thirty-six patients (thirty-eight eyes) with mean age 77 (SD ± 7), who were treated with aflibercept 2.0 mg (Eylea, Bayer) at the Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague. All patients were treated in fixed regimen, which means 3 loading doases 1 month apart, followed by further 2-monthly doses over total 12-month period. Best corrected visual acuity (BCVA) was evaluated on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Diameters as PED height, width and central retinal thickness (CRT) were assesed using spectral-domain optical coherence tomography. All previously mentioned were analyzed et the baseline and than at every visit. Therapy complications were also evaluated. Results: Borderline significant improvement in the mean of BCVA score of 3.2 letters (SD ± 11.6, p = 0.05) at the end of follow-up period was observed. Mean PED height at 12 months significantly decreased by 140 µm (SD ± 238, p < 0.01). Reductions in PED height were correlated with reductions in central macular thickness (R = 0.94, p < 0.001) simultaneously with PED width (R = 0.45, p < 0.01). There was no significant correlation between PED height decrease and visual acuity. PED rupture was observed in 3 eyes (8 %). Conclusion: Aflibercept intravitreal therapy in fixed regimen in patients with PED secondary to occult CNV shows great anatomical effect. However, correlation between PED diameters and visual acuity was not observed.

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Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes

Journal of Ophthalmology ◽

10.1155/2018/9572805 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Nimet Yeşim Erçalık ◽

Serhat İmamoğlu

Keyword(s):

Postoperative Complications ◽

Final Visit ◽

Light Perception ◽

Ahmed Glaucoma Valve ◽

Surgical Interventions ◽

Surgical Success ◽

Intraocular Hemorrhage ◽

Pars Plana ◽

The Mean ◽

Valve Implantation

Purpose. To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. Materials and Methods. The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception. Results. The mean follow-up duration was 11.7 ± 5.5 (range, 6–23) months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg (p=0.001) and the mean number of glaucoma medications decreased to 2.3 ± 1.3 (p=0.021). At the last visit, 11 eyes (84.4%) had stable or improved VA and one eye (7.7%) had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%). Postoperative complications were bleb encapsulation (69.2%), early hypotony (38.5%), hyphema (23.1%), decompression retinopathy (23.1%), choroidal detachment (15.4%), intraocular hemorrhage (7.7%), and late endophthalmitis (7.7%). One eye (7.7%) was enucleated because of late endophthalmitis. Conclusions. Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation.

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